Divided in opinion with Medicare Local

Announced as part of the 2010 Health Reform, Medicare Locals will be rolled out as early as in the middle of this year. However, groups in the field are still divided in opinion regarding the plan, writes Jeff Li.

In the closing address of the 11th National Rural Health Conference, the Minister for Health and Ageing Nicola Roxon said that through strong engagement with local health services, Medicare Locals will make it easier for rural patients to use the health system and to reduce mismatch between services provided and services needed.

Jenny May, chairperson of the National Rural Health Alliance, says that Medicare Locals is a chance to bring focus to primary care, but stresses that it is important for it to be aware of the needs of the local community.

“There are some principles, if you like, in terms of Medicare Locals that the Alliance feels very strongly about, and they are the need for them to be local, and the need for them to be genuinely consultative and the need for them to be very multi-disciplinary in their approach and to really model a primary health care approach to prevention to early diagnosis and to support the services,” May says.

“There needs to be collaboration between the local players involved in primary care, that comprises general practices, including GPs, practice nurses and others, including aboriginal medical services, the local government sector and numbers of other private or public allied health commissions, who all currently provide primary healthcare services.”

She also says that primary healthcare organisations can collaborate in terms of planning services, identifying service gaps and providing or supporting a range of services.

“I think practitioners, in collaboration with service providers, have a much better idea at a local level, where the gaps in services are. So I think they have much to bring to the table.”

However, Steven Hambleton, vice-president of the Australian Medical Association says that one of his concerns is that general practices will repeat the process in hospitals where doctors and other health professionals are taken out of management and become disconnected with the needs of the patients.

“The overarching concern is that we don’t want to see primary care goes the same way as hospital care in that a bureaucracy gets in the way between patient and doctor.”

“If there is going to be a body of Medicare Locals, there definitely needs to be GPs in there in the majority to make sure that it remains connected to the patients. The GPs have in this space for a long time and has the expertise.”

Hambleton says another concern is the nature of Medicare Locals as fund holders.

He says it implies that there is a definite fund pool and that when it runs out, there is none left. “[It] basically means that there is a great potential for rationing of healthcare at the Medicare Locals level.”

He also says GPs should be providers of medical care and that working with other primary healthcare providers is the way of the future. But he says that patients need to be educated on what services are available and when to seek healthcare.

“We’ve gone from episodic healthcare to chronic disease managed healthcare and are about to proactive chronic disease management, which must be linked in with health literacy from the patients and a lot of self-management. You can’t do that with just one provider. We do work well with nurses; we do work well with health professionals and all parties that contribute to the healthcare of the patient. I guess the key person in all this is the patient themselves.”

Hambleton also says the fact that funding for primary healthcare and community services coming from different pools of fund will reduce the efficiency of the two systems working together.

“The structural drivers of health reform, which was the Rudd government’s push to have the majority of the funding of primary care all coming from the Commonwealth has been unbound by the current Prime Minister, meaning that it is going to be a lot harder for Medicare Locals to actually achieve to what they originally planned to do in the National Health and Hospitals Reform Commission.”

“We’ve seen Medicare Locals issues accelerated, when at the same time, the structural drivers that pushed the groups in the Medicare Locals’ base together have been lifted. So at the very least, we have to stop the rate of roll out, stand back a bit and do some more planning. With the way things have been rolled out right now, the AMA is not happy with it.”

May agrees that there has been some haste in the process, especially when some of the organisations for Medicare Locals cover a large geographical area with different needs. The NRHA will see with interest on how the applicants for Medicare Locals funding plan to operate and that it has some principles on whether a Medicare Locals bid is successful.

“The important thing from our point of view is to see integration of the best available services in rural areas. Often there is a deficit of any services, and we are keen to see those needs articulated and then met.”

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