Less transparency and high travel costs are former Portland District Health Service chief executive officer Chris Giles' top fears in response to the ever-increasing likelihood of public health services amalgamating as part of the state government's Health Plan.

Health leaders are providing the government with feedback on the optimal design and governance of its public health network and some have raised the idea of amalgamations, but no decisions have been made.

Each of Victoria's 76 health services has a CEO, board and administration and if there were amalgamations, efficiencies and savings could be made in these areas.

But Ms Giles said in her experience, that wasn't the case and the move could be disastrous for the Portland community.

"I know that it's to supposedly save money, but amalgamations never save money, all they do is shift the cost," Ms Giles said.

"The only way it can save money is to cut services. It won't bring more services to Portland either regardless of what you do, it just puts a layer of bureaucracy between the Portland community and the minister.

"If we amalgamate with Geelong, which is where I think we're probably going to go, then all that's going to happen is jobs will be lost and there'll be a bigger bureaucracy built in Geelong.

"The figures for Portland will get lost in Barwon South-West's figures and you won't know what's actually happening.

"It'll all be rolled up and very hard to see, so the local community will completely lose any ability to question what's going on."

But a state government spokesperson said since Grampians Health was created by amalgamating Ballarat, Horsham, Stawell, Dimboola and Edenhope in 2021, the initiative had resulted in more frontline staff and patients. They said the move was not about cost savings.

Significant improvements in care included:

"Victoria's world-class health system continues to be our government's largest investment and we have the track record to prove it - with record funding across our hospitals, health workforce, opening new and redeveloped facilities and introducing new services," the spokesperson said.

But Ms Giles said any claim a merger could ease staffing shortages was "untrue".

"You can't just move a staff member from Warrnambool's hospital, for example, and tell them they'll spend the day in Portland because they don't have enough staff - that'll never happen, but that's the premise for what they want to do," Ms Giles said.

"This is what's happening at Grampians Health. They can't get enough doctors to readily travel from Ballarat up to Horsham, it's a two-hour drive, so if they do go up there they're losing two hours of consulting time both ways.

"If they lose a key position or someone from Ballarat, who's going to take over their workload while they're gone? Unless you've got an oversupply of clinicians or doctors - and that's not the case at the moment - you can't get them to move easily.

"We've got nurse-patient ratios for nurses, we've got intern hours which are packed and junior doctors can only do so much.

"There's all this pressure to have safe working hours, and we're in an under-supply environment. They're not there to employ, and if they don't employ more, they're never going to move them from the more acute facility to the rural - it never happens."

She said the disadvantage would be that rural people would have to travel.

"This centralising model is pulling back services to the highest population levels and everyone else will have to travel," Ms Giles said.

"I came across this scenario really often - getting told 'you've chosen the rural lifestyle and enjoying the benefits, the price for that is that you have to travel for healthcare'.

"That's not the premise of the Australian healthcare system. They have what's called the Victorian Patient Transport Assistance Scheme and they'll say that's how they'll help people travel between health services.

"The rate is 21 cents per kilometre if a private car is used and the accommodation rate is something like $45 a night. Tell me where you can get that anywhere.

"The reason why rural areas are sicker - why we've got high rates of chronic disease, cancer, problems with young children - is because people have to travel.

"If you want to travel to Warrnambool or Geelong, you have to catch a 4am bus or drive and spend $100 in fuel alone - a lot of families can't do that.

"If you are travelling and you're a farmer or working in manufacturing, which is very common in Portland, who milks the cows when you're away?

"You can't go down and get services done in a day. You put your animal welfare ahead of your own welfare and you get sicker.

"Then when you do travel and go to the Royal Children's Hospital, Geelong or even Warrnambool, there's no accommodating a rural patient to have them seen and out the door quickly.

"You're just one of the many going through those clinics and you just take your turn."