Medicare Locals: A model for integration in primary health care

Abstract

Objective: Australian Medicare Locals (MLs) have been established to improve the patient’s journey through the health care system by facilitating integrated services that meet the local community’s needs. How MLs are expected to achieve better integration is not clearly defined. This absence of a clear definition is reflected in the literature, where a multitude of definitions exist. The main objective of this study was to explore MLs’ understanding of integrated care, how they planned to integrate services across primary health and acute care sectors, and identify the challenges faced by MLs as agents for integration. Methods: Five CEOs from the first round of 19 established MLs agreed to participate in semi-structured telephone interviews. Participants represented MLs from different States and Territories, ranging from metropolitan to rural and remote areas. Interview transcripts were analysed using a thematic approach. Lessons learned: ML CEOs identified several key themes in their interviews, including: variation in understanding of integration; tension between competition and collaboration in service delivery; patient-centred care as a key principle; barriers and enablers to integration; impact of historical factors; and need for ongoing resources to sustain integration efforts. Implications: This project enabled participants to contribute their knowledge and experience to an analysis of a key building block of the Australian health reform agenda. The variation across MLs regarding their understanding of integration, challenges and ways to operationalise integration may assist other primary health care organisations and policy makers to develop effective implementation strategies for integrated care.