While it may not have received the same media attention as the proposed GP co-payment, the Horvath Review of Medicare Locals, released yesterday, may have a greater impact on the future of primary health care.
Given the negative sentiments expressed towards Medicare Locals previously by both the Prime Minister (“move the money from the back office to front-line services”) and the Health Minister (“an extra layer of bureaucracy”), they may be disappointed in the Review’s overall endorsement of MLs’ role as coordinators and facilitators of community-based health care.
In recognising the difficulties many consumers face in navigating the health system, Professor Horvath states in the Report “There is a genuine need for an organisation to be charged with improving patient outcomes through working collaboratively with health professionals and services to integrate and facilitate a seamless patient experience.”
The main findings of the Review include that the high performing MLs are making a positive contribution to improving the quality and coordination of primary health care, in particular through working with local health care professionals and services.
Recommendations include changing the name to Primary Care Organisations and reducing the overall number of MLs to achieve administrative savings. Professor Horvath also recommended aligning ML boundaries with those of Local Hospital Networks or other regionally-based organisations.
A lack of clarity about the specific functions of MLs was noted, with the Report stating “This lack of clear purpose has perpetuated a sense of confusion and relevance with service sectors, governments and the community.” Another key recommendation was to cease funding for the national peak ML body, the Australian Medicare Locals Alliance.
Alison Verhoeven, AHHA Chief Executive, responded to the Report saying that the recommendations in Professor Horvath’s report to the Health Minister strongly reflect the original description of the role and function of Medicare Locals described in the 2010 report, Building a 21st Century – Primary Health Care System, which emphasises the importance of the coordination role in primary care.
She argued that while Professor Horvath’s acknowledgement of the negative impact of complex and burdensome reporting requirements is welcomed, his findings regarding the variability in the structure, programs and approaches of Medicare Locals is somewhat contradictory to his recommendation that primary health organisations should have ‘…flexibility of structure to reflect the differing characteristics of regions…’.
In relation to Professor Horvath’s recommendation to reduce the number of ‘Medicare Local’ equivalent bodies, Ms Verhoeven stated that it will be critical for the replacement organisations to maintain an appropriate connection with the communities they will be serving. The savings achieved by the economies of scale of larger organisations must be balanced against the need to retain strong local connections. AHHA also stressed its support for the proposed alignment of the new organisations with the boundaries of local hospital networks, either on a one-to-one basis, or a one-to-many basis if the size remains manageable and community connections can be retained.
General Practice NSW also responded to the Review’s recommendations, supporting an alignment with LHNs but noting that in many regions this is already occurring. GP NSW also stressed the need for MLs to reflect the heterogeneity of general practice and to provide incentives for quality improvement.
In supporting the need for greater clarity of purpose, GP NSW said that this should be articulated as a joint message with LHNs and engaged clinicians. GP NSW also pointed out that the Report struggled with the trade-off between localisation of priorities vs. national theme consistency.
In relation to the recommended de-funding of the AML Alliance, GP NSW said that the Alliance may seek funding from members to continue in some way, pointing out that if the number of MLs reduces, the case for state based and national organisations will presumably be less.
The Report concludes by recommending that “PHOs only provide services where there is demonstrable market failure, significant economies of scale or absence of services.”
Professor Stephen Duckett tweeting for @WePublicHealth questioned whether the underlying problem identified by the Review may have been caused by ‘over hyping’ by previous Ministers. He also asked whether Professor Horvath had examined the role of the Department of Health, which was charged with overseeing the budget and accountability framework for MLs.
The Government has not formally responded to the Review but may address some of the Recommendations in tonight’s Federal Budget.