The Coalition's plan to hack into an estimated 3000 employed in federal Labor's grassroots health scheme is shaping as a crunch issue at the election. At stake is the fate of the 61 Medicare Locals, established in every corner of Australia to crank up primary health care and reduce demand for hospital treatment.
The Coalition is pitching its promise as part of a program to slash what it says is bloated public spending on health bureaucracies. But it courts a potential backlash from communities, some in marginal electorates, already growing used to Medicare Locals.
Their focus is on community health including better connecting GP services with other allied health practitioners like psychologists, and with taking over supervision of after-hours medical services.
Shadow health spokesman Peter Dutton lifted the lid on the issue this week, telling Crikey
health blog Croakey
that Medicare Locals "may be well intentioned, but we can't afford Labor's dozen new bureaucracies with over 6000 people in the department and portfolio agencies and over an estimated 3000 people employed across Medicare Locals".
"We support a co-ordinated primary care approach, but we don't support the way Labor has implemented Medicare Locals. The Coalition will detail its plan for primary care in the run up to the next election," Dutton said.
also reported the comments of a NSW Local Health District board member who asked to remain anonymous and who said Medicare Locals were "vulnerable" to closure because they did not have a big impact on local services.
But axing Medicare Local staff would trigger "a huge impact", particularly in rural communities, according to Dr Arn Sprogis, chairman of the Australian Medicare Local Alliance. Many of the estimated 3000 employed by Medicare Locals around Australia have active roles in healthcare, such as psychologists, support staff and care coordinators.
Sprogis acknowledges Medicare Locals are vulnerable to Coalition abolition. "But they should not be," he said. Dutton needs to understand Medicare Locals could make a substantial improvement to productivity in the health sphere, says Sprogis, which had hitherto been subject to very little in the way of serious productivity measures.
As Australia's most ambitious attempt yet to establish an integrated primary health care system, Medicare Locals could not be seen as another layer of bureaucracy. Primary healthcare schemes had been shown by research in several countries to reduce dependence on expensive hospital treatment, particularly for chronic conditions like diabetes and mental illness.
"The opposition has not yet come to grips with this ... it is a major productivity gain," Sprogis said.
He says there are already several Medicare Locals seeking active links with public hospitals to explore ways of shifting care, where medically appropriate, from hospitals to services organised by the scheme. The highest priority of the Medicare Local Alliance is to gather evidence showing how better co-ordinated services in the community reduced demand for hospital beds.