What will the hospital reforms mean for primary health care reform? And when the Government finally gets around to addressing what should be a central part of its health reform agenda, what should be on the table?
These and other questions are addressed below by Tony McBride, a consumer engagement consultant and Chair of the Australian Health Care Reform Alliance (although this is personal view). He writes:
“The Prime Minister has sent a clear signal that hospitals will be front-and-centre in the election campaign. Hopefully, the Government will also be putting as much effort into developing its plans for primary health care reform – an even more essential piece in the jigsaw for a better health system.
There are many questions yet to be answered about the Government’s intentions for this sector, and within that for the role and composition of the mooted primary health care organisations (PHCOs).
Will the reform be reshuffling of the current fragmented primary care deckchairs? Or a more desirable move to an integrated primary health care model? And how far down the tree will fund-holding go?
Until we know this, concrete proposals about such facilitating organisations as PHCOs are difficult to assess, especially now the new hospital networks have been proposed.
Of course it is useful to float possibilities. If the Commonwealth can get agreement from the States for something akin to the latter integrated primary health model, (as recommended by the National Health and Hospitals Reform Commission) then this implies quite a paradigm shift.
Consumers currently experience a mixed uncoordinated set of services using various models. Most are located separately, funded differently and leave the consumer often with disparate and unpredictable costs. These include:
- general practices;
- private allied health practices;
- rehabilitation and other outpatient type services which currently are hospital-based but don’t need to be; and
- community health services (although models vary across states).
The first three sets of services offer predominantly one-to-one treatment based on a medical model, and can be described as primary care.
Community health services (again esp. in Victoria and SA) are more (although far from entirely) based on a social model of health and the primary health care paradigm, engaging well with their diverse populations and placing a stronger emphasis on prevention, social well-being and a team approach than the rest of the sector. Ideally the new comprehensive PHC services will be of this ilk.
To shift the current fragmented patchwork into a nationally consistent and rational system will require not one but several key drivers and facilitators. These are:
- a funding structure which gradually encourages such a model (and eventually only this model);
- population health planning to enable the system to grow where it is needed;
- fund-holding and management of services; and
- supports to enable providers to move towards the PHC paradigm and service network.
A nationally consistent distribution of needs-based funds by the Commonwealth to the regions could achieve the first foundation stone.
The Australian Health Care Reform Alliance supports regional bodies to undertake the planning and local distribution of funding, using the national framework but doing so in a context relevant manner. The new networks seem far too hospital-centric to consider them as having such a role, and this is a pity, so separate primary health care bodies will be required.
Services based on new models of primary health (emerging from both community health and general practice) will need to evolve which allow health professionals (with consumer input) to create new more equitable, preventive and effective forms of care. However the development over time of such collaborative arrangements and integrated services on the ground might also need the facilitating assistance of new versions of the successful GP divisions model.
In this context, the name PHCO is merely a label. It might be used to describe any of the bottom three possibilities above. Critically, the structure and composition of any of the above would depend heavily on their purpose. They clearly need to involve all PHC stakeholders including consumers. But if they are to allocate funding, then providers have a conflict of interest and cannot play significant decision-making roles.
And talking of labels, the obvious question is why one would permanently limit such facilitating and funding bodies to just primary health?
Perhaps calling them HCOs or something more general, would allow for the possibility of expanded roles, as more reform is unrolled over time. However, the existence of the local hospital networks will remain a complication in this.”