Wednesday, November 17, 2010

Medicare Locals and E-Health - Does It All Fit Together?

The following appeared rather too late for me to comment on.

Medicare Locals - discussion paper on governance and functions

PDF Medicare Locals - discussion paper on governance and functions

08 November 2010The Australian Government has committed to establishing a national network of primary health care organisations, known as Medicare Locals. This paper specifically addresses the following areas:

- What will Medicare Locals do?

- What will Medicare Locals look like?

- How will Medicare Locals interact with patients and providers?

The aim of this paper is to provide information to the public and other interested parties as to the proposed roles and functions specific to Medicare Locals.

You are invited to provide written comment on this Discussion Paper. Submissions can be sent by post or email and should be provided to the Department of Health and Ageing (DoHA) by 15 November 2010.

Full Post is here:

http://www.apo.org.au/research/medicare-locals-discussion-paper-governance-and-functions

First, what on earth is going on here the document is dated 29 October and Comment is due by November 15. Very short notice I must say.

Here is the guts of what this is about: (Page 5/1)

“From 1 July 2011 the Australian Government will establish Medicare Locals, a national network of primary health care organisations, to improve integration of primary health care services and improve access to services.

Medicare Locals will be an important part of the new National Health and Hospitals Network (NHHN). Medicare Locals will be established as independent legal entities with strong links to their local communities, health professionals, service providers and consumer and patient groups, enabling them to respond effectively to local needs.

Medicare Locals will be responsible for making it easier for patients and service providers to navigate the health care system. Medicare Locals will support health professionals to provide more co-ordinated care, while maintaining the important role that general practice plays in the primary health care sector. Medicare Locals will facilitate improved access to services for patients and encourage greater integration between the primary health care, hospital and aged care sectors.

Improvement in primary health care is critical to improving the overall health care system.

The first Medicare Locals (around 15 organisations) are expected to commence operations in mid 2011, with the remainder commencing in mid 2012. The final number of Medicare Locals to be established is to be determined by around the end of 2010 and is subject to ongoing discussions between the Commonwealth and state and territory governments, to allow consistency with the boundaries of Local Hospital Networks as appropriate.”

What will they do you ask?

“Medicare Locals will retain, and expand, the functions and activities currently undertaken by the Divisions of General Practice – including general practice support and delivery of programs.

A key role for Medicare Locals will be undertaking local health planning, identifying gaps in services at the local level, examining opportunities for better targeting of services and establishing formal and informal linkages with the acute and aged care sectors. In doing this, Medicare Locals will drive more efficient use of our health resources – by encouraging the delivery of primary care, ambulatory and acute care in the centres that are most able to safely and effectively provide them. Patients will benefit by experiencing shorter and safer patient journeys, within streamlined, and better focused clinical systems. Greater efficiency will mean that more ‘health’ can be provided for the same health care dollar.” (Page 8/4)

There is a lot more:

There are to be between 50 and 75 Medicare Locals covering anywhere up to 1,000,000 people (hardly local!)

They are to report to the Federal Government but be Companies Limited by Guarantee (like NEHTA)

They are to be important in co-ordination, safety and clinical governance.

What is missing is just how any of these hoped for improvements will actually be established, funded and staffed. It looks to me like part of a new and possibly amazingly complex bureaucracy which is likely to be very intrusive and annoying to the present clinicians. More jobs for the boys what! Maybe those failed bureaucrats who have lost out in the New Health Network structures?

E-health gets just one mention I can find. Among reform initiatives of the new hospital networks we get the task which will be undertaken or supported:

“the development of the Personally Controlled Electronic Health Record and other eHealth developments”

Certainly the concept of having e-Health at the centre of a quality, safe and co-ordinated system does not seem to be any priority.

I think we should all be pretty alarmed by this. I reads to me as policy rubbish developed by people who are a zillion miles from the actual patient coalface and are pretty clueless. Be alert and very alarmed would be my take.

David.

11 comments:

Anonymous said...

A quick check of ASIC suggests the stampede has begun:

BRISBANE SOUTH MEDICARE LOCAL LTD
METRO SOUTH MEDICARE LOCAL LTD

Anonymous said...

That's so presumptuous! The boundaries for Medicare locals haven't as yet been finalised or do those Divisions know something no-one else knows? Anyway, what right have they to use Medicare's name like that?

Aren't they infringing Medicare Australia's intellectual property?

Anonymous said...

They probably are if Medicare Australia has protected its name. The same probably goes for Medicare Locals.

If that's the case they would have to ask Medicare Australia for the right to call themselves 'Such-n-Such Medicare Local'.

Anonymous said...

I wonder how these jobs fit into the equation of deling with the new Medicare Locals in NSW:

http://executive.seek.com.au/Job/chief-executive-local-health-network-15-positions/in/sydney/18491718

It is described in the advert:
"In April 2010 the National Health and Hospitals Network Agreement was reached between State and Federal Governments to reform health care delivery. A central requirement of this reform is the establishment of Local Health Networks. The Chief Executive of the Local Health Network, with its Governing Council will be responsible for the provision of health care in their local areas consistent with nationally established targets. Each of these local health networks will operate a group of hospitals and other health services and will be administered jointly by a Chief Executive and Governing Council to provide efficient and effective health services to their local community and State priorities."

Lots of jobs and movement - is it co-ordinated?

Anonymous said...

“Medicare Locals will retain, and expand, the functions and activities currently undertaken by the Divisions of General Practice".

... sounds more like the Fox is to be in charge of the chookhouse.

Anonymous said...

David, you make an extraordinary and very disturbing observation – “the concept of having e-Health at the centre of a quality, safe and co-ordinated system does not seem to be any priority”.

How can this be? Are the administrators and bureaucrats so out of control that they do not understand that ehealth is fundamental to delivering improved coordination of patient care? Without ehealth at the core Medicare Locals will fail to deliver on every front.

Oliver Frank said...

Anonymous people said:

"Anyway, what right have they to use Medicare's name like that? Aren't they infringing Medicare Australia's intellectual property?"

and another (presumably) Anonymous replied:

"They probably are if Medicare Australia has protected its name. The same probably goes for Medicare Locals. If that's the case they would have to ask Medicare Australia for the right to call themselves 'Such-n-Such Medicare Local'. "

I have news for Anonymous 1 and Anonymous 2: it is the federal government through our Health Minister which is not only allowing the use of the name "Medicare Local" but actually insisting on it. Nicola Roxon was asked repeatedly two weeks ago at the Australian General Practice Forum in Perth to allow the proposed Primary Health Care Organisations to be called something else, such as Primary Care Locals, and she made it absolutely clear that they will be called Medicare Locals, so that the public knows where the money is coming from, she said.

Dr David More MB, PhD, FACHI said...

Thanks Oliver,

Typical of Minister Roxon in my view.

David.

Anonymous said...

I agree with Oliver - that Nicola Roxon wants the public to not only know where the money is coming from, but more importantly, she wants the public to know that it is the Government which has the vision for reforming the health system - not a doctor led and driven organisation which in the past has not shown much of a liking for embracing other health care providers, like nurses and pharmacists and a variety of allied health and other organisations which have a broader more inclusive focus on population health and community well being, including the disadvantaged in our midst.

Anonymous said...

That's interesting Oliver - mmmm - you said "it is the federal government through our Health Minister which is not only allowing the use of the name "Medicare Local" but actually insisting on it."

What you say is correct but in doing so the Government has no control over the process except who it will and will not provide funding to. So there is nothing to stop Ed Bateman's Primary Health Care Limited or anyone else for that matter from positioning their clinics under a banner line ..... "at the heart of Medicare Locals". I like it but I don't think Medicare will.

Anonymous said...

Wednesday, November 17, 2010 6:12:00 PM
You missed this one: GOLD COAST MEDICARE LOCAL

QLD is on the move. Mining for 'GOLD' - they might be lucky.