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

Show all
Show less
Back to top