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The great adventure story of Medicare Locals: will it have a happy ending?

As recently mentioned, the Australian Healthcare Reform Alliance has released a report investigating the state of play with Medicare Locals, and where they are heading.

Its author, health policy analyst Jennifer Doggett, got the sense that while the first chapter of the Medicare Locals story is now being written, the final outcome of this adventure story is from clear. It could all end in tears of frustration – or joy, perhaps.

“Without a supportive policy and funding environment over the next decade, it is unlikely that MLs will be able to fulfil their potential,” she writes in the article below. (Please note that this article reflects Jennifer Doggett’s personal views and does not represent AHCRA).

 ***

Once upon a time, there were high hopes and dangers ahead…

Jennifer Doggett writes:

Despite broad political agreement around the need for Australia’s health system to focus more on the prevention and management of chronic disease, there is ongoing controversy about the role of Medicare Locals, the organisations being established to coordinate primary care at the community level.

In fact, the first chapter of the Medicare Locals (MLs) story reads like a ‘Choose your own adventure’ book with the potential for either wild success or abject failure, depending on who is writing the narrative.

The Government’s version sees MLs save thousands of lives through improving access and quality of care, whereas the Coalition’s plotline would see MLs disappearing into a bureaucratic black hole, weighed down by unrealistic expectations, onerous reporting regimes and unnecessary organisational complexity.

A new paper from the Australian Healthcare Reform Alliance helps clear up this confusion and provides useful information about the progress thus far of the first tranche of MLs and their future plans. Medicare Locals: the first 6 and next 12 months also identifies key factors which will influence whether or not these new organisations can, over the longer term, drive much-needed improvements to our primary care system to deliver more equitable and consumer-focussed care.

MLs were established to solve the problems in primary care that individual health care practitioners find difficult or impossible to address on their own.  These problems are becoming more critical because, like most developed countries, Australia has an ageing population and increasing rates of chronic disease. We also have a high number of preventable hospital admissions and a significant number of consumers who report cost or other barriers to receiving care.

International evidence demonstrates that primary care meta-organisations, such as Medicare Locals, can help address these problems by improving the ways in which primary care is planned and delivered in their communities.

Promising early progress

The AHCRA paper provides some positive indications that MLs have made promising early progress in tacking these issues.

In particular, AHCRA’s research found that MLs are:

• Building and strengthening relationships within the primary care sector. With few or no policy or financial levers to coerce practitioners into changing their behaviours, MLs need to rely on strong and trusted relationships with providers to achieve lasting changes to the way in which health care is delivered. AHCRA found that MLs are actively building on existing relationships with GPs and cultivating similar relationships with consumers and allied health providers.

• Focussing on consumer/community engagement. For MLs to promote a genuinely consumer-focussed health system they need to involve consumers at all stages, including the planning and evaluation of health services. AHCRA was encouraged that all the MLs interviewed for its project expressed a high level of commitment to improving consumer engagement in primary health care.

• Engaging in needs analysis and planning. Knowing what health services the community needs and what are available is the key to improving both the equity and efficiency of our current health system. MLs provide the opportunity, for the first time, to take a national and systematic approach to planning primary care. AHCRA’s research found that MLs are actively involved in assessing their communities’ health care needs and developing plans to address identified gaps.

But risks ahead

However, despite these positive findings, AHCRA’s paper warns that a successful outcome for MLs could be jeopardised by external factors, including political uncertainty, unrealistic expectations from stakeholders and an inflexible approach to funding and reporting requirements.

Achieving culture change within primary care takes time and an ongoing commitment to building lasting relationships and trust. It needs a clear agreement between all parties about the scope of MLs’ influence and an understanding that some key factors affecting access to care (such as the fees charged by private practitioners) lie outside their control.

Without a supportive policy and funding environment over the next decade, it is unlikely that MLs will be able to fulfil their potential.

But if political and policy agreement on these issues can be reached, there is a genuine chance that MLs can successfully tackle some of our most complex and intransigent health system issues.

A better and fairer health care system for Australia’s future? That’s a happy ending worth working for.

• The AHCRA paper referred to was prepared by Jennifer Doggett on the basis of research undertaken by the AHCRA Executive. The opinions expressed here are her own and do not represent AHCRA.

 

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