Medicare Local. Photo: Fairfax
Dr Paul Mara, president of the Rural Doctors’ Association of Australia, wants rural doctors to look at how new funding arrangements wil affect after-hours services.
With existing rural after-hours medical services facing significant funding uncertainty from July 2013, rural doctors should urgently “pin down” their new Medicare Local on how after-hours services will be provided in their area from that time on.
From next July, after-hours funding – currently delivered through the federal Practice Incentives
Program system to practices providing after-hours services – will instead be diverted to Medicare Locals, which will have responsibility for determining how the
services are provided.
Unless the funding is then passed in full to the rural practices providing after-hours services, these practices could stand to lose tens of thousands of dollars in critical support payments.
In many cases, the loss of financial support could make providing the existing after-hours service unviable.
The Rural Doctors Association of Australia has urged the federal government to continue the current after-hours funding arrangement, rather than direct it through Medicare Locals.
Health reform was supposed to eliminate the potential for cost-shifting. This simply adds another layer of bureaucracy and more complexity. In the past there were two funding layers – and soon we’ll have three!
We are extremely concerned that, under Medicare Locals, existing after-hours services in small rural towns will simply be
centralised to large regional centres only.
We fear that numerous after-hours services provided for decades by dedicated rural doctors to their communities will cease to be funded or have financial support for their service significantly downgraded to the point where the service will need to close.
Should after-hours funding not be passed in full to local rural practices by Medicare Locals, it is
highly likely that these practices will not be able to afford to keep their after-hours service going and will simply pull out altogether from
providing it.
Despite the federal health department recently telling the Senate inquiry into the factors affecting the supply of health services and medical professionals in rural areas that general practices currently providing a good after-hours service will continue to be funded, we have had no firm assurances from any Medicare Local, and no guarantee from the department or federal government, that this will be the case – nor the release of any formal documentation or process to ensure this.
I mean, how long does it take? This issue has been on the agenda for a number of years now and it is still not sorted as we reach the eleventh hour.
The removal of after-hours funding from the Practice Incentives Program is a further erosion of this important program, and it has broader implications for quality healthcare than the survival of local after-hours care alone.
We are urging all rural doctors to contact their Medicare Local this week to ask:
* Whether their Medicare Local has undertaken any formal survey of after-hours activity in their area;
* Whether, and to what extent, their Medicare Local will be continuing to fund rural doctors already providing 24/7 after-hours services through either their practices or hospitals;
* When their Medicare Local is likely to enter into formal agreements with local rural practices to ensure the continuation of after-hours services from July 2013; and
* Whether their Medicare Local has received clear guidelines from the federal health department as to how they should determine the local allocation of after-hours funding from July, 2013.
We are then asking doctors to let us know what the response of their Medicare Local has been to each of these questions, so we can take further action at the national level to resolve the situation. We are also asking doctors to let us know if there continues to be no advice or communication from their Medicare Local on this issue, as this is just as concerning.
You can’t just turn off rural after-hours services and turn them on again overnight – rural practices need adequate time and certainty to plan the provision of these
services.
If Medicare Locals think they will be able to sign agreements at 5.30pm on June 30, 2013 with eternally grateful rural practices for vastly downgraded after-hours funding, they should think again.
The horse will have bolted.