April 11, 2012
A central strand in health reform under the Rudd/Gillard Labor Government is trying to shift the centre of gravity of the health system from hospitals to primary healthcare in order to achieve greater equity and to use resources more efficiently and effectively.
The vehicle being built to do this are the sixty-two new primary healthcare organisations known as Medicare Locals, which are being built from the current regional Divisions of General Practices across Australia to identify and plug the gaps in the current health care system.
They are a first step towards a more integrated health-care system. Their strength will lie in their ability to bring together a wide group of health service providers to address the community’s health problems.
Melissa Sweet in Medicare goes local in search of “disruptive innovation” at Inside Story says that Medicare Locals are being asked to do what may well prove to be impossible: to be a type of super-bandaid patching together a fractured health system.
Their task is to integrate a fragmented primary care sector by helping GPs, practice nurses, psychologists, physiotherapists, community health workers, allied health professionals, pharmacists and others in the public and private sectors to work more closely with each other. In addition to roping together the silos within primary care, Medicare Locals are expected to develop better links between primary care and public and private hospitals as well as aged care services. They are intended as the glue in a system whose entrenched funding and structural divisions have not been budged by efforts at national health reform..Beyond all this, they are also charged with shifting the focus of primary care to population health.
I cannot see it happening myself. Medicare Locals don't have that much money and little authority to pull the patchwork of private primary care services into networks and to fill service gaps. GPs, for instance, are being asked to share power and influence and to see their own clinical practice and business models in a broader primary care context.
They won’t be in a position to address the chronic imbalance between hospital and community care, and given their birth in Divisions of General Practice, they won't have a broad vision of primary health care (ie., social and community health) that is necessary to help keep people out of hospital.