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  1. 1

    Andrew Pesce

    Before people accept what has been written here, perhaps they might actually
    read the AMA statement which stimulated this piece.

    If they do, they will see that the AMA is not opposing the concept of a PHCO
    to coordinate primary care services.

    They might also note that our initial response to the announcement of
    Medicare Locals was cautiously optimistic about the role they might play in
    improving health care for Australians.

    Many seem concerned that doctors insist they should be adequately
    represented on the governance structures of our health systems, but we only
    need to look at the chaos wrought upon our public hospitals when they are
    administered without appropriate reference to the doctors (and other health
    workers) who actually deliver the health services in the hospitals. Garling in NSW, incidentally, was not an agent of the AMA

    The statement that the Rural Health Alliance “has great hopes for Medicare Locals” is hardly an ringing endorsement of the announced structures, even if they do manage to change the name. And AHCRA’s comments contained as much criticism of the Medicare Local structure and function as it did of the AMA’s position.

    Inconvenient truth 1. New Zealand’s initial experience with PHCOs run by
    “skills based” boards was heading for disaster until the situation was
    retrieved by an increased presence of doctors on those boards.

    Inconvenient truth 2. Medicare Locals will be funded separately, governed
    separately and will function separately to the acute hospital system. Chance
    of evolving a ML inspired integrated health system: just about zero. Likelihood of continued cost and blame shifting between commonwealth and states: extreme
    Like it or not, the assumption that health care is improved by marginalising the role of doctors in decision making is to say the least contestable, and the AMA will certainly continue to argue against it.

    Andrew Pesce
    President, Australian Medical Association

  2. 2

    Tim Woodruff

    Whilst the negative response of the AMA is to be expected, it is hard for those interested in genuine health reform to become too excited by Medicare Locals. The vision is limited, the plans are sketchy at best, and it is hard to know whether MLs will be just another white elephant or worse.
    Regional entities could have the capacity to pursue the Federal Government’s rhetoric of ‘central funding, local control’. Unfortunately, the current plan is more likely to result in central funding and control and local blame.
    It is proposed that MLs will be engaged in population health planning. That requires knowledge of health needs which is also flagged. But there is no mention of information on current health spending at a regional level. (Remember how hard it was to get the Government to put in expenditure on the MySchools website). With health expenditure data at a regional and subregional level we would see the very stark inequities which exist in health funding and could plan to address them. That could then form the basis for health planning.
    Governance of MLs remains vague especially with respect to consumer and citizen involvement. This is partly because the Government has no national policy framework for consumer involvement and generally pays lip service to the concept. The transition of MLs from Divisions inevitably means that governance will be biased towards control by general practitioners currently involved in Divisions. Whilst this may work well in some regions, it is hardly the best way to achieve balanced governance with all stakeholders well represented.
    There are no plans for MLs to have sufficient funds at their disposal for them to exert much influence on current models of care. Whilst it will take time for MLs to build the capacity to use funds appropriately, it does not appear to be a significant part of the vision. In addition, they will be relatively powerless in their relationship with the well funded Local Hospital Networks. This is despite the rhetoric that we need a much greater emphasis on primary health care.
    The recent backflip by the Federal Government to abandon its plans to take over all primary health care funding will now mean that MLs will have to work with three levels of government in their co-ordination and integration role. That role would be hard enough with one level of government funding everything. It will now be even harder.
    Adequate data, resources, governance, and needs based funding at a regional level with national standards including for marginalised groups are required for MLs to evolve into anything useful.
    Where is the vision?

    Tim Woodruff
    Vice President
    Doctors Reform Society

  3. 3


    Could the author please explain in 25 words or less what a Medicare Local is and does?

    After Medicare Gold, the epic COAG reforms that never quite occured, the federal takeover that Rudd threatened, which never occured, I’m very confused by this government’s plans and have not seen a single example of how MLs or anything else will actually relate to human beings and their health requirements.

  4. 4


    For example I googled Medicare Locals and this is an example of what I found:

    “The South West Sydney Health Coalition has recently been made aware of certain assertions made by the Macarthur and Southern Highlands Divisions of General Practice concerning the formation of a Medicare Local in south west Sydney.

    The purpose of this letter is to inform you that the South West Sydney Health Coalition denies each of these assertions categorically as being completely without basis in fact.

    The Macarthur-Southern Highlands Divisions are not the official bid for the South West Sydney Medicare Local. The Macarthur-Southern Highlands Divisions do not enjoy any exclusive right to lodge a bid for a Medicare Local covering the Bankstown, Fairfield, Liverpool, Campbelltown, Camden, Wollondilly, and Wingecarribee local government areas. “

  5. 5
    Melissa Sweet

    Melissa Sweet

    Hi Rechoboam

    Take a look at this previous Croakey post which links to a series of posts about Medicare Locals: what they’re intended to do, and debate about how they will work etc.


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