Evaluations of the Medicare

 

Internationally strengthening primary health care services is a priority for health reform. A decade ago the Australian Government embarked on a major reform agenda of the primary health care sector “International evidence suggests that a strong primary health care orientation within the health service system exerts a positive effect on both population health outcomes and overall health system costs” (AIHW 2014)
Using the example of Medicare Locals, critically assess the role of evaluation in wide-scale health system reform. In doing so, consider how the perspectives of different groups of stakeholders were taken into account.

 

Introduction:

The essay presents the evaluation in the wide-scale health system reform. It is the fundamental requirement for the health reforms to strengthen the primary healthcare services. The Australian government has taken the initiatives of reforming the primary healthcare services in the last decade. It has been revealed and believed to be the fact that a strong primary healthcare service system not only impacts the health outcomes of the population but also the overall cost of the healthcare system. The evaluation of the Medicare Locals has been conducted in this write up. In the process the perspectives of different groups of stakeholders have also been considered. The outcomes from the evaluation of the Medicare Local have been discussed. The influence and the impacts of the evaluations in shaping the future health system reforms on Primary Health Networks or PHNs have also been discussed in the essay. The primary healthcare services are much vital for the healthcare outcomes of the entire population. Medicare Local provides a new framework and structure to the primary healthcare services. The new organizations with this new structure could become more efficient in delivering the primary healthcare and could make the same equally relevant for the aging population. 

Discussion:

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1.    Outline the Medicare Local initiative:

Medicare Locals are the most important and useful discovery of the primary healthcare and they form integral part of the entire healthcare reforms. They are the elements of current health agenda of the Federal Government. Medicare Locals are basically the regional organizational which is inclined towards the planning and coordinating several improvements in the primary healthcare segment which is dedicated towards the effective healthcare outcomes of the population (Australian Health Care Reform Alliance, 2012). The main objectives of the Medicare Locals include support to the primary healthcare services and the providers of the same in the front line, providing support to the general medical practitioners and private allied health providers and to bring in improvements in the services of healthcare. They are committed towards the coordination of the care services. The main intention of the Medicare Locals is to make the healthcare services convenient for the patients and to help in negotiation of the networks of the services. The investments towards the Medicare Locals will be made with the aim of tackling some specific problems like primary mental healthcare and post-operative primary medical care. The Medicare Locals have also built up the links between the hospitals and other services based on the communities like that of the Aboriginal Health care and local councils. They will also work hand-in-hand with the self-help groups and some of the social care organizations with an intention to improve the community health. It has been expected that Medicare Locals would be able to replace the divisions of the Divisions of General Practice and would extend their emphasis from normal general healthcare practices to private owned and allied healthcare organizations which are non-governmental. There was a time when the private allied healthcare organizations were not given that priority and importance (Horvath, 2014). The Medicare Locals intend to improve the service delivery of these private sector organizations so that the scope of healthcare could be extended. In some of the states the Medicare Locals would be taking over some of the community health services. In case of community requirements the Medicare Locals would be providing support to the patients by linking their GPs with the private allied healthcare organizations and would draw the attention of some more dieticians so that they become willing in working in some of the communities where the primary healthcare services have been found to be weaker.  

The success of the Medicare Locals would depend on the commitments serving the local communities and the patients with varied needs and their main intention would be the improvements in the overall healthcare services being provided to the local communities and to aging population. It is highly expected that the outcomes would be better. The Medicare Locals are also committed towards bridging the gap between the GPs and the private allied healthcare organizations so that the patients could get the medical help and support whenever they need. Another important lookout of the Medicare Locals is to initiate the educational programs in the communities engaging the social care service providers and the healthcare service providers so that they could also assist the GPs in times of emergency. The social support program could be improved. The Medicare Locals would also be able to identify the difference between the social and health issues so that they might assist the local councils and youth organizations and even churches and educational institutions to come up with some of the recreational initiatives for the children and could provide the young children with education (The Conversation, 2011). 

2.  Learning from the evaluations of the Medicare Local:

The Australian primary healthcare system has been facing some of the challenges in the last few decades and the major issue has been related to the restructuring the system which ended in huge tensions. The challenges have been there because of the efficiency and effectiveness. There have been some challenges in respect to the equality and basic concepts which have been used for the evaluation of the performance of the health systems. The optimum use of the resources could lead to higher efficiency and effectiveness in the primary healthcare sector.  There have been some challenges in respect to the healthcare outcomes of the population and in meeting their needs. There have been issues in relation to equity and fairness in the delivery of the primary healthcare services. There have been several planning for improving the situation and to ensure satisfied primary healthcare services to the community. The Primary Health Care policy makers and their networks faced several issues and challenges when they have been inclined towards bringing in some of the robust improvements in the health of the population (Robinson et al., 2014). The senior staffs of the Medicare Locals have helped the policy makers with the needful information and data in relation to the areas where the improvements are much needed. From the analysis of the findings of the discussion and research the major areas of improvements have been identified (Javanparast et al., 2017). 

The Medicare Locals have been able to ensure community engagement. There is opportunity for the flexible funding. The relationships with the stakeholders have been made cordial and strong. The links with the GPs, healthcare providers and customers could be established. There is positive collaboration. The relationship with the GPs has been made robust. The capacity of e-health has been enhanced. The governance structure has been made robust. There is less government intervention. There are some of the barriers which have also identified from the evaluation of the Medicare Locals. The barriers include the shortage of workforce and existing issues in distribution. Other barriers include funding fees for the payments of the system, system of funding needed to collaborate with NGOs, insufficient overall funding, need for onerous reporting and differences in expectations from different groups of professionals. The challenges include the competing interests, making the internal stakeholders understand the aims of the Medicare Locals, insufficient alignment between the network boundaries of local hospitals and Medicare Locals, limited timeframes for delivering the goals, eliminations of Divisional SBOs, some unrealistic expectations of the stakeholders, inadequate clarity in defining the role of the Medicare Locals and true engagement of the customers with some key resources (Australian Health Care Reform Alliance, 2012). 

3.    takeholder perspectives captured in the evaluations:

The stakeholders are the key people in an organisation that are the main pillars for any business organisation in any sector. In the Australian primary healthcare sector also, the role of the stakeholders in various projects and initiatives such as the Medicare Locals (MLs) is pivotal in ensuring that the organisation can carry out their social responsibilities and service to communities effectively. The stakeholders mainly consist of the investors, management personnel, employees, customers and other partners that have vested interest in such healthcare projects. In case of Medicare Locals, the primary stakeholder is the Australian Health Care Reform Alliance (AHCRA) which is a coalition that is formed by more than 30 top-class health groups endeavouring to offer advanced and improved health care service delivery to the people of Australia. The other stakeholders comprise of the National Health and HospitalsReform Commission, Department of Health and Ageing (DoHA), the medical professionals, staffs, paramedics, patients, their families and the entire community. All these stakeholders’ needs are to be met to the extent practicable. Regarding the several healthcare bodies and authorities it can be said that they are dedicated to improve the overall access to primary healthcare in Australia by undertaking ethical and benevolent approaches to offer the healthcare services through the 62 MLs operating in different parts of the country.

Regarding the role played by the MLs in satisfying the demands of the various stakeholders, it can be said that the program of launching the MLs for improving the overall level of healthcare in the country has been effective as today many more people have access to improved and modern infrastructure of healthcare in the country. Previously, they did not have such easy access to high quality of healthcare when the healthcare service deliveries used to be extremely expensive for the normal and the lower level income group in the community (James Murphy, 2015).For the socially underprivileged sections such as the aborigines, the state of healthcare was far from being satisfactory. But the launching of the MLs in 2015 was a revelation to the improvement of the primary healthcare services in Australia that made modern and state-of-the-art healthcare facilities available to people from all sections of the society. However, there are some drawbacks to the implemented campaign by the government due to which the MLs have not been able to achieve the expected level of success that it deserved to have (Elnour et al., 2015). This is because there are gaps in the form of lack of coordination and control from the management, lack of understanding and communication gap between the various entities in the healthcare system, lack of observation of equitable practices in healthcare delivery and some other factors that have acted as barriers to the success that should have been achieved by the healthcare department of the country through the launching of its MLs. There are some stakeholders that are focused on their own gains and profitability and therefore they have created certain loopholes into the system due to which there are issues such as discrimination of people belonging to some distinct social groups such as the aborigines. Even today, many of the aborigines are looked down upon and are not treated with respect of offered empathetic and patient-focused healthcare service delivery in many of the healthcare centres in the country (Dogget, 2012).

4.    Influence of the evaluations in shaping future health system-reforms on Primary Health Networks (PHNs):

The evaluations have highlighted various areas of strengths as well as weaknesses that are required to be addressed in order to improve the role of the Medicare Locals further and for making sure that there is equitable primary healthcare services that can be accessed by people from all the sections of the society whether they belong to the affluent group or the socially underprivileged group. The evaluation of the activities undertaken by the MLs has necessitated the following recommendations that need to be undertaken for ensuring that there is an improved primary healthcare infrastructure within the country whose benefits can be reaped by people belonging to different strata of the society:

•    There needs to be development of a much clearer and comprehensive vision by the Federal Government to ensure better healthcare delivery and support to the public and keep on investing behind the furtherance of the MLs such that they can provide healthcare services through effective coordination and control among the professionals that look beyond their self-interests in offering evidence based and patient-focused service delivery. These policies will strengthen the foundation of the MLs such that they can contribute effectively and meaningfully towards fostering future change in the primary healthcare service delivery to the people from all communities within the country (Health Direct, 2018).
•    There should be funding from the government towards the Medicare Local for the next 10 years to provide the financial support for growth and development.
•    Instilling the desire to offer equitable healthcare services to all the communities should be a major performance indicator for the success of the MLs. There should be much improvement in this area as gaps still continue to exist in this domain.
•    The Australian Medicare Local Alliance should offer holistic training and development to the staffs working in the MLs in various domains, specifically in the area of population health planning such that they can inculcate knowledge on the current status of primary healthcare within the country and its various pros and cons.
•    There should be effective collection and dissemination of data related to local communities and this should be done through liaising between the Medicare Local and stalwarts in the domain of population health data such as the AIHW.
•    The MLs should be active and prudent in looking for opportunities to utilise the population health data for collaborating with different healthcare authorities in the domain of issues related to population health (Sara Javanparast et al., 2017).
•    There should be an effective engagement framework between the Australian National Preventive HealthAgency and the Medicare Local.
•    In the set of the Key Performance Indicators there should be consideration of the prevention activities.
•    In the list of the Key Performance Indicators of the healthcare professionals, the need and motivation to engage with the local communities and carers should be considered as positive criteria of success as healthcare professionals working under the MLs.
•    There should be effective coordination and integration of the activities at the local and regional levels that should be facilitated by agreement between the government and the Medicare Local.
•    The Australian Medicare Local Alliance should participate in active engagement with the bodies like NHPA and IHPA for ensuring that the arrangements for funding new hospitals and healthcare centres do not affect the objectives of the MLs (Dogget, 2012).

Conclusion:

In conclusion it can be said that the services of the Medicare Local in the domain of primary healthcare in Australia has been pivotal in the achievement of overall improvement of the healthcare infrastructure in Australia. The initiative has made it possible for people belonging to different communities gain access to modern high level of healthcare that has offered them a much better and sustainable life. However, there are still plenty of opportunities for improving the services of the MLs so that they can eradicate instances of inequity in the services towards all the communities, management problems and various other issues that need to be sorted out with immediate effect such that the vision of providing Australia with a comprehensive and effective Primary Healthcare Network succeeds in the long run.

References:

Australian Health Care Reform Alliance (2012) 'Medicare Locals: the first six and next twelve months', Medicare Locals: the first six and next twelve months Report, June, pp. 1-28.
Dogget, J. (2012) 'Medicare Locals: the first six and next twelve months', Australian Health Care Reform Alliance Report, no. http://www.healthreform.org.au/wp-content/uploads/2012/06/Medicare_Locals_Project-FINAL_13_June.pdf, pp. 1-26.
Elnour, A.A., Dunbar, J., Ford, D. and Dawda, P. (2015) 'General practices’ perspectives on Medicare Locals’ performance are critical lessons for the success of Primary Health Networks', Australas Med J.; 8(10), no. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4643609/, pp. 320-324.
Health Direct (2018) Primary health networks (PHNs), [Online], Available: https://www.healthdirect.gov.au/primary-health-networks-phns.
Horvath, J. (2014) 'Review of Medicare Locals', Report to the Minister for Health and Minister for Sport, March, pp. 1-22.
James Murphy (2015) 'New Primary Health Networks to deliver better local care', THE HON SUSSAN LEY MP; Minister for Health & Minister for Sport, no. http://www.health.gov.au/internet/ministers/publishing.nsf/Content/B35C8B8CFF4A5C22CA257E25007BCEEE/$File/SL036.pdf.
Javanparast, S., Baum, F., Freeman, T., Labonte, R., Ziersch, A.M., Kidd, M.R. and Mackean, T. (2017) 'Lessons from Medicare Locals for Primary Health Networks', Med J Aust , vol. 2017, no. 2, July, pp. 54-55.
Robinson, S., Varhol, R., Ramamurthy, V., Denehy, M., Hendrie, D., O'Leary, P. and Selvey, L. (2014) 'The Australian primary healthcare experiment: a national survey of Medicare Locals ', BMJ Open, vol. 5, no. 3, pp. 1-8.
Sara Javanparast, F.B.T.F.R.L., Ziersch, A.M., Kidd, M.R. and Mackean, T. (2017) 'Lessons from Medicare Locals for Primary Health Networks', Med J Aust; 207 (2), no. https://www.mja.com.au/journal/2017/207/2/lessons-medicare-locals-primary-health-networks, pp. 54-55.
The Conversation (2011) Everything you need to know about your Medicare Local (but didn’t know who to ask), 7 November, [Online], Available: https://theconversation.com/everything-you-need-to-know-about-your-medicare-local-but-didnt-know-who-to-ask-851.

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