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:

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


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

Parliamentary Library Logo showing Information Analysis & Advice




refugees asylum immigration parliament climate change Australian foreign policy elections social security welfare reform women welfare policy school education private health insurance Taxation Indigenous Australians Australian Defence Force health financing higher education emissions trading Australian Bureau of Statistics employment people trafficking statistics Middle East illicit drugs gambling health reform federal election 2010 income management Medicare disability Sport United Nations Asia politics criminal law Afghanistan health forced labour transport aid Australian Sports Anti-Doping Agency World Anti-Doping Agency United States federal budget Industrial Relations Carbon Pricing Mechanism dental health OECD Senate Australian Public Service constitution Australian Electoral Commission WADA child protection environment poker machines Australia in the Asian Century steroids National Disability Insurance Scheme detention aged care 43rd Parliament slavery health system multiculturalism ASADA Law Enforcement Australian Federal Police Fair Work Act governance labour force people smuggling debt international relations New Zealand food Australian Crime Commission pharmaceutical benefits scheme leadership electoral reform Census election results UK Parliament Papua New Guinea banking International Women's Day corruption pensions public service reform children's health Aviation federal election 2013 foreign debt gross debt net debt defence capability parliamentary procedure Senators and Members ALP Newstart Parenting Payment Youth Allowance sea farers domestic violence military history by-election political parties High Court skilled migration voting mental health Federal Court terrorist groups science social media Higher Education Loan Program HECS federal state relations accountability youth paid parental leave same sex relationships coal seam gas customs planning doping crime health risks Gonski Review of Funding for Schooling sex slavery Special Rapporteur Northern Territory Emergency Response social policy Productivity United Kingdom firearms public policy Population violence against women China ADRV terrorism transparency research and development welfare ASIO intelligence community Australian Security Intelligence Organisation carbon tax mining employer employee renewable energy regional unemployment fishing European Union family assistance United Nations Security Council Australian economy forestry food labelling vocational education and training Drugs welfare systems Indonesia children Constitutional reform local government codes of conduct terrorist financing homelessness Parliamentary remuneration money laundering Trafficking in Persons Report energy social inclusion human rights paternalism Ireland election timetable citizenship asylum seekers early childhood education Canada Financial sector national security fuel disability employment Tasmania integrity standards NATO Australian Secret Intelligence Service sexual abuse World Trade Organization Australia public health housing affordability bulk billing water health policy Governor-General US economy trade unions export liquefied natural gas foreign bribery question time speaker superannuation public housing expertise climate Intergovernmental Panel on Climate Change Department of Agriculture Fisheries and Forestry regulation Pacific Islands reserved seats new psychoactive substances synthetic drugs UNODC carbon markets animal health middle class welfare Indigenous constitutional recognition of local government referendum consumer laws PISA competition policy royal commission US politics language education baby bonus Leaders of the Opposition citizen engagement policymaking Australia Greens servitude Trafficking Protocol forced marriage rural and regional alcohol entitlements ministries Hung Parliament social citizenship maritime Iran ANZUS regional students school chaplains federal budget 2011-12 salary Medicare Locals primary care Building the Education Revolution family violence government financial advisers financial planners Financial System Inquiry Murray Inquiry China; Economic policy; Southeast Asia; Africa housing Speaker; House of Representatives; Parliament 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 Bills anti-corruption fraud bribery corporate ownership whistleblower G20 economic reform innovation 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 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 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 same-sex marriage disorderly conduct retirement Parliament House standing orders prime ministers sitting days First speech defence budget submarines workers Somalia GDP world heritage political engagement leave loading Trade; tariffs; safeguards; Anti-dumping public interest disclosure whistleblowing Productivity Commission limitation period universities cancer gene patents genetic testing suspension of standing and sessional orders live exports infant mortality 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 Rent Assistance 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 regional engagement social determinants of health abortion Members suspension workplace health and safety marine reserves hearing TAFE Victoria astronomy resources sector YMCA youth parliament Korea rebate Australian Greens presidential nomination Racial Discrimination Act political parties preselection solar hot water Financial Action Taskforce Horn of Africa peacekeeping piracy Great Barrier Reef Stronger futures political financing political education Social Inclusion Board early childhood National Quality Framework for Early Childhood Education and Care Murray-Darling Basin sanctions Norway hospitals republic President Barack Obama Presidential visits qantas counselling Korean peninsula Work Choices biosecurity hendra environmental law federalism federation preselection therapeutic goods Therapeutic Goods Administration plebiscites computer games pests suicide nuclear COAG Ministerial Councils floods ADHD stimulant medication advertising electricity extradition conscience votes poverty preventative health rural health coastal erosion Parliamentary Budget Office work-life balance

Show all
Show less
Back to top