The increased Medicare rebate for IUD insertion has been welcomed by doctors but they say it still does not come close to covering the full cost of the procedure.
The rebate rose from $47.35 to $70.90 in non-hospital settings such as GP clinics, and from $41.80 to $62.55 in hospital settings on March 1.
The long-acting reversible contraceptive (LARC) is one of the most effective forms of birth control, consisting of a small T-shaped device that is inserted in the uterus.
It acts as hormonal or non-hormonal birth control for anywhere between 5 to 12 years, depending on the model.
IUDs can also be used to manage symptoms of endometriosis, polycystic ovarian syndrome (PCOS) and other conditions.
A straightforward procedure with high costs
The Royal Australian College of General Practitioners (RACGP) called for the rebate to be raised to $150 to cover the costs of the procedure and the specialised training healthcare professionals need to be able to perform it.
Sydney GP Charlotte Hespe, chair of the NSW/ACT faculty of RACGP, said the increased rebate is a step in the right direction.
"I'm delighted that there is a rise in the rebate but disappointed that they haven't recognised what the actual cost for insertion of IUDs is," Dr Hespe said.
The procedure requires specialised training along with consultation and counselling, particular sterile instruments and materials plus an assistant, often a nurse on hand.
On top of those costs, some patients need 30 minutes after the procedure to rest before leaving the clinic.
"It's not just a come in, have a chat, do something really quickly, go out the room type of procedure," Dr Hespe said.
"You do require the GPs to have spent a specialised amount of time in terms of training, upskilling and maintaining that particular skill set.
"[That] is why we actually want to encourage GPs to do it, by making sure that it is adequately compensated for the time that the room is used, the extra equipment and the extra set of hands."
Danielle Mazza, head of the Department of General Practice at Monash University and a director of SPHERE, is also pleased the rebate has gone up but disappointed it has not been raised further.
"It does not adequately reflect the costs to providing IUD insertion in general practice," she said.
"Nor does it encourage GPs to take up this service provision, which is really an essential service for women across the country.
Professor Mazza said the cost was even higher for those who opted for the non-hormonal copper IUD because those devices are not subsidised by the pharmaceutical benefits scheme, unlike hormonal options.
More accessible training required
Professor Mazza said insertion training for healthcare professionals needed to be more easily accessible.
"Not only does the rebate need to increase, but support for general practice training in IUD insertion is urgently required because otherwise we won't have the workforce to be able to offer women this contraceptive option in the future," she said.
Professor Mazza would also like to see support for nurses to be able to deliver the procedure.
"Particularly in rural areas, there are big barriers for nurses and, for instance, midwives to be able to deliver IUDs and [contraceptive] implants," she said.
"So we also need to expand our workforce and enable nurses to also deliver these services."
Kathleen McNamee, the medical director at Sexual Health Victoria, said the organisation was working to meet the demand for training.
"We've actually amped up our training quite a bit and most of the family planning organisations around the country to do IUD trainings. So there are increasing numbers of GP's doing IUD insertions," she said.
Like Dr Hespe and Professor Mazza, Dr McNamee welcomed the increased rebate but would like to see it go further and have other rebates considered that reflect the costs of the procedure.
Long-acting reversible contraceptives key part of national strategy
A significant amount of misinformation about IUD insertion and contraception circulates online.
Like any form of contraception, the IUD is not suitable for everyone, but Dr McNamee says they are a long-term, comfortable and affordable option for most patients.
"They certainly are cost-effective for the community, they've got a higher up-front cost, but they've got a really high satisfaction and continuation rate," she said.
Increased access to LARCs is a key benchmark in the National Women's Health Strategy from 2020-2030.
But Australian take up of IUDs and other LARCs is low in comparison to other countries.
Professor Mazza said part of the reason for that was there were not as many GPs providing the service and more needed to be done to increase those numbers.
"Long-acting reversible contraception is the most effective form of contraception that we have, but that is reversible, so it's over 99 per cent effective," she said.
"Only about 6 per cent of women of reproductive age use IUDs in Australia, the international benchmark is up to about 20-25 per cent."
Dr Hespe said, like any medical procedure and device, it would not be the best choice for every patient, but for the majority, it was a good option.
"For the vast majority of women, it's very well tolerated, easy and got lots of benefits," she said.
In a statement to the ABC, the Department of Health did not directly address questions about further raising the rebate.
The department said the current increased rebate "encourages the greater uptake of GPs using long-acting reversible contraceptives as opposed to traditional contraceptives."
"This change was recommended by the [Medicare Benefits Schedule] Taskforce to better reflect the level of training, skill, equipment and time required to provide the service," the statement said.
