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Medicare locals + health care « Previous | |Next »
June 20, 2011

The Federal Government has announced the final boundaries for an Australia-wide network of 62 Medicare Locals. The reform vision behind this was for:

less micromanagement by Canberra and the States, greater flexibility through block funding arrangements, local community led primary health care organisations that understood the needs of their constituency, determined the best method of delivering services and went about their business. The notion of Canberra’s ‘one size fits all’ approach where the funding arrangements gave much the same money and proposed the same model of care to deliver a mental health service to a middle class white patient in Penrith as it did to an Ngaanyatjarra Aboriginal patient from the Central Desert was meant to be dead in the water. Regional differences such as morbidity and mortality rates, access to resources, the cost of those resources, cultural differences, the need for outreach services, housing, education, employment – the social determinants of health - were to be the new approach.

As expected, this vision of primary health care resulted in professional tussles over the roles and influence of GPs, nurses and pharmacists and who would run the Medicare locals. The Australian Medical Association has been agitating loudly for a “leadership role” for GPs in opposition to those interested in developing a more community-centred approach.

Realistically the community approach was never going to get off the ground, but what was hoped was that there would be a greater inclusion of allied health professionals, a shift away from the medical model of disease to a wellness model; and a greater emphasis on illnesses such as diabetes, hypertension, obesity, mental health and trauma, violence and substance abuse.

It is unlikely that the Medicare Locals will generate anything like this approach to health care, and it may be that it only come if communities and health practitioners develop it themselves, independent of the formal structures in the health system. The formal structures are shaping the content of Medicare locals.

Firstly, it is increasingly apparent that the Federal Government has capitulated on the issue of level of primary health care funding and is leaving the States to run primary health care services through their existing community and population health organisations with no promise of reform in health care.

Secondly, the Medicare Locals have lost their independence to the top down approach. As Lohengrin highlights the:

forerunner Medicare Locals which were formerly autonomous of Government, as most were independent locally managed organisations, will be nationalized, becoming regional offices of the Department of Health and Ageing. Their former independence of Government, able to lobby vigorously of behalf of their constituency, influence health policy and help drive continuing health reform will be neutered and potentially replaced by a new set of overly regulated, unresponsive, frustrated minions of the Government in Canberra, albeit with an office in your town.

So it is going to be more of the same kind of health care even though community health requires so much more than providing medical services. It is community health that the social determinants of health and health inequality come to the fore.

| Posted by Gary Sauer-Thompson at 10:54 AM |