Wednesday, December 18, 2013

Medicare Local Review Announced - Very Short Response Deadline - Commments Welcome

This popped up very recently.

Medicare Locals review

Australia’s former Chief Medical Officer Prof John Horvath AO will oversee the Australian Government’s review of Medicare Locals.

Page last updated: 16 December 2013
PDF Printable version of Medicare Locals review (PDF 30 KB)

16 December 2013

Australia’s former Chief Medical Officer Prof John Horvath AO will oversee the Australian Government’s review of Medicare Locals.

Prof Horvath is a distinguished doctor, researcher and health adviser and served as the nation’s CMO from 2003 to 2009.

Health Minister Peter Dutton has announced details of the review which was a Coalition election commitment.

It will begin immediately with Professor Horvath providing his independent advice to the Government by March next year.

The 61 Medicare Locals established by the former Labor Governments were allocated flexible federal funding of more than $1.8 billion over five years as well as additional funding for specific programs.

Health Minister Peter Dutton said the government’s priority from the program was to ensure that Commonwealth health funding was used as productively as possible.

“We are committed to reducing waste and spending on administration and bureaucracy, so that greater investment can be made in services that directly benefit patients and support health professionals who deliver those services to patients,” he said.

Stakeholders have been invited to comment on various aspects of Medicare Locals’ functions including:

  • The role of MLs and their performance against stated objectives
  • The performance of MLs in administering existing programmes, including after-hours GP services
  • Recognising general practice as the cornerstone of primary care in the ML functions and governance structures
  • Ensuring Commonwealth funding supports clinical services, rather than administration
  • Processes for ensuring that existing clinical services are not disrupted or discouraged by ML programs
  • Interaction between MLs and Local Hospital Networks and other health services, including boundaries
  • Tendering and contracting arrangements
  • Other related matters.
Here is the link:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/health-mediarel-yr2013-dutton025.htm

The deadline for those asked to respond is 23rd December, 2013 I am told.

Anyone who has comments that might be fed back on all these issues and MLs effectiveness feel free. Will pass them on if I can.

Most will know I see them as a rather nebulous set of entities whose purpose and actual performance is pretty unclear - given their cost.

David.


9 comments:

Anonymous said...

The key idea behind MLs is to devolve control of health service planning to the locations where those services are delivered. This is an evidence-based and admirable ambition, that like so many things with the previous government, was poorly implemented. Some of the best MLs (e.g. Wentwest) are doing incredible work that will ultimately percolate through to other MLs over time.

I hope the biggest change announced by the Horvath Review will be the (merciful) change of their name...

Anonymous said...

The major problems are duplication and a lack of collaboration. There is still hope. Some ML's are now trying to share information, reduce duplication of effort, increase shared program development but the ML funding and ML structures have hindered not helped. They were created too quickly and have wasted a lot of the funding for very little benefit. It has made it look like a lot of work has been done but mostly to re-invent the wheel. While the patient demographics, morbidities and needs vary – the fundamentals of medicine don’t change according to location.
The major problem with having so many ML's is the health promotion, interventions and monitoring projects are repeated and overlap. Much of the money is being spent on redundant work done elsewhere. Brochures, posters, software, development of training programs, development of patient education programs should have been limited to 1 group for development, then piloted and collaborated with other ML's and then expanded to the rest of the ML's with their ability for minor changes if needed. The ML's then choose which programs to use and how much of them to use.
How many data extraction and analysis projects have been started that will repeat the same functionality, encounter the same stumbling blocks and fail to deliver usable data far less the expected outcomes.
It's like paying each school to develop text books for the same curriculum instead of a few text books mass produced for all schools.
~~~~ Tim C

Anonymous said...

What we need is a health information system strategy.......

Anonymous said...

"What we need is a health information system strategy......."

Cart before the horse!

What is really needed is true Health System Reform, and the rest will follow-on and flow-on naturally from there...

Not the Claytons health reform proposed in 2009 by the NHHC, which as deficient as it was from the get-go, not surprisingly has been perverted and distorted to self-serve the entrenched dysfunctional self-interest chronically incumbent within Australia's healthcare system...

Until the perversions and distortions are expunged from the healthcare system through "courageous" reform, health information and the related systems and technology associated with health information are the least of the worries and causes of our current health system problems!

Bernard Robertson-Dunn said...

IMHO, Health systems, health information systems and technology are all interrelated.

You can't reform health systems without understanding and using the others. The others don't follow-on or flow on naturally, they are enablers and must be leveraged. The trouble with the PCEHR is that it isn't an enabler, it's just more of what's there already and is likely to be a hindrance, not a help to health system reform

The big question is: "should reform come from a centralised, command and control approach or as a decentralised, competitive, emergent approach?".

History suggests that Governments often prefer the first but the latter is quicker, more effective and more efficient.

Anonymous said...

”You can't reform health systems without understanding and using the others. The others don't follow-on or flow on naturally, they are enablers and must be leveraged.”

Bernard, I believe you may be confusing means with ends and the cause and effect relationship between the two… Once “health reform” is the chosen pathway to create solutions to existing problems, and characterised in terms of newly created objectives, desired outcomes and required performance criteria that constitutes success or improvement over the status quos (ends), of course decisions will be made about “what” information, information systems and technology (means) will be required to achieve newly defined ends, following-on and flowing-on naturally.

The fact that they are enablers and must be leveraged to achieve newly definedhealth reform objectives, demonstrates they are indeed means and therefore constrained to be dependent on whatever health reform objectives are defined and set out to be achieved through such a reform initiative.

Health information and the related systems and technology associated with health information are unequivocally means not ends in and of themselves. To be otherwise is nonsensical as the imputed meaning attributable to what constitutes “information”, its value and relevance and the systems and technology required for its optimal management, cannot be achieved without the proper context and motivation to do so…

’The big question is: "should reform come from a centralised, command and control approach or as a decentralised, competitive, emergent approach?".’ This again is confusing means with ends…

Indeed it is “one” of the big questions required to be answered in selecting the most efficient and effective pathway (means) to achieve any health reform objectives (ends). The greater challenge is gaining agreement and defining the “what” and “why” of health reform (ends) before attempting any definitions of potential solutions (means) for how best to get there!

In this respect, ”health information and the related systems and technology associated with health information are the least of the worries and causes of our current health system problems!”.

Perverse incentives and dysfunctional behaviours by health system actors, stakeholders and decision makers, creating inefficiencies, massive waste and less than desirable outcomes within the health system operations are the true causes of our health system problems…

The establishment of Medicare Locals and their less than stellar track-record of performance are just another artefact of this overall dysfunctional political dynamic around the healthcare system! The PCEHR is another very relevant case in point…

Bernard Robertson-Dunn said...

Anonymous,
re: "confusing means with ends"

I do know the difference between an end (an objective) and a means (a way of achieving that objective. What I am suggesting is that they are intimately connected.

Are you suggesting practical ends can be specified without knowing if they may be achieved?

For example, is it practical to specify an objective that says every Australian should be able to see a health professional within a maximum of thirty minutes, in their own home?

IMHO, one reason why strategic planners often fail is because they do not pay enough attention to how the strategy may be implemented.

Anonymous said...

Bernard,

"Are you suggesting practical ends can be specified without knowing if they may be achieved?"

Unsure how you may be drawing this conclusion on what I'm suggesting based on what I've posted??

To answer your question regardless, absolutely not, as by definition, if that indeed were the case, they could not possibly be reasonably considered "practical ends"...

Agree with your last statement although conversely, focusing purely or predominantly on the means at the expense of clearly defined and thought out ends, often results in solutions looking for problems at best, or as you've pointed out earlier, a solution to the wrong problem entirely!

PCEHR ringing loud bells here...

Bernard Robertson-Dunn said...

Anon,

We seem to be going round in circles yet in agreement.

I think we are on the same wavelength, although maybe out of phase, so let's just leave it at - PCEHR bad.