There has been considerable speculation about what might be in the Federal Budget (13 May). Some of the attention has been on the future of Medicare Locals.
The Alliance is on the public record as saying that what matters are some principles which, currently, are only given expression through the work of the Medicare Locals.
The first of these principles is that it is both just and efficient for local people, including clinicians, to be closely engaged in decisions about how money for health services is spent in a particular local region. This is about the local identification of health service gaps and collaborative action locally to fill them.
The second principle is that primary care should be organised and coordinated in such a way as to involve all health professionals, not just GPs. This is particularly important in rural and remote areas where the numbers of professionals are smaller. Those who are present are working in primary, acute and aged care settings, rather than specialising in just one of them.
So what is essential is that they should be local entities, by whatever name, pursuing these principles and ensuring that there is a good organisation of primary care and close collaboration between it and the hospital, aged care and disability care systems.
In its submission to the Government’s Review of Medicare Locals in December 2013, the Alliance outlined some of the important elements for achieving cost-effectiveness in the health system that were embedded in Medicare Locals although, given the short period of time for which they have so far been established, they cannot be expected to have delivered on them fully as yet:
- they provide the basis for collaborative and cooperative work across all of those individuals and professions involved in the delivery of primary care in their specific locality;
- they comprise a central point or 'locus of primary care authority' to enable the primary care system to negotiate and manage an efficient and effective relationship with hospitals and other acute care services;
- they offer the prospect of a valuable amount of direct local engagement of health consumers with health services;
- they constitute a new (and useful) level at which analyses of health and health-related services may be tracked; and
- eventually they will be able to engage more fully across the breadth of primary health care activity for the people of their region, through such things as health education, special programs for those who are experiencing long term unemployment or living in unstable or unsuitable housing, and targeted support for at-risk individuals in their homes.