In part four of a Croakey series analysing the plans for Medicare Locals, Martin Laverty, ceo of Catholic Health Australia, argues that the new organisations must broaden their vision beyond health services if they are to maximise their impact upon the community’s health and to address health inequities.
Martin Laverty writes:
Last year before a Senate Inquiry into Kevin Rudd’s promised reform of the health system, a Senator cut my evidence short. What I was arguing was in his view not relevant to the health reform process.
The evidence, on behalf of the network of Catholic hospitals, which on any given day care for one in every ten Australians in hospital beds, argued that early childhood experiences, educational attainment, housing, income, and social connectedness was more important to keeping people healthy than GST financing.
Most agree a person’s socioeconomic standing impacts their health, but many say it’s too hard to fix. For governments, cross portfolio thinking is tough. For some health charities, including one close to my heart, social determinants are just too big to tackle.
Last September, with the help of the National Centre for Social and Economic Modeling (NATSEM), Catholic Health Australia (CHA) published research showing a person in the lowest twenty percent of income earners will die on average three years earlier than a person in the highest twenty percent.
The CHA/NATSEM research also found those in the lowest wealth groups have up to three times the prevalence of chronic illness than those in the highest wealth groups.
The CHA/NATSEM data proved something we already knew: your level of wealth determines your health. It also pointed to how health reform could address social determinants that are the cause of billions of dollars in avoidable hospital expenditure.
When the CHA/NATSEM report was published, we argued primary health care networks, or Medicare Locals, should be given mandates to improve the social determinants of health.
Expressions of interest to establish the first fifteen Medicare Locals were released last week, accompanied by vague detail on what these new bodies will actually do.
The focus of the new primary health bodies must be to improve health outcomes, not just to improve health care access. To improve health outcomes, the science tells us Medicare Locals should monitor, report, and then act on the social determinants of health.
To act on social determinants, Medicare Locals will need links with early childhood educators, schools, welfare and social service bodies, in addition to general practice, allied health, and community health workers.
Medicare Locals are to be established as independent companies, managed by skills based boards. CHA believes one of the key skills needed, in addition to standard management requirements of any board, is knowledge of and a readiness to tackle social determinants. If Medicare Locals do not have knowledge of the drivers of ill health and premature death, they’ll not be properly qualified to do their job.
In establishing the first fifteen Medicare Locals and those that eventually follow, priority should be given to geographic areas known to have the poorest population health outcomes. Governments know where these areas are, and should resource them through the new primary health bodies to improve health outcomes (not just health system access).
The impact Medicare Locals have on local communities should be measured and publicly reported. Yes, they should demonstrate how they improve patient access to health services, and in particular they should demonstrate how they improve medical care for the aged to cut avoidable hospital admissions.
Yet they should also prioritize targeted programs for improving health outcomes of the lowest socioeconomic groups within their boundaries. To do this, Divisions of General Practice as we know them today will need to forge new links with social services and educators to be ready for this task.
In deciding which applications to select for the establishment of the first fifteen Medicare Locals, the Commonwealth should pick those with social determinant plans. It should require them to report publicly on how they improve chronic illness prevalence, and be willing to fund initiatives that directly reach people most at risk.
If you’re thinking of putting a bid together to become one of the first Medicare Locals, the government has allowed a mere six weeks. This short time frame advantages Divisions of General Practice, and the Divisions are mostly expertly placed for this new primary care coordination role.
Yet Medicare Locals will fail if they focus only on coordination. They must be built to provide improved patient access through better coordination, but also be made accountable for lifting community health outcomes. Doing so will require thinking beyond the traditional health system boundaries. Doing so will require action on the social determinants of health.
• Martin Laverty is the CEO of Catholic Health Australia, a network of public and private hospitals and residential and community aged care services.
For previous posts in this series:
For previous related Croakey posts:
• How will Medicare Locals work?
• We need a broader focus, and stronger commitment to consumer/multidisciplinary involvement
