There is little support for creating one national fundholder, with the exception of the arrangement that has been established for ophthalmology. There was limited support for devolving fundholding arrangements to a more local level (such as Medicare Locals), although mostly the concerns were about local control and planning of outreach services.
Amongst most stakeholders consulted, with some limited exceptions, there was strong support for a single fundholder in each jurisdiction. As discussed earlier in this report, different types of fundholder organisations have certain advantages in managing relevant relationships. In some jurisdictions some relationships are more important than in others.
A finding of this review is that the fundholder model is an appropriate approach for implementing the MSOAP program. However, there should be only one fundholder in each jurisdiction. In transitioning from multiple to a single fundholder, special attention needs to be paid to relationships between the previous fundholder and service providers. There is a case for allocating funding to the previous fundholder to undertake some of the coordination functions that were formerly undertaken in that organisation.
Arrangements for KPOP and PSOP should be incorporated into MSOAP and management devolved to the relevant jurisdictional fundholders.
Better linkages and coordination between fundholders should be encouraged through the following steps:
- On at least a biannual basis, there should be a joint face to face meeting by relevant DoHA staff and MSOAP fundholders through which program developments and issues can be communicated and discussed, feedback obtained and joint strategies developed.
- Opportunities for joint initiatives should be explored across fundholders, for example, information systems developments or development of planning and priority setting approaches. DoHA should consider allocating MSOAP funds to joint projects based on an assessment of their value to the program.
- Smaller jurisdictions (e.g. Northern Territory and Tasmania) should be encouraged to network with interstate fundholders to access a broader range of service providers.
Recommendations Fundholder arrangements20. One fundholder organisation should be supported in each jurisdiction. This will reduce costs and potentially improve coordination.
21. Management of the Kimberly Paediatric Outreach Program should be devolved to the Western Australia fundholder.
22. The New South Wales component of the Paediatric Surgery Outreach Program provided by New South Wales service providers should be devolved to the New South Wales fundholder, and the Victoria component should remain with the Victoria fundholder.
23. Management of the Baker IDI funding agreement should be reviewed at the end of the funding agreement, with a view to devolving management of the funding agreement to the Northern Territory fundholder.
24. Mechanisms are required to ensure coordination of the IRIS initiative with jurisdictional based fundholders (see recommendation 18 above).
25. Better linkages and cooperation between fundholders should be encouraged through holding a face to face meeting with relevant DoHA officers on a biannual basis, and joint initiatives in areas such as information systems developments.