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NEW DECADE, NEW OPPORTUNITIES. AHCWA ANNUAL STATE SECTOR CONFERENCE 12-13 April 2011 Scarborough Presentation by Gavin Mooney. Medicare Locals and the National Funding Formula. Gavin Mooney Professor of Health Economics, Universities of Sydney, Cape Town and New South Wales. Background.
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NEW DECADE, NEW OPPORTUNITIES AHCWA ANNUAL STATE SECTOR CONFERENCE 12-13 April 2011 Scarborough Presentation by Gavin Mooney
Medicare Locals and the National Funding Formula Gavin Mooney Professor of Health Economics, Universities of Sydney, Cape Town and New South Wales
Background • Primary Health Care • Social determinants of health • Medicare Locals • Just bigger Divisions?
Ode to Medicare Locals: I Medicare locals are creating big divisions. We long for some unifying and healing decisions. Where are the social determinants of health? (They appear to be secret - to be processed by stealth?)
Ode to Medicare Locals: II GPs seemingly are to hold all the power (The others excluded must really be sour!) The community controlled sector? Missing from here. Oops … forgotten… (Why can’t black fellas just disappear?)
Ode to Medicare Locals: III We need radical thinking, leaders charismatic Revolutionary strategies, truly dramatic! Bold, inspiring, healthful, new visions. Else, what do we get? Just bigger Divisions.
Question regarding funding On what bases/criteria will the total money available for Medicare Locals be allocated to the different individual Medicare Locals?
What we know • $477 million over 4 years to establish Medicare Locals • Then total core funding of $171 million per annum • The distribution of funding between Medicare Locals will use a national funding formula based on rurality, socio-economic and Aboriginal and Torres Strait Islander status
GP Divisions Formula • Largely population based • But weighted for socio-economic, rural/remote/ metro and for Aboriginality • Former weighting for Aboriginality was 2.9
Medicare Locals: Funding Formula AGPN tell me that Access Economics has been given the task of devising the Medicare Locals formula
Nicola Roxon on National Funding Formula for Medicare Locals Australian General Practice Network National Forum Perth Convention and Exhibition Centre Western Australia 4 NOVEMBER 2010
From Minister Roxon’s Speech: I “Different parts of Australia have different populations, health needs and health services, and it will be important for the funding to individual Medicare Locals to take this into account.”
From Minister Roxon’s Speech: II “My Department is engaging professional economic 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.”
From Minister Roxon’s Speech: III “The consultants will consider whether and how factors such as population, socio-economic status, rurality and indigenous-status should be taken into account in distributing funding fairly.”
From Minister Roxon’s Speech: IV The crunch … “Once the consultants have completed their analysis, the Government will consult with the AGPN before finalising the funding formula.”
The History of Funding Formulae: I • Formulae in the past • Weightings • Weightings for what? • Need and vertical equity
The History of Funding Formulae: II • None of the formulae that have existed to date has taken any account of the issue of cultural security. • Cultural security costs money … • It also delivers health benefits!
Study on Cost of Cultural Security Only study* of its kind showed that the cost per patient encounter was up to 50% higher when it was a culturally secure encounter. *COSTING ABORIGINAL HEALTH SERVICES: ELEMENTS OF CULTURAL SECURITY, G Mooney, K Collard and T Taylor, SPHERe, Curtin University, Perth
Benefits of Cultural Security • DerbarlYerrigan • Opening of clinic at Midland • Previously 400 clients in Midland area came into clinic in East Perth • After a culturally secure clinic opened at Midland, clients increased to 2200!
What weight in National Funding Formula for MLs for Aboriginal people? Mooney and Henry’s study shows that ‘fairness’ in funding in Primary Health Care requires a weight on Aboriginality of about 5 to account for both greater need and cultural security.
Rurality and Remoteness BUT that figure of 5 will be higher once we take into account weighting for rurality and remoteness since a higher proportion of Aboriginal people than non Aboriginal people live in rural and remote Australia.
Yesterday’s Conversation Primary and Ambulatory Care Division, DOHA • The funding formula is still under wraps but is “an urgent priority” • It is being devised by “financial experts”. • The DOHA will “not be going out to consultation on the formula”. • But “the Minister might …”
Institutional Racism • Wrote before in the MJA on institutional racism in Australian health care • Spoke at an earlier AHCWA conference on institutional racism in Australian health care • Seen in my work for AHCWA on Medicare Locals that institutional racism is alive and well in the DOHA, in Minister Roxon and in AGPN.
Shocking I want to go on record to state how appalled I have been at the way in which the most disadvantaged section of the Australian population – that is Aboriginal people - and that section of the population who are most dependent on primary health care – again Aboriginal people – have been denied their rights to be heard in the biggest shake up in decades in Australian Primary Health Care.
My Proposal to AHCWA • This issue of funding matters. • Question DOHA and the Minister QUICKLY on what is happening on the formula and who is to be consulted on its contents • Try to get some work done on it quickly BEFORE the formula is finalised. • That is the best way to influence what will go in the formula. • Especially, work to get recognition of the need for funding to be allocated to cultural security.
