Reforming Victoria's primary health and community service sector:rural implications

Abstract

In 1999 the Victorian primary care and community support system began a process of substantial reform, involving purchasing reforms and a contested selection process between providers in large catchment areas across the State. The Liberal Government's electoral defeat in September 1999 led to a review of these reforms. This paper questions the reforms from a rural perspective. They were based on a generic template that did not consider rural-urban differences in health needs or other differences including socio-economic status, and may have reinforced if not aggravated rural-urban differences in the quality of and access to primary health care in Victoria.

Stretching District Nursing Services to Meet Rural Needs

“…Although the project methodology focused on one particular rural area, its results corroborate the growing body of literature on barriers to health care in rural Australia, including those imposed by the three Ts 7–10 …”

Surviving neoliberalism, maintaining values: Community health mergers in Victoria, Australia

“…10,22 In the 1990s, such reforms caused Victoria's community health sector to undergo a wave of state government-imposed funding cuts and amalgamations. [23][24][25] Two decades later, amalgamations are again occurring among Victorian CHS; but this time, they are sector led rather than government imposed. Mergers are typically motivated by perceived economic, clinical, and political gains.…”

“…This is partly due to its philosophical clash with Australia's shift since the 1980s towards a neoliberal approach to policymaking across all areas of government, including health and welfare . In the 1990s, such reforms caused Victoria's community health sector to undergo a wave of state government‐imposed funding cuts and amalgamations . Two decades later, amalgamations are again occurring among Victorian CHS; but this time, they are sector led rather than government imposed.…”

Providing Integrated Mental Health Services: A Policy and Management Perspective

“…It has long been recognized that Australian funding and service delivery models for primary health and community care are fragmented and are often disconnected from acute and continuing care services, and that these, in turn, are often disconnected from one another. 4,5 In the area of mental health, private psychiatrists provide a significant contribution to the care of those with a wide range of illnesses, but they are unavailable to many because of their uneven distribution across the community or because consumers cannot afford their services and because they often do not or cannot work collaboratively with the public mental health sector, for a variety of reasons. Non-government organizations such as Psychiatric Disability and Rehabilitation services also provide significant services for those with a wide range of mental illnesses.…”