Suzanne Robinson: Healthy change

AUSTRALIA’S new federal government has a lot to do to improve population health and maintain Australia’s place as a high performing health care system.

Existing primary care services are fragmented and focused largely around general practice, hospital services are costly and overutilised, and the system fails to seriously focus on disease prevention and health promotion activity. There are also gaps and inequities in access to services and variations in health outcomes between different population groups.

The system is often criticised for being provider-centric rather than patient-focused.

There have also been some whisperings around the fate of Medicare Locals under a Coalition government.

The establishment of Medicare Locals was a fundamental element of the previous federal government’s national health reforms.

The key principle underlying the Medicare Local reform is that local agencies are able to interact and network more easily with local communities and are thus better placed to interpret and understand the needs of these communities, while also having the potential to be more open and transparent in the delivery of public policy.

However, when in opposition the Coalition criticised them as wasteful bureaucracies.

With many Medicare Locals only just celebrating their first anniversary it is too early to have strong evidence on their success or failure. Reform and change takes time. A strong message from the literature is not to change for change’s sake — a trap that many governments across the world seem to fall into.

Medicare Locals have, so far, managed to undertake a population approach to needs assessment, providing detailed information on the health needs of the populations they serve. They have also started to map local need against the supply of health services, identifying gaps and inefficiencies in service provision.

A number are also using spatial information to inform planning — this approach can allow for focus on aspects around equity and the wider social determinants of health. This type of population planning and information generation can play an important role in the development of local health systems and over time this could allow for more integration and focus on aspects around efficiency, equity and quality.

Involvement of GPs is crucial to population planning, but it is not something that they have traditionally been able to undertake beyond their local practice area. Thus, Medicare Locals have a unique and key role in working with GPs and other health providers in shaping and coordinating primary care services.

This role is not easy, especially given the limited powerbase of Medicare Locals. Other countries grapple with similar issues and there have been a number of different technical solutions developed to help primary care population planners.

While such approaches can be helpful it seems it is the people and relationships that are a key ingredient to success. Medicare Locals will need leadership skills that can navigate the political complexities of working within and across organisations with differing incentives systems and cultures.

So what does the government need to consider if we are to tackle some of these issues? Policy needs to focus on system reform and value, recognising that patients’ needs are complex and the health system needs to reflect this with more integration between community and hospital services. If we are serious about equity then services need to be better directed around patient needs.

There is extensive evidence to demonstrate that strong primary care systems have been shown to improve health outcomes and cost effectiveness. When coordinated effectively they can also lead to more equitable service provision.

All political parties seem to agree that the country needs to use resources wisely and evidence would suggest that irrational structural change based on political need, rather than population, could prove very costly in both the long and short term.

It’s important to give Medicare Locals a chance and reflect on what has been achieved to date. Some change is probably needed, but more around the number of Medicare Locals and the support (both state and national) they are offered in their role, rather than developing new organisations — or worse, reverting to the old system.

A strong message to the new government would be that it is never a good idea to throw the baby out with the bath water.

Associate Professor Suzanne Robinson is director of Health Policy and Management, Faculty of Health Sciences at Curtin University.