TY - JOUR
T1 - Challenges facing primary health care in federated government systems
T2 - Implementation of Primary Health Networks in Australian states and territories
AU - Freeman, Toby
AU - Baum, Fran
AU - Javanparast, Sara
AU - Ziersch, Anna
AU - Mackean, Tamara
AU - Windle, Alice
PY - 2021/4
Y1 - 2021/4
N2 - In many federated countries, there is divided health system responsibility that can affect primary health care (PHC) policy and implementation, and complicate collaboration between PHC actors. We examined an Australian policy initiative, Primary Health Networks (PHNs), which are regional PHC organisations, to examine how they collaborated with state and territory PHC actors, and what factors enhanced or constrained collaboration. For PHNs we surveyed 66 staff, interviewed 82 staff, examined board membership, and analysed documents from all 31 PHNs. We also interviewed 11 state and 5 federal health bureaucrats. We mapped the PHC system in each state, and conducted team thematic analysis of the qualitative data collected. We found variation in how well PHNs collaborated with state and territory actors, ranging from poor relationships through to strong cooperation and co-commissioning. This was affected by factors to do with the state health department, geography, PHN funding and regulations, ambiguities in the federal/state divided responsibilities for PHC, and the extent of use of collaboration mechanisms and strategies. Resourcing and supporting such collaboration mechanisms, and increasing regional funding flexibility of funding would increase the potential for regional organisations to successfully navigate ambiguities in responsibility and foster a more integrated, cohesive PHC system.
AB - In many federated countries, there is divided health system responsibility that can affect primary health care (PHC) policy and implementation, and complicate collaboration between PHC actors. We examined an Australian policy initiative, Primary Health Networks (PHNs), which are regional PHC organisations, to examine how they collaborated with state and territory PHC actors, and what factors enhanced or constrained collaboration. For PHNs we surveyed 66 staff, interviewed 82 staff, examined board membership, and analysed documents from all 31 PHNs. We also interviewed 11 state and 5 federal health bureaucrats. We mapped the PHC system in each state, and conducted team thematic analysis of the qualitative data collected. We found variation in how well PHNs collaborated with state and territory actors, ranging from poor relationships through to strong cooperation and co-commissioning. This was affected by factors to do with the state health department, geography, PHN funding and regulations, ambiguities in the federal/state divided responsibilities for PHC, and the extent of use of collaboration mechanisms and strategies. Resourcing and supporting such collaboration mechanisms, and increasing regional funding flexibility of funding would increase the potential for regional organisations to successfully navigate ambiguities in responsibility and foster a more integrated, cohesive PHC system.
KW - Federal government
KW - Health care reform
KW - Health policy
KW - Integrated health care systems
KW - Primary health care
UR - http://www.scopus.com/inward/record.url?scp=85101306659&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1064194
U2 - 10.1016/j.healthpol.2021.02.002
DO - 10.1016/j.healthpol.2021.02.002
M3 - Article
AN - SCOPUS:85101306659
SN - 0168-8510
VL - 125
SP - 495
EP - 503
JO - Health Policy
JF - Health Policy
IS - 4
ER -