Medicare Locals - many questions yet be answered

Parliament house flag post

Medicare Locals - many questions yet be answered

Posted 3/03/2011 by Rebecca de Boer


The Government has released the guidelines for the establishment and initial operation of Medicare Locals (MLs) following the consultations around its discussion paper on the governance framework. Applications are invited for the operation of MLs to commence in either mid 2011 or January 2012. Approximately 15 MLs will be awarded in each round. The guidelines and prior ministerial statements would indicate that the initial groups of MLs are likely to be drawn from existing Divisions of General Practice.

The overarching objective of MLs is to ‘coordinate primary health care delivery to address local needs and service gaps’. The guidelines set out the functions of MLs, including the expectations of the Government, according to the following ‘strategic objectives’:

  • Improve the patient journey through developing integrated and coordinated services
  • Provide support to clinicians and service providers to improve patient care
  • Identification of the health needs of local areas and development of locally focussed and responsive services
  • Facilitation on the implementation and successful performance of primary health care initiatives and programs
  • Be efficient and accountable with strong governance and effective management
Commentators have highlighted the gaps in the guidelines: namely the absence of any mention about the social determinants of health, ownership and governance arrangements and how MLs will balance competing objectives in the delivery of primary care. Beyond what has already been canvassed, there are some key issues that are not addressed by the guidelines. Firstly, ‘primary health care’ is not defined, perhaps reflecting that there is not yet agreement between the States and the Commonwealth on what constitutes primary health care. As a corollary to this, there is no reference in the guidelines to the primary health care services currently provided by state and local governments (or other relevant state funded services such as housing) and what the integration with MLs might be. Specific areas integral to effective primary health care such as mental health services, aged care, Indigenous health, culturally and linguistically diverse programs/services and disability services are also not mentioned in the documents.

With the publishing of the guidelines there will now be a number of questions that turn to the detail of how MLs will operate:

  • What outputs or outcomes are MLs expected to deliver and how their performance will be evaluated? The Minister for Health has recently introduced the legislation to establish the National Performance Authority (NPA). The Second Reading Speech notes that the NPA will ‘collect, analyse and interpret’ information and report on Healthy Communities (structured around MLs). It would appear that the NPA will play a major role in the evaluation of MLs, particularly in relation to statistical information. It is not clear whether consumers and primary health care provides will have an active role in the evaluation of MLs. As noted in the guidelines, the performance framework for MLs is still being developed by the Commonwealth but MLs are expected to provide a series of reports to the Commonwealth about financial information and reporting against program objectives and outcomes on a regular basis. A challenge for government will be to ensure that the various reporting requirements do not overlap and create a significant administrative burden for MLs. A greater challenge will be to ensure that the performance framework has the appropriate measures and tools to effectively monitor, and evaluate, the performance of MLs.
  • Among other expectations, MLs are expected to ‘improve the planning of primary health care services to respond to local needs’ and ‘support the development of e-health and health information’. Will the budget of $477 million over four years for approximately 57 MLs (as noted in Senate Estimates on 23 February 2011), which is around eight million dollars per MLs over four years, be adequate to meet these expectations?
  • Will MLs be sufficiently empowered to engage in the planning that will be required to deliver on these expectations? Planning for primary health care services has traditionally been the domain of the States and it not clear if this role will continue under the Heads of Agreement – National Health Reform signed by COAG in February 2011. Access to adequate data and high-level expertise required for planning may be an issue for MLs. The COAG Reform Council has already highlighted lack of information about primary care services in its Baseline Performance Report on the National Healthcare Agreement (2008-09). It notes that there are no measures of the adequacy of access to primary health care or whether the availability of primary health care services is meeting need. MLs are being expected to maintain a population health database but it not clear from the guidelines what role they will play in the development of this database or if this information will be provided by the Commonwealth.
  • What role might MLs have in the Government’s ehealth agenda? There have been significant delays in the implementation of the Government’s ehealth agenda, some of which have been attributed to multiple funding streams and jurisdictions. The Government has recently announced funding to a small number of Divisions of General Practices (on which the MLs are initially expected to be based) for ‘Lead Implementation Sites’ of ehealth projects undertaken by the National E-Health Transition Authority. This approach may continue under the proposed ML structure.
MLs are expected to ‘provide more integrated care’ and ‘ensure more responsive local GP and primary health care services’. These examples point to the importance of the interface between MLs and the Commonwealth and MLs and the States if they are to achieve their objectives. Integration at the local level is also likely to be critical. The goodwill of external organisations and individuals, over which the ML has little or no control, and the availability of incentives to encourage organisations to participate in the MLs will be important.
Although the first group of MLs are likely to be drawn from ‘high functioning’ Divisions of General Practice, many of which have had experience in negotiating some of these issues, as MLs their role is much broader. To fulfil the Government’s long term objective for MLs to provide a ‘coordinated package of care’ and act as fund holders for primary care, an agreed definition of what constitutes primary health care and sufficient empowerment of MLs would seem to be necessary pre-requisites.

Picture source: http://www.illustrationworks.com/image/zito_a0082c


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 Indigenous Australians Australian Bureau of Statistics Employment Sport illicit drugs people trafficking taxation Medicare welfare reform Australian Defence Force higher education welfare policy United Nations Asia income management Middle East criminal law disability Australian Sports Anti-Doping Agency World Anti-Doping Agency United States federal budget health financing gambling school education forced labour aid statistics Australian Electoral Commission WADA emissions trading Australia in the Asian Century steroids detention Private health insurance OECD ASADA labour force transport Law Enforcement Australian Federal Police Industrial Relations people smuggling dental health National Disability Insurance Scheme Australian Crime Commission slavery Senate election results Papua New Guinea Australian Public Service International Women's Day corruption Afghanistan Fair Work Act child protection debt federal election 2013 parliamentary procedure poker machines ALP New Zealand Newstart Parenting Payment 43rd Parliament political parties Census constitution High Court skilled migration voting Federal Court terrorist groups Higher Education Loan Program HECS youth paid parental leave Aviation environment foreign debt gross debt net debt defence capability customs 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 politics banking firearms public policy violence against women domestic violence mental health China ADRV terrorism social media pensions welfare ASIO intelligence community Australian Security Intelligence Organisation governance 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 United Nations Security Council Australian economy food vocational education and training Drugs Indonesia children codes of conduct terrorist financing money laundering Productivity asylum seekers early childhood education Canada Population Financial sector national security fuel disability employment Tasmania integrity science research and development Australian Secret Intelligence Service sexual abuse federal state relations World Trade Organization Australia accountability 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 Senators and Members 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 health reform 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 health system Australia Greens servitude Trafficking Protocol energy forced marriage rural and regional Northern Territory Emergency Response ministries social citizenship human rights citizenship Defence High Court; Indigenous; Indigenous Australians; Native Title ACT Indigenous education Norfolk Island External Territories 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 transparency 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 human rights; Racial Discrimination Act employment law bullying 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 federal election 2010 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

Show all
Show less
Back to top