The Federal Budget is looking like bad news for Medicare Locals – and this means bad news for the community’s health and the future of healthcare costs, says health policy analyst Jennifer Doggett.
Below her article are links to recommended reading on recent health policy news – and some Twitter reaction to today’s headlines.
Jennifer Doggett writes:
Abolishing Medicare Locals, as reported in today’s media, would reverse the gains they have already made in primary health care and ultimately result in a less equitable and efficient health care system.
Medicare Locals (MLs) were set up by the previous government to lead the planning and coordination of primary health care in each of their 62 local areas nationwide.
The need for MLs (or similar primary health care organisations) was identified by the National Health and Hospitals Reform Commission (NHHRC) in its final report in 2009.
The NHHRC cited international evidence demonstrating that a health system oriented around primary health care delivered better outcomes at a lower cost than one focussed on hospital services. A strong primary health care sector has also been shown to increase the overall equity of the health system.
Like most developed countries, Australia has an ageing population and rising rates of chronic disease and multi-morbidity. These challenges can only be successfully addressed at the primary health care level.
Without an effective approach to the prevention and management of chronic disease in the community we will continue to spend more on hospital care while achieving poorer health outcomes.
Our current high rate of preventable hospital admissions is evidence of the potential gains we can still make in this area.
Health Minister Peter Dutton has repeatedly stated that it wants to ‘return GPs to the centre of the health system’ as though the establishment of primary health care organisations, such as MLs, have somehow ostracised them from their roles as key primary health care providers.
However, the reverse is true. Medicare Locals have supported the central role of GPs through providing them with the tools and support services they require to become integral members of primary health care teams.
By linking them with other primary health care providers, such as physiotherapists and psychologists, MLs have allowed GPs to take on a more central and coordinating role in the delivery of comprehensive and better coordinated care.
In fact, by abolishing or cutting back the role of MLs, the Government would be reducing the capacity of GPs to lead primary care interventions at both the individual and population health levels.
This is not because GPs are incompetent or are not committed to population health but because without the information and infrastructure support provided by a primary health care organisation, a GP working in isolation can do little beyond responding to the immediate needs of individual patients presenting to their surgeries.
Prior to the establishment of primary health care organisations in Australia, our health system performed below that of many developing countries in key areas. Former Health Minister Dr Michael Wooldridge often explained how Australia had a childhood immunisation rate lower than that of Indonesia’s before the Divisions of General Practice Network (the forerunners to MLs) implemented an immunisation incentive program across its nationwide network.
Significant progress has been made in these areas since the establishment of Divisions, specifically, since the inception of MLs in their engagement with consumers and the community.
All MLs are either undertaking or planning to undertake a needs analysis of their local areas, involving consumers and community groups, which will form the basis of population health planning. They are also developing productive relationships with other health and community care providers in their community local areas.
For example, the Hunter Urban Medicare Local has developed an innovative online portal HealthPathways which helps GPs and primary care providers manage a condition, or to accurately refer a patient to local specialists and services in as little as a few seconds.
Using HealthPathways GPs simply log-in, enter a patient’s condition or suspected illness, assess symptom outlines and management options and access information about how to refer to the most appropriate local services and specialists. This ensures consumers in the region receive the most appropriate care as quickly as possible.
Medicare Locals are also addressing some of the most complex and challenging health issues in our communities. For example, the Metro North Brisbane Medicare Local is supporting innovative local mental health programs, such as using neighbourhood centres to design and implement a triage system to ensure people with a mental illness who are homeless have direct access to support and housing.
These programs, along with other ML initiatives, are providing front-line support to primary health care professionals and delivering tangible improvements in quality of care.
They all require an intimate knowledge of the local community and established relationships with local stakeholders, community groups and service providers. These types of programs cannot be replaced by increased funding for GPs or through a program developed by a private health insurance fund for its members.
Abolishing or reducing the current level of funding and policy support to the ML Network will reverse the gains being made by these innovative programs and overall will reduce the capacity of our health system to meet the health care challenges of the future.
• This article was first published at Crikey today.
***
Further reading
• Australian Doctor reports there will instead be 20 primary healthcare organisations.
• Doctors Reform Society: Dutton dumbing down the health system
• AML Alliance highlights costs of avoidable hospital admissions
• The Australian says $6 GP copayment fee will be in next month’s budget and The Guardian says Clive Palmer isn’t ruling out the idea.
• Professor John O’Dwyer calls for the hard work of useful reform: “We should be demanding reform rather than asking us to pay more money for a system that no longer meets the needs of Australians.”
• The latest edition of Health Voices from the Consumers Health Forum focuses on health reform and includes an article from the Health Minister, Peter Dutton supporting a role for private health insurance in primary care. He doesn’t address the question of whether this would exacerbate health inequalities.
***
And some reaction from the Twittersphere…
And from last week:
And yet in the recent AMA survey in 2013, over 70% of GPs stated that their Medicare local had not improved primary care and should not be retained.
Not quite great support from the front line.
How many GPs were included in that survey again? And how representative was the sample? And what proportion of GPs are AMA members (last I heard, it was less than than 50% of GPs are AMA members). And what’s the difference between rigorous research and push polling?
Besides, while the views of GPs and other primary healthcare providers are important, surely the real test of the worth of Medicare Locals should be their impact upon patients’ and population health, and how local communities perceive their work.
The AMA survey to which Scott refers was reported by the AMA as a survey of approximately 1200 respondents of whom 70% provided negative feedback. So it was not 70% of the GP population. A very big difference.
Karen Warner, AML Alliance Media & Communications Adviser
1200 sample out of a population of 30000 GPs will give you a result +/-3% at the 95% confidence interval. Statistically, the sample is large enough to be an accurate reflection of the population.
And the GP voice on primary care is the definitive one. If they are saying medicare locals are ineffective, we should be listening. If not to replace them, than at least to improve them.
In the Frankston-Mornington Peninsula area the Medicare Local has been very much involved in improving the access to GPs and other health services by homeless people, and for people at risk of homelessness.
The Medicare locals are ideally position to improve health services for those at risk in local areas. They do important research and co-ordination work. It would be a great loss if they were to go.
I posted a brief anti ML yesterday which hasn’t run. Anyway I am a GP in Frankston area ( see another’s post below) and as a GP who treats most of the area’s homeless and disadvantaged in the little addiction clinic near the station the response of ML to pleas for help has been absolute silence. They have apparently chosen to focus on the non problem which is age ( Seriously tell me how increasing age is a health ‘problem’. It is not an issue except for the prolonged payment of the aged pension!) and chronic diseases- as if the latter is a new issue!!
Finally I have spent 35 years in GP and public hospitals and the promise of actually preventing hospital admissions with excellent primary care is rarely , if ever, kept. We GPs are good at enabling rapid discharge, and in palliative care we shorten admission frequency. A bit. But frankly a lot of our screening results in increased and completely unnecessary hospital stays!
Andrew
What a load of codswallop, “to make statements” that by reviewing and or abolishing Medicare Locals will have a negative impact on provision of healthcare and so on. Medicare Locals have become a victim of their own arrogance, forming unethical relationships, empire building and simply failing to appropriately form sound structures where planning and delivery of services could have been improved. At least there are some poeple who have actually seen past all of the propaganda and assessed what has been achieved and not what has been portrayed. The persons who are defending the imminent changes obviously have had little to do with grass roots healthcare and seeing what Medicare Locals have done/not done. If anything there has been a demise in the general coordination and planning of health services simply due to the power games, selectiveness and exclusion behaviours. The money wasted would be far better off spent in areas of need where it can be utilised to met real patient needs.
I suggest that you open the window, let some air in, take a breath and look beyond the walls of Canberra. Maybe you will realise what actually happens……
Wayne
Hi Andrew. I used to work in Frankston but left almost a year ago. Not long before that there was a huge Forum at Seaford Community Centre called ‘Frankston Connect’ in which the Medicare Local played a significant part. The Forum was about getting information and services to people living in nearby rooming houses or on the street.
From memory the Medicare Local organised vaccinations and quick physical checks and referrals for many of the people who came to the forum. There were several hundred.
I know that the Medicare local was interested in follow up work in this area but I don’t know what has happened since I left Frankston. Homelessness is a huge issue in that area.
I know that many of us had some hope that the Medicare Local would take a lead role in co-ordinating strategies and services for rooming house residents especially as it seemed to have more resources and interest in doing so than other lead agencies in the area including the local government.
With regard to older people, I remember that housing issues were an increasing concern for this group in the Frankston area because of financial losses during the GFC and difficulties in transferring from ownership of the family home to more affordable and suitable accommodation.
I suggest that you contact the Frankston Council because there was some research specifically on this issue in 2011/2012 and they do have a reference group looking at some of these issues. I was involved in facilitating some of the 2011/12 research at the time and in developing draft strategies that could be implemented in subsequent years but I’m not sure what ultimately happened.
As you would be aware, City Life now have an RDNS nurse whose task is to support their work and to outreach to homeless people. I think that Centrelink also had some social work staff dedicated to this purpose.
All the best. I had heard excellent reports of your work in Frankston.
Andrew, Have decided to use my own name now! Have been a little wary of social media.
I was formerly Senior Policy Officer and then Social Policy Co-ordinator at Frankston Council from 2009 to mid 2013.
The research to which I refer was conducted by Carmel Boyce for Planisphere when they were doing a new draft Integrated Housing Strategy for Frankston. It was called ‘Special Needs Housing in Frankston’.
It was an excellent piece of work using available data at the time and widespread consultations with special groups.
Affordable housing is one of the most critical social issues of the current time in Victoria, indeed Australia. My interest in housing and homelessness goes back to my first community work role in 1984 in women’s refuges and family violence, another very topical issue at present.
All the best 🙂