Health reforms walking a weak and wobbly plank
The Federal Australian Medical Association opposes the Government’s Medicare Locals as currently proposed.
What happens if you take the doctor out of the picture?
There is little detail on structure or funding. There is no explanation of patient benefit. There is plenty of uncertainty.
Medicare Locals are supposed to be a major plank of the Government’s health reforms. It is a weak and wobbly plank.
We have called on the Government to defer the establishment of any primary health care organisations (PHCOs) until there has been genuine consultation with the medical profession.
The AMA has for some time been calling for consultation and more detail about the governance and operation of Medicare Locals, but those calls have been met with silence.
The AMA and the medical profession cannot support primary care reforms that do not explain how they would benefit patients or communities, and which do not guarantee they would maintain and support the leadership role of GPs in primary care.
There must be meaningful dialogue with the medical profession about a way ahead that is best for patient care.
The AMA is not opposing the concept of a primary health care organisation to coordinate primary care services. When Medicare Locals were first announced, we were cautiously optimistic about the role they might play in improving health care for Australians.
But since that time there has been little detail about governance, funding arrangements, or the envisaged role of doctors in their management. It is a big ask for us to support a concept that is very short on principles, let alone detail.
Some commentators seem concerned that the AMA insists that doctors should be strongly represented on the governance structures of our health systems.
You need only look at the chaos wrought upon our public hospitals when they are administered without appropriate reference to the doctors (and other health workers) who actually deliver the health services in the hospitals.
New Zealand’s initial experience with PHCOs that were run by ‘skills-based’ boards was heading for disaster until the situation was retrieved by an increased presence of doctors on those boards.
The assumption that health care is improved by marginalising the role of doctors in decision making is, to say the least, contestable - and the AMA will certainly continue to argue against it.
Locally, we examined closely how the proposed Medicare Locals were intended to integrate with Local Hospital Networks. Our examination was not too encouraging – hence our concerns.
Medicare Locals will be funded separately, governed separately, and will function separately to the acute hospital system.
The chances of evolving a Medicare Local-inspired integrated health system are just about zero.
The likelihood of continued cost and blame shifting between the Commonwealth and the States is extremely high.
The Prime Minister has also stated that Medicare Locals could be fundholding bodies and, despite our requests, she has not ruled out fundholding for GP services.
Currently, patients decide when they need a GP service, not a distant bureaucracy that works to a fixed budget, and which increasingly emphasises cost control rather than access to quality services.
This is a big change in the way a patient’s visit to a GP is funded. The community needs to understand that this will inevitably lead to the rationing of GP services – in the just the same way as public hospital services are rationed.
Although Medicare rebates have failed to keep up with the costs of providing GP services, patient co-payments, where necessary, have kept general practice viable.
Fundholding arrangements delivered by Medicare Locals could be the final straw that breaks the back of general practice.
Doctors practise according to the principle of ‘first do no harm’. Perhaps the Government should apply the same principle to its currently proposed Medicare Locals.
