A few years ago, together with two Aboriginal colleagues, I wrote about institutional racism in the Australian health care system.
In the last few months, reading some of the documentation around on the new Medicare Locals (or Primary Health Care Organisations — PHCOs) from the Department of Health and Aging, the Minister and the Australian General Practice Network (AGPN), it is evident that today such institutional racism is alive and well.
Indeed it is being built into the future of these PHCOs. In the current discussions on primary health care for the future in this country, the Aboriginal community controlled sector and its voice are being ignored.
The concern of that sector at not being invited to be engaged adequately in deliberations about the PHCOs is reflected in a recent media release here in the west from the Aboriginal Health Council of WA. That states, for example: “We are alarmed that there has been so little effort made by the minister and the Divisions of General Practice to involve our sector.”
I do not think this is sour grapes on their part. I share that view. The views of the Aboriginal community controlled sector are not being sought and not being heard by the Minister, by the department or by the AGPN.
The reason? The new PHCOs are being seen as just bigger if fewer GP Divisions, with a few bells and whistles (which have been forced to be?) added on. This is reflected in the fact that all 15 of the new PHCOs are to be GP Divisions-based and according to the recent discussion paper from the department on Medicare Locals the rest will be “largely” Divisions-based.
In her speech to the APGN Forum in Perth 10 days ago this Divisions-focus was confirmed by the Minister.
As one example (but there are many) in that speech, she stated that her department was engaging consultants “to develop a funding formula that will enable funding for Medicare Locals to be fairly distributed, taking into account the needs of different parts of Australia”.
According to the Minister the only body that the government will consult “before finalising the funding formula” is … the AGPN! No others seemingly and certainly no mention of consulting the Aboriginal community controlled sector on this funding formula.
But then, as the funding formula, according to the Minister, is to take into account only differences geographically (“the needs of different parts of Australia”) and there is no mention of the differing cultural needs of Australians, such as the special cultural needs of Aboriginal Australians, then maybe she feels no need to run the funding formula past the community controlled sector.
The discussion document is similarly neglectful of the community controlled sector.
Yes, it lists that sector as one of several with appropriate “skill-sets” that “complement those offered by the Divisions of General Practice Network”. But where is the recognition beyond “skill-sets” of the need to embrace the cultural base of the community controlled sector? Where is the acknowledgment that AMSs already often have the breadth of primary care that Divisions currently lack and which PHCOs are being asked to embrace?
It is noteworthy that the AGPN has set out some good principles, including on equity and on Aboriginal health, in its ‘blueprint document’ on PHCOs.
It is most unfortunate, however, that when AGPN comes to the operational end of things, as in its paper on a framework for PHCOs, both equity and Aboriginal issues are sadly neglected. When push comes to shove, the principles in the AGPN blueprint document thus turn out to be empty rhetoric.
There is still time for Minister Roxon and for AGPN to think again.
There remains a wonderful opportunity to build an exciting, fair and inclusive primary care sector in Australia. This needs to start with the idea of caring for patients and their health, sharing the vision with all relevant parties, including the Aboriginal community controlled sector, and embracing more firmly both equity and the social determinants of health.
Indeed I’d like to switch the letters round and have PHCOs become COPHs — Caring Organisations for People’s Health, even if not in name at least in principle and practice.
I suspect that is what Australian citizens want. It is just a pity they are not being asked.
Gavin Mooney is a health economist with an honorary appointment at the University of Sydney
Gavin
I completely concur with your views on the direction of Medicare Locals in relation to indigenous health care. More broadly the complete absence of community health, including mental health and alcohol and drug services, from the so called “historic health reforms” further enshrines the bio-medical dominance of health care in this country and strengthens the position of the professions to dictate health policy.
The Government’s commitment to come back to COAG and sort out mental health and alcohol and drug servcies (and nothing else in community health) a year after the major decisions, is indicative of the simplistic view of our health and community care systems from Canberra.
Far from placing our health care system on a sustainable base, these chanegs will widen the gap in taxation income and health care costs forecast in the Treasury’s Intergenerational Report.
The growth in out-of-pocket costs to all Australains and inequities in access to and quality of care already apparent will accrelerate under these reforms. More and more Australians will be unable to access timely and affordable care meaning more with only ‘surface’ in the system when they have an acute need.
And this from a social democratic party?
John Mendoza, Shelly Beach
You could be.Now I say this only because I have watched it happen with my Mother who has less qualifications than you. She took the approves Spanish course at the Hospital She worked at & still had a hard time getting a promotion or a different job at the Hospital, because She didn’t speak Spanish!!!!!
Bodyquick
Gavin, you know as well as I do that this is par for the course with successive governments. The ability of Governments both State and federal or GP networks to engage with ACCHO’s before development of plans has been sadly lacking in the past, indeed it would appear to be getting progressively worse. The point you make in relation to GP networks re PHCO’s and the lack of discussion would make one think they had been informed by the Government that they will get the nod so why bother
Gavin. The paper written above is one of the best I read in relation to the medicare locals. The reluctance of the Federal Government to engage with the ACCHO’s was made clear last Wednesday when Minister Roxon spent all of 20 minutes talking to the NACCHO AGM members and leaving without taking one question. Compare this with the speech and day spent in Perth with the AGPN. It would appear the Government are clearly hoping to take ACCHO’s into the mainstream and handing over responsibility for Aboriginal Health to those trusty predominately WASP GP’s of course they know better than the Aboriginal people on the ground providing holistic services that many providers of health services could only dream about.