SA HealthPlus, one of nine national Australian coordinated care trials, addressed chronic illness care by testing whether coordinated care would improve health outcomes at the cost of usual care. SA HealthPlus compared a generic model of coordinated care for 3,115 intervention patients with the usual care for 1,488 controls. Service coordinators and the behavioral and care-planning approach were new. The health status (SF-36) in six of eight projects improved, and those patients who had been hospitalized in the year immediately preceding the trial were the most likely to save on costs. A mid-trial review found that health benefits from coordinated care depended more on patients' self-management than the severity of their illness, a factor leading to the Flinders Model of SelfManagement Support.Keywords: Chronic disease, coordinated care, care plan, self-management, health outcomes.
In Australia, the coordination of care for patients with multiple service needs may be hampered by mixed funding sources and the lack of integrated systems of care. Each of the commonwealth, state, and territory governments funds public health services: the commonwealth government administers the taxpayer-funded Medicare program to provide universal access to public health services by reimbursing general practitioners (GPs) and specialists on a fee-forservice basis, and the state governments support public hospitals. A mixture of state and commonwealth programs fund community care, including allied health services, and individuals can purchase private health insurance, which provides private hospital care and a range of ancillary services (physiotherapy, psychology, podiatry, etc.).In 1997, Australia's governments began trials of coordinated care to develop and test models of service delivery for chronic conditions (Commonwealth Department of Human Services and Health 1995). The impetus for reform was escalating health care costs driven by an aging population and advances in technology, a shift in emphasis of health care delivery from the tertiary-to the primary-care sector (World Health Organization 2002), and demands by consumers for more patientcentered care.The principal national hypothesis that the trials were asked to test within a two-year time frame was the following: Coordinating the care of people with multiple service needs, who receive their care through individual care plans and funds pooled from existing commonwealth, state, and joint programs, will improve their health and well-being using existing resources. The main purpose of the trials was to "develop and test different service delivery and funding arrangements, and to determine the extent to which the coordinated care model contributes to• Improved client outcomes.