Review of Medicare Locals

Friday, 20 December 2013

As a key stakeholder in the health sector, the National Rural Health Alliance has been invited to provide input to the Government’s Review of Medicare Locals being overseen by Prof John Horvath, formerly Australia's Chief Medical Officer. Three-page submissions are due by 23 December 2013 to

The Alliance's submission expresses its belief that as long as Medicare Locals are properly supported and resourced, their work will ultimately result in a simpler and safer patient journey, a more patient-centred focus for the health services provided, and a closer relationship than currently exists between health need and health expenditure. The more than 6.7 million people of rural and remote Australia have much to gain from improvements in the performance of the health system and the Alliance believes that Medicare Locals can deliver. Locally-focused and responsive services are needed but may well be constrained by workforce shortages. Population health needs are greater outside the major cities. Patient journeys are more complex for rural people, integration and coordination of services is more challenging over large distances, and health professionals are more likely to be working remotely from their multidisciplinary teams.

The NRHA believes that the Commonwealth Government should lead the way in investing trust, confidence and resources in Medicare Locals and their future. These investments should be matched by equivalent support – in terms of both attitudes and resources – from State, Territory and local governments; and will be balanced by the acceptance of public accountability on the part of the Medicare Locals themselves.

Greater community involvement in the management of local hospitals has been on the policy agenda for a considerable time and it makes good sense for rural primary care to be organised locally rather than centrally as well. It is best for local communities and clinicians to have a genuine say in the management of all their health care, so that health services are responsive to local needs.

Important principles for achieving cost-effectiveness in the health system are 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.

The NRHA will maintain its close interest in Medicare Locals and government support for them.

Stakeholders have been invited to comment on:

  • the role of MLs and their performance against stated objectives;
  • the performance of MLs in administering existing programs, including after-hours GP services;
  • recognising general practice as the cornerstone of primary care in the ML functions and governance structures;
  • ensuring Commonwealth funding supports clinical services rather than administration;
  • processes for ensuring that existing clinical services are not disrupted or discouraged by ML programs;
  • interaction between MLs and Local Hospital Networks and other health services, including boundaries;
  • tendering and contracting arrangements; and
  • other related matters.

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