Medicare Locals and reform of primary care

Parliament house flag post

Medicare Locals and reform of primary care

Posted 17/02/2011 by Rebecca de Boer


In their joint statement about the Agreement signed at the Council of Australian Governments (COAG) meeting on 13 February 2011, the Prime Minister and the Minister for Health stated that one of the aims of the reform package was to ‘shift the centre of gravity from hospitals towards primary health care’. To that end, the Government has committed to: increasing the number of Medicare Locals (MLs) that are to be established as a result of the health package announced by the Government in March 2010, bringing forward the establishment of more MLs, fast-tracking reforms to after-hours GP care and ensuring that local communities have more information about their local primary health care services.

The National Health and Hospital Reform Commission (NHHRC) saw reform to primary care as integral to the development of a ‘person-centred’ health system. The Commission recommended significant investment in primary care infrastructure and the integration of all publicly funded primary health care services. It also advocated for Primary Health Care Organisations to take on a population health planning and service coordination role and the Commonwealth to assume policy and funding responsibility.

The proposed MLs are along the lines of what was proposed by the NHHRC. As part of the health agreement, the plan is for each ML to form part of a national network of Primary Health Care Organisations with a mandate to improve access and integration of primary health care services. MLs are to have a key role in local health planning, identification of service gaps, better targeting of services and improved linkages between the acute and aged care sector. A discussion paper about the governance and functions of MLs provided a focus for consultations conducted in the second half of 2010. The agreed boundaries for MLs (although the boundaries for Victoria have not yet been agreed) were announced prior to the February 2011 COAG meeting, yet these may change as a result of the Government’s commitment to establish more MLs.

Some states have attempted to reform primary care within their own jurisdiction. The Victorian Government introduced ‘Primary Care Partnerships’ (PCPs) in 2000. In many respects, the objectives for MLs are similar to those for the PCPs. The intention of the PCPs was to develop a more effective and more efficient primary health care system with linkages to broader health and human services system and with General Practice. In Victoria the PCPs have led to improvements in service coordination, integrated health promotion and integrated chronic disease management across Victoria.

The proposed establishment of MLs has however not been without controversy. There have been criticisms about the appropriateness of the name and, perhaps more importantly, concerns have been raised about the lack of clarity about what is considered ‘primary care’ and how primary care (and MLs in particular) will be integrated with other parts of the health care system. Others have argued that the concept does not adequately acknowledge the role of General Practitioners in the provision of primary care. The proposal has also been described as a missed opportunity for the implementation of ‘true primary care’ which is multi-disciplinary in approach and delivers both illness prevention and health promotion. These issues were not addressed in the discussion paper, and, to date, the Government has not reported on the consultation process.

The proposal to establish additional MLs as part of the new health deal has therefore also had a mixed response. The Chair of the Australian General Practice Network (AGPN), Emil Djakic suggested that if the boundaries were redrawn, it would be difficult for participating organisations to meet the 1 July implementation date. In response to media reports about increased MLs for Victoria, he argued that any increases to the number of MLs would weaken the proposed national structure.

The new package falls short of the NHHC’s (and the Government’s initial) proposal that the Commonwealth assume full funding and policy responsibility for primary care. Yet the chair of the NHHRC has provided some support for improving the delivery of primary care, considering it to be ‘linchpin’ of any health reform, and full funding as 'something we can work towards'. Under the February 2011 Agreement, roles remain largely unchanged with the Commonwealth having the ‘lead role’ in delivering primary health care reform and the States responsibility for service delivery. While there is a clause in the Agreement about the States and the Commonwealth working together on ‘system wide’ policy to achieve better integration between State and Commonwealth funded services, there is little detail about the mechanisms to achieve this, suggesting that the agenda to advance primary care has yet to be articulated, or even agreed to.

The Government’s proposals for MLs as presented in the consultation paper and the Victorian experience with PCPs, might lead us to expect that MLs will lead to greater coordination and integration of local primary health care services. Yet, the task of integration is not well defined and will require participation from multiple agencies each with different goals and agendas. Research into PCPs in Victoria highlights the complexity of collaboration. It notes that for organisations to work collaboratively they must be willing to give up some control over their actions and potentially be affected, adversely or otherwise, by the consequences of the activities of other organisations. It also noted that trust was integral to effective relationships and, further, effective relationships were integral to improved outcomes for clients.

How MLs will operate will therefore be critical. Questions have already been asked about whether MLs have sufficient funding to achieve their objectives. At this stage there is very little detail about how they will work, what the accountability frameworks might be or their relationship with the proposed governance structures of the health package. It is expected that MLs will be established as companies limited by guarantee formed by a small number of initial members. Adequate representation is likely to be critical to achieve integration of primary care across a range of service providers. In Victoria, each PCP has ‘core members’ including hospitals, community health, local government and divisions of general practice. Other organisations can also join the PCP. The core members represent the majority of primary care providers in a local area and there are sufficient incentives to ensure that key primary care organisations participate in the PCP. Currently, no such frameworks exist for MLs, and this may need to be addressed so that MLs can achieve their objectives.

As the PM noted, there are many details yet to be resolved in the health reform package. And it will take some time for the reforms to be institutionalised. Initially MLs will have responsibility for the coordination of the reforms to improve access to GPs after hours. Much therefore remains to be done before MLs will be able to achieve improved integration of primary care services in a local area and reorient the health system towards primary health care.

Source for image: http://www.fotosearch.com/illustration/public-health.html


Thank you for your comment. If it does not require moderation, it will appear shortly.
Facebook LinkedIn Twitter Add | Email Print

FlagPost

Flagpost is a blog on current issues of interest to members of the Australian Parliament


Parliamentary Library Logo showing Information Analysis & Advice

Archive

Syndication

Tagcloud

refugees asylum immigration Parliament climate change elections social security health financing Australian Defence Force women taxation welfare policy Australian foreign policy welfare reform sport Medicare employment illicit drugs gambling higher education disability Middle East Australian Sports Anti-Doping Agency World Anti-Doping Agency Australian Bureau of Statistics health reform emissions trading industrial relations united states statistics private health insurance Carbon Pricing Mechanism United Nations school education indigenous Australians aid steroids WADA federal budget politics labour force Australian Federal Police transport detention criminal law ASADA Afghanistan governance poker machines income management people trafficking Fair Work Act 43rd Parliament Australian Public Service International Women's Day Australian Crime Commission Papua New Guinea parliamentary procedure National Disability Insurance Scheme children's health food OECD debt defence capability federal election 2013 Australian Electoral Commission aged care environment election results Senate pensions law enforcement UK Parliament pharmaceutical benefits scheme planning skilled migration multiculturalism people smuggling doping child protection HECS Higher Education Loan Program paid parental leave High Court international relations corruption federal state relations Asia Australia in the Asian Century dental health New Zealand ALP political parties constitution public service reform forced labour aviation coal seam gas crime customs social media ADRV Census Newstart Parenting Payment health employee employer Federal Court foreign debt gross debt net debt European Union domestic violence Constitutional reform food labelling carbon tax banking terrorist groups United Kingdom leadership public policy terrorism welfare Australian Security Intelligence Organisation intelligence community Drugs research and development voting mental health health system human rights Northern Territory Emergency Response science Electoral reform regional unemployment productivity accountability military history Indigenous Indonesia Pacific Islands speaker superannuation middle class welfare welfare systems question time animal health Department of Agriculture Fisheries and Forestry trade unions integrity same sex relationships foreign bribery Australian Secret Intelligence Service firearms export liquefied natural gas local government referendum children Australian economy mining forestry Tasmania financial sector Canada United Nations Security Council climate Intergovernmental Panel on Climate Change expertise Senators and Members family assistance by-election US economy housing affordability ASIO new psychoactive substances synthetic drugs UNODC reserved seats regulation Parliamentary remuneration Population Hung Parliament federal budget 2011-12 paternalism public health slavery Trafficking in Persons Report homelessness school chaplains ministries water federal election 2010 Medicare Locals primary care regional students Youth Allowance entitlements salary sea farers violence against women Special Rapporteur transparency money laundering early childhood education asylum seekers national security bulk billing China disability employment World Trade Organization Australia renewable energy language education Italy roads international students skilled graduate visas temporary employment visas apologies standard of proof arts health risks World Health Organisation disciplinary tribunals railways infant mortality honorary citizen suspension of standing and sessional orders live exports contracts workplace policies peace keeping disorderly conduct same-sex marriage Parliament House retirement Rent Assistance constitutional recognition of local government anti-dumping national heritage NHMRC nutrition GDP world heritage submarines Somalia defence budget First speech election timetable sitting days prime ministers standing orders public housing cancer gene patents genetic testing carbon markets universities Ireland public interest disclosure whistleblowing Productivity Commission vocational education and training limitation period Trade; tariffs; safeguards; Anti-dumping leave loading political engagement Korean peninsula counselling pests suicide social policy alcohol computer games plebiscites therapeutic goods Therapeutic Goods Administration federalism federation preselection Iran sanctions baby bonus early childhood National Quality Framework for Early Childhood Education and Care Murray-Darling Basin citizen engagement policymaking biosecurity hendra environmental law COAG Ministerial Councils nuclear Work Choices republic hospitals qantas ANZUS Norway President Barack Obama Presidential visits advertising electricity energy maritime floods ADHD stimulant medication 44th Parliament 2015 e-voting internet voting nsw state elections Indigenous health procurement citizenship Defence ACT Norfolk Island External Territories High Court; Indigenous; Indigenous Australians; Native Title Indigenous education ABS Trade Age Pension Death penalty capital punishment execution Bali nine Bali bombings emissions reduction fund; climate change child care funding refugees immigration asylum ACT Assembly Criminal Code Amendment (Misrepresentation of Age to a Minor) Bill 2013 sexual abuse online grooming sexual assault of minors social services EU fishing asylum refugees immigration political finance donations Antarctica Diplomacy Disability Support Pension by-elections state and territories China soft power education Fiji India fuel Scottish referendum Members of Parliament Middle East; national security; terrorism Racial Discrimination Act; social policy; human rights; indigenous Australians Migration; asylum seekers; regional processing China; United States; international relations fiscal policy innovation Bills NATO workers anti-corruption fraud bribery corporate ownership whistleblower G20 economic reform standards copyright Australian Law Reform Commission industry Governor-General Animal law; food health policy employment law bullying Economics efficiency foreign aid human rights; Racial Discrimination Act smoking plain packaging tobacco cigarettes Work Health and Safety Asia; Japan; international relations youth Foreign policy Southeast Asia Israel Palestine political financing US politics Australia Greens Horn of Africa peacekeeping piracy Great Barrier Reef solar hot water Financial Action Taskforce terrorist financing Gonski Review of Funding for Schooling Stronger futures rural and regional political parties preselection presidential nomination Racial Discrimination Act Australian Greens

Show all
Show less
Back to top