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A smart government would strengthen, rather than weaken, primary health care

Uncertainty about the future of Medicare Locals must be having a negative impact upon those involved with these organisations as well as those using their services. At least one Medicare Local (Country North SA) has felt the need to reassure its community that it is still open for business.

In the article below, Carol Bennett, CEO of the Hunter Medicare Local, says there is strong evidence to support a continued investment in Medicare Locals.

“Unless we are prepared to invest in specialist primary care organisations like Medicare Locals, we risk leaving our children a health legacy that may mean their life expectancy is less than ours,” she says.

****

Stronger primary health care means a more sustainable health system

Carol Bennett writes:

It is clear from the latest round of budget speculation about the future of Medicare Locals that decisions have been made, but we are not to be told until budget night what they might be.

Of course, this kind of pre-budget speculation is almost inevitable – although not really necessary.  I am not sure why we cannot have a sensible discussion about budget measures before they are finalised, let alone announced.

To the best of my knowledge, no-one involved in the Hunter Medicare Local where I work has been asked to provide any input or advice about what might improve our capacity to make a difference to the health needs of people across the Hunter Region.

I would like to know what measures or evidence is informing budget decision making, particularly about our region.  Ideally, the evidence used to inform health policy might be evidence about health outcomes.

This would be a very difficult measure to apply to all health service provision because so many aspects of our health system are completely outcome blind.

What we do know, however, is that an overwhelming body of peer reviewed evidence shows that the sustainability of any health system is improved by strengthening primary health care.

Indeed, it seems self-evident that treating health problems before they become acute and need more expensive hospital care will save money.

It is also fairly self-evident to anyone interested in examining the facts that the biggest and fastest-growing spending category in health is hospitals – they receive almost $18 billion more in real terms than they did ten years ago.

We know that a significant percentage of the patients currently in hospitals – the most expensive part of our health system – could be and should be receiving more appropriate care in the community within an effective and responsive primary health care system.

Primary care not only delivers better health outcomes, it provides real savings and better bang for the buck than most other health investments.

Hunter Medicare Local has demonstrated that it is delivering better health outcomes and better value for money through programs like the Connecting Care in the Community Program.

This program supports people with chronic disease to better manage their condition in order to improve their health, well being, and quality of life, prevent complications, and reduce their need for hospitalisation.  The results of this program speak for themselves.

Pre and post studies involving actual case studies of patients from Maitland and Newcastle show a marked reduction in hospital Emergency Department presentations (average 32%), reduced number of admissions (average 12%), and an average reduction of 32% in the average length of stay in hospital.

Millions of dollars have been saved by this program alone, not to mention the benefit of improved health and less hospital admissions for the patients involved.

The Connecting Care in the Community Program is really a specialist primary care program run by specialist primary care providers operating within a locally connected organisation focused solely on responding to the health needs of local communities. This program runs in partnership with a range of providers including local hospitals.

Investing in primary care is an investment in sustainability of our health system into the future.

History shows that when State governments are asked to offer community based programs, they tend to look for ways to incorporate them into their hospital programs and settings.

An example of this is mental health sub-acute beds meant to be mainly in the community ending up mainly in the hospital setting.

In my experience, unless we are prepared to invest in specialist primary care organisations like Medicare Locals, we risk leaving our children a health legacy that may mean their life expectancy is less than ours.

And if you think that cannot happen, you need only look at the consequences of the more free market approach to health in the US.

• Carol Bennett is CEO of the Hunter Medicare Local

• For Twitter discussions about primary health care futures and Medicare Locals, follow @WePublicHealth this week where the guest tweeter is Jason Trethowan, CEO of the Barwon Medicare Local covering the Geelong region in Victoria – aka @BarwonML.