Medicare Locals: Guideline Number One

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice
Article Date: 23 Feb 2011 – 3:00 PST

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AMA President, Dr Andrew Pesce, said that Medicare Locals could enhance primary care and benefit patients if they are established according to the core guideline that GPs must remain the coordinators of patient care.

“Medicare Locals will only work to improve primary care if their main purpose is to support the central role of GPs in caring for patients,” Dr Pesce said.

“This means that GPs must be the coordinators of patient care, they must be strongly represented on the Medicare Local Boards, and there must be an absolute minimum of bureaucracy and red tape.

“Significant clinician engagement must be the key feature of Medicare Locals in the same way that it has been recognised as being crucial in public hospital reform.

“The Medicare Locals must support general practices and not divert services from GPs or engage in fundholding arrangements that would steer funding away from GPs and their patients.

“Primary care reform is needed but it has to be the right kind of reform.

“There must be no duplication of services that currently work well, gaps in local service provision must be identified, and those gaps must be remedied.

“The current system makes it difficult for GPs to easily access all the care they require for their patients, there are not proper links between general practice and hospitals, and there is not enough overall funding for general practice.

“These things need to be fixed, but we are yet to see how the Medicare Locals will fix them.”

Dr Pesce said that the Medicare Locals Guidelines document contains some positive themes but it leaves the door open for some arrangements that would be strongly opposed by the medical profession should they proceed.

“The AMA has some concerns that today’s document appears to have extended the reach of Medicare Locals without any consultation with the profession about increased roles and activities,” Dr Pesce said.

“The Government is pushing ahead with Medicare Locals with good intentions but it has yet to comprehensively rule out the introduction of role substitution, managed care, and fundholding, which have plagued primary care reform in other countries.

“The possibility of these arrangements being introduced has increased with the release of the Guidelines.

“Above all, the operation of Medicare Locals must not repeat the failures of the centralised ‘top down’ governance of the public hospital system, from which we are now extricating ourselves.”

Dr Pesce said the Government has previously committed to the central role of GPs in its publication – A National Health and Hospitals Network for Australia’s Future: Delivering Better Health and better Hospitals (the ‘red book’) on page 42, where it states:

Strong clinical engagement will be a key feature of Medicare locals. The role of Medicare Locals will be to support clinicians, not to get involved in clinical decision-making about individual patients.

“This commitment must be maintained throughout the establishment and operation of Medicare Locals,” Dr Pesce said.


Australian Medical Association

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