A recent article in the Canadian Medical Association Journal should be top of the reading list for the new Minister for Health and his/her advisers.
This article looks at the characteristics of primary care practices that are associated with quality and should be particularly relevant to the Review of Medicare Locals (MLs), promised by the Coalition in the lead-up to the election.
Croakey was originally alerted to the article by Professor Stephen Duckett via the following tweet
The commitment to review MLs was announced after initial statements from the Coalition indicated that they did not see any value in the new primary health care organisations, established as part of Labor’s health reform agenda.
Croakey has no inside knowledge on what changed the minds of the Coalition leaders, however, has heard that visits to individual MLs by (then) Shadow Parliamentary Secretary for Primary Healthcare Dr Andrew Southcott, may have played a role.
Apart from the commitment to review MLs, the Coalition has said little about its vision for primary health care and its role in tackling some of the major health problems facing our community.
However, once Coalition politicians have finished sorting out the important details of forming government (for example, who gets the plum Parliament House offices closest to the Senate and House of Reps chambers ) they will need to turn their attention to other aspects of their role, like how to run the health system.
This will include working out what they want to get out the ML Review (as anyone who has had anything to do with governments knows, a review never takes place until those running it know what they want the outcomes to be).
Reviewing MLs at this stage may seem premature when some of them have barely had the ink dry on their contracts. Even those established as part of the first tranche in 2011 can hardly be expected to have achieved significant population health outcomes in this relatively short timeframe. Changing health-related attitudes and behaviours takes time and there are no easy shortcuts to improving the complex intersection of individual and structural factors which result in the significant health inequities in our community.
Had Peter Dutton consulted Croakey before making this decision, a number of other programs could have been suggested as more appropriate for evaluation and review.
For example, the private health insurance rebate, which has an annual budget over thirty times that of Medicare Locals ($5.5 billion vs $173 million) has been running for over a decade without any formal evaluation of its efficacy.
However, given that the Coalition is unlikely to back down on its commitment to a review, there are some potential positives in looking at the progress thus far of MLs and how they are working to integrate and coordinate health care at the community level.
If done properly, it could provide useful information on the challenges they are facing early in their implementation process and ensure the successes of individual MLs are highlighted and used to assist others.
It may also help the incoming government develop a vision for primary health care, something that was lacking in its pre-election policy statements.
The Canadian Medical Association Journal article may help the incoming Minister and advisors in this regard. The article identifies a number of characteristics of practices which are associated with quality in primary care, many of which relate to the roles and functions of MLs.
The study contains a number of useful findings, particularly in relation to the complex relationship between quality, accessibility and efficiency.
Overall, it demonstrates the complexity of assessing performance in primary care and warns against using any single issue outcome measure, without taking its broad context into account.
This may not be the simple message an incoming Health Minister wants to hear, but if s/he understands these issues now, it could make a real difference to the fate of Australia’s primary health care system over the next three years.
