MLs offer flexibility and local responsiveness
FIVE years ago we commenced a major review of our health system. The issue: the complexity, inefficiency and ineffectiveness of Australia’s divided Commonwealth-state and public-private responsibilities for health care.
The ‘blame game’ was meant to come to an end in a new era of health system harmony. It was meant to take place quickly. It was meant to put patients first and Commonwealth-state disputes last.
The review led to reform – our first ever Primary Health Care Strategy, a renewed commitment to prevention, new health infrastructure and a national-regional approach to health governance that included Medicare Local (ML) primary healthcare (PHC) organisations and Local Hospital Networks (LHNs).
But has it delivered what the community really needs?
The answer after five long years is not yet, and there needs to be a renewed effort by the Commonwealth and states to make it work, particularly now that the machinery of MLs is in place and ready to go.
To overcome the divided accountabilities, the Commonwealth was originally going to take 100% responsibility for primary healthcare policy and funding (previously shared between states and Commonwealth), and hospital funding (primarily overseen by states) was going to be readjusted to give more responsibility and funding to the Commonwealth.
What we finished up with was a much watered down version of the original vision.
This left Commonwealth funded MLs with a responsibility to determine, coordinate and address PHC service delivery needs for their regional populations in a system where there remains fragmentation and major schisms between service settings.
Some $365 million a year in flexible funds for MLs to do this may sound like a lot, but as a proportion of overall health expenditure, it’s just about 0.29%, with MLs already over-delivering on this funding.
Can this be seen as a serious commitment to health – and especially PHC – reform?
In the UK, the Primary Care Trusts held 80% (around $120 billion) of the NHS budget.
For reform to be meaningful to the community – to stop it being about sectors and shift it towards being about the people who use the services – the Commonwealth needs to seriously raise its commitment.
In fiscally constrained times, clearly we must look at quality, productivity based value-for -money propositions. And that also means looking at where care can be delivered best.
Primary care is the place in which more equitable and better outcomes can be delivered at better cost. We do still need to shift more funds in this direction to get the reorientation towards PHC that we really need.
We also need to start thinking more about the system as a whole. We need to start being clever about how we spend our whole health budget – looking at integrated models where Commonwealth-state funding pools can be used to provide the best bang-for-buck quality, integrated care for patients.
Now that we have a national efficient price for public hospital services, there is a real incentive for hospital system managers to look critically at the efficiency that the primary healthcare setting offers.
We must introduce to the system the notion of efficient pricing across the board.
MLs offer an infrastructure through which this can be achieved. And as a start, through a shift of existing, rather than an injection of new funds, there is progress that can be made quickly and easily. There are already a number of state health services that could be more effectively delivered through MLs because of the flexibility and local responsiveness that MLs offer.
What’s needed along with the shift in funding is a shift in mind-set and an understanding and commitment to putting patients – rather than sectors – at the centre of healthcare delivery.
Dr Arn Sprogis
Chair, AML Alliance
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