In response to a recommendation from the Review of Medicare Locals undertaken by Professor John Horvath AO in March 2014, the Minister for Health, the Hon Peter Dutton MP, announced this Review of after hours primary health care (the Review), to consider the most appropriate and effective delivery mechanisms to support ongoing after hours primary health care services nationally.
In his Review, Professor Horvath found significant stakeholder frustration associated with Medicare Local (ML) responsibility for funding after hours primary health care and considered it timely to reflect on the appropriateness and effectiveness of the current delivery strategy.
Contextually, the timing of this Review is pertinent, given the establishment of Primary Health Networks (PHNs) and the transfer of responsibilities from MLs from 1 July 2015.
A variety of methodologies have informed this Review, including a stakeholder written submission process, analysis of the submissions received for the Review of Medicare Locals, interviews with many key stakeholders and opinion leaders, six targeted in-depth case studies, analysis of Medicare Benefits Schedule (MBS) and Practice Incentives Programme (PIP) data and a desktop review of international models of after hours primary health care.
Across the country, availability and access to after hours services varies considerably. Both the Commonwealth and states/territories invest considerable resources to meet after hours demand. There is heterogeneity in arrangements, both across and within MLs, states and territories – particularly in rural areas. In addition, after hours service options are not well articulated nationally and consumers do not have visibility of an overall structure for appropriate after hours services.
The Commonwealth Government plays a significant role in directly funding and supporting after hours primary health care. In 2013-14, funding of approximately $769 million was provided through the MBS ($604.6 million), MLs ($122.11 million) and Healthdirect Australia’s After Hours GP Helpline ($42.17 million). The Commonwealth also part-funds Healthdirect Australia’s nurse triage helpline with all states and territories. This investment is on track to increase, with a 68 per cent increase in after hours MBS items over the six year period from 2008-09, particularly over the past 2 years. Whilst the MBS items themselves were not within the parameters of this Review, primary care after hours policy settings, delivery strategies, infrastructure and administrative arrangements which drive this expenditure, are.