Are you ready for the Auditor - AMA WA

Medicare Locals
One issue that has dominated debate for some time within the
wider medical community is likely to make another appearance
very soon – and almost certainly near you!
Political watchers believe that as the next federal election
moves closer, so will mention grow louder of the disaster that
we know by the name Medicare Locals.
And it will be the Federal Government that will try and
get all the positive political coverage that can be generated by
mentioning the two words “Medicare” and “local.”
By themselves, both of these words normally elicit a nice,
cuddly feeling.
Combined into the one term ‘Medicare locals’ the feeling
is meant to be especially warm and heartening – and
vote-attracting.
But establishing Medicare Locals – or health care
organisations – may prove riskier than many spin masters
employed by the Government believe.
With the federal election due by early next year, the
Government will almost certainly use Medicare Locals as an
indication that its health reform agenda is working well.
At a cost of $477 million over four years plus base annual
funding of $171 million, Medicare Locals were aimed to
streamline primary healthcare and ease the pressure on the
Australian public hospital system.
As many would already know, the AMA (WA) is not
a natural friend of Medicare Locals. Many months ago,
we identified them as an incredible waste of that valuable
resource, cash, and not only were they bureaucratic but also
confusing.
Many of the Medicare Locals will look anything but local
and in fact will cover a huge area or a confusing mix of city
and rural areas.
To quote AMA (WA) President Associate Professor
David Mountain almost a year ago, Medicare Locals are a
“clear attempt to disenfranchise GPs and their key role in
co-ordinating care.”
Importantly, A/Prof Mountain argued that Medicare
Locals were not only going to build an expensive barrier
between medical practitioners and patients but are seen by the
Government as a vehicle to impose NHS-style fund holding.
Examining the websites of some of the Medicare Locals
in WA is an insightful experience. Many are expansive, even
attractive to look at. However the amount of information is
virtually nil. Early days, yes, but there is no sign that the sites
are being populated with relevant information. One of the
former Division which has now become a Medicare Local does
not generate much confidence; the last annual report available
on its website is dated 2009.
As has been pointed out before, Medicare Locals are
certainly not local and have no connection with medicine, so
the name itself will go down as one of the most misleading in
Australian public policy.
Let us not forget that Medicare Locals – incredibly – were
designed to be the main foundation of the Federal Labor
Government’s Health Reform program under former Prime
Minister Kevin Rudd and current PM Julia Gillard.
There is still the opportunity to make a substantial cut to
Federal spending by ending what is already a disaster and close
Medicare Locals down before they do too much damage.
Sometimes the vision is splendid, for the verbiage used to
describe Medicare Locals has been appealing, but a good
speech is too easily written and even sometimes well delivered.
The key is actually delivering something substantial and
ensuring that the rhetoric meets the reality.
The inspiringly delivered “I have a dream” moment, in
other words, has to be met by good delivery of an improved
health service on the ground for ordinary Australians. But
there is no evidence that Medicare Locals have resulted in a
better health service, or that the public health outcome has
been improved.
For all intents and purposes the result has been little more
than a disaster meeting a joke. But no one is laughing.
Future political science tomes will include Medicare
Locals in the same political history lesson as the wastage and
bumbling bureaucratic disasters of “pink batts” and “building
the education revolution.”
All badly handled, all a massive waste of money and all a
disaster for the long-suffering people of Australia.
48 MEDICUS May