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    A very cogent and important statement on the current situation.
    Our experience as a community health service in relation to the establishment of a Medicare Local in our region was very illuminating – and depressing. The local GP Divisions submitted their ML proposal with almost no consultation with local community health services and no reference to, or understanding of, local municipal councils’ responsibilities for health and well-being. (That, of course, didn’t prevent the submission from claiming the wholehearted support of those organisations.) The resulting submission was rejected by the Commonwealth and, despite the community health services and local councils then convening a meeting to offer assistance and information to the Division, a second submission was made that still had very little reference to genuine consumer involvement or commitment to work with education, welfare or housing interests.
    I have a pessimistic view of the economic environment for at least the next decade. I think there will be significant tightening and redirection of public funding because of global influences and structural changes in the Australian economy. In this difficult context I see the demands on community health services substantially increasing (particularly as medical services become increasingly corporatised) while public funding for their services will be given lower priority. So those of us committed to the community health model will not only need to work hard, we will need to work collectively and a lot smarter.

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    Tim Woodruff

    Sadly the sliver of visionary thinking suggested by the quote from the National Health and Hospitals Reform Commission was lost by the time the Federal Government and Department of Health announced a vague policy for a direction for Medicare Locals. The structure being developed might facilitate such a vision, but only with some very significant changes. The resistance to the devolution of power to the community is strong and comes from many concerned about their own position, but also from the central controllers in Canberra who are risk averse, and can’t see that with appropriately developed national standards and a commitment to the collection and publication of adequate data at a regional level, local communities can develop the capacity to decide for themselves what priorities they should set in terms of prevention and addressing social determinants like education, housing, and poverty. This is a huge step for Canberra based bureaucrats and politicians caught by 3 year agendas.
    It may be possible however, to use the evolving Medicare Locals structure to pursue this agenda. It will take many more articles like the above to point out the deficiencies in the current vision and structure.
    Recognition is needed that data on regional health status, health needs, and health spending, national standards, and a major effort to involve the community in decision making and priority setting are essential first steps.

    Tim Woodruff
    Doctors Reform Society


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