KEVIN RUDD has unveiled a $436 million program to pay doctors to keep diabetics out of hospital, but the sweetener has failed to move Victoria which is digging in against the Prime Minister’s health reform plan.Last night, after their second meeting in as many days, Mr Rudd sent the Victorian Premier, John Brumby, a letter saying the Commonwealth could address five of his seven key concerns.”Equally, I am sure that we can continue to work through the remaining matters prior to [the Council of Australian Governments meeting on April 19].”Mr Brumby, followed closely by Western Australia’s Colin Barnett, is proving the hardest to shift of the state leaders. The two key sticking points are Victoria’s demand for an immediate annual funding increase of $1.2 billion and funding arrangements for emergency departments.Medical groups, led by the Australian Medical Association, expressed their collective anger at the federal government yesterday over what they said was a lack of consultation over the diabetes announcement.Individually, however, groups such as the Australian General Practice network offered strong in-principle support.In a dramatic change, diabetics could opt to have their treatment regime managed by their doctor, rather than have to co-ordinate it themselves. This can involve dealing with multiple professionals such as dieticians, optometrists and physiotherapists.For every patient enrolled, the government will pay the doctor $1200 a year to cover day-to-day costs. Each general practice will receive up to $10,800 annually, some of which will be based on performance.The aim of the program is to give diabetics better treatment, keep them out of hospital and ease the strain on the system.In 2007-08, there were 237,000 hospital admissions related to avoidable diabetes complications. This accounted for one-third of all avoidable admissions.The program, which will replace Medicare payments for diabetics, was recommended by the National Health and Hospitals Reform Commission, which the government established to advise on its healthcare overhaul.There were mixed messages from the Coalition. Tony Abbott reiterated that the opposition was now prepared to support the government’s plan provided it was satisfied when all the details were known. But his health spokesman, Peter Dutton, rubbished the diabetes plan as a waste of money.”This is not about helping patients, it’s about helping Mr Rudd out of a sticky spot with the state premiers,” he said.The acting chief executive of Diabetes Australia, Greg Johnson, said 275 people a day develop diabetes. He welcomed the initiative.”It can be enormously difficult if [patients] have to navigate a system by themselves,” he said.The government intends to keep unveiling components of its healthcare plan before the COAG meeting as leverage to get the states to sign up.A government spokeswoman would not confirm yesterday whether the diabetes funding was contingent on the states adopting Mr Rudd’s new funding and operational model for hospitals.with Julie Robotham