Journal articles on the topic 'Health care reform Australia'
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1
Glasgow, Nicholas, and Lucio Naccarella. "Guest Editorial: Getting Evidence into Policy - Stimulating Debate and Building the Evidence Base." Australian Journal of Primary Health 13, no. 2 (2007): 7. http://dx.doi.org/10.1071/py07016.
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In this special edition of the Journal, we have brought together papers with the aim of contributing to primary health care reform in Australia. The papers will stimulate further debate and increase the evidence base through which policies can be informed. Does primary health care in Australia need reform? Are there fundamental problems with the health system demanding a reform response? The challenges confronting Australia's health care system over the next decade are real and well documented (Productivity Commission, 2005; Australian Medical Workforce Advisory Committee [AMWAC], 2005). They include the ageing population and longer life expectancies, the increasing prevalence of chronic illness and co-morbidity, heightened consumer expectations, advances in health technologies and shortages in the health workforce.
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P Marchildon, Gregory. "Canadian health system reforms: lessons for Australia?" Australian Health Review 29, no. 1 (2005): 105. http://dx.doi.org/10.1071/ah050105.
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This paper analyses recent health reform agenda in Canada. From 1988 until 1997, the first phase of reforms focused on service integration through regionalisation and a rebalancing of services from illness care to prevention and wellness. The second phase, which has been layered onto the ongoing first phase, is concerned with fiscal sustainability from a provincial perspective, and the fundamental nature of the system from a national perspective. Despite numerous commissions and studies, some questions remain concerning the future direction of the public system. The Canadian reform experience is compared with recent Australian health reform initiatives in terms of service integration through regionalisation, primary care reform, Aboriginal health, the public?private debate, intergovernmental relations and the role of the federal government.
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Wilton, Paula, and Richard D. Smith. "Budget-holding: The answer to Australian primary care reform?" Australian Health Review 22, no. 3 (1999): 78. http://dx.doi.org/10.1071/ah990078.
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In common with other Organisation for Economic Cooperation and Development (OECD)countries, Australia is experiencing growth in expenditure on health care. However, while many other nations continue to pursue some variation of managed competition to address these problems, Australia has chosen a more incremental reform path, with initiatives such as the General Practice Strategy, restrictions in doctor supply and coordinated care trials. This article reviews the likely effectiveness of such initiatives in the light of experience and evidence of budget-holding in achieving similar objectives overseas. It concludes that budget-holding offers a more effective strategy than current 'piecemeal' reforms to contain costs and increase efficiency within Australian health care.
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McBride, Tony, and Viola Korczak. "Community consultation and engagement in health care reform." Australian Health Review 31, no. 5 (2007): 13. http://dx.doi.org/10.1071/ah070s13.
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In advocating for significant reform of the health care system, the Australian Health Care Reform Alliance (AHCRA) supports a process of citizen engagement that will allow the wider community to have a say in the future direction of their health care system. Models that have engaged community opinions have been successful overseas, and this article calls for similar processes in Australia.
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Yarmo-Roberts, Deborah. "Editorial." Australian Health Review 33, no. 4 (2009): 558. http://dx.doi.org/10.1071/ah090558.
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The AHR Models of Care section aims to provide a diverse number of articles that canvas many areas of health care. In this issue, we look at transition care and mutidisciplinary case conferencing in aged care services, and a psychosocial model of care in breast cancer services. The first article by Giles et al is entitled ?The distribution of health services for older people in Australia: where does transition care fit??. The second article is ?Perceptions of multidisciplinary case conferencing in residential aged care facilities? by Halcomb et al. A case study write up of a quality assurance project is also presented ? ?The Breast Service Psychosocial Model of Care Project? by Williams and Mann. As this year draws to a close, there are multiple health care reforms occurring in Australia and abroad. One of the more dominant reforms occurring is the United States health care reform considering universal coverage of its population (among other relevant reforms). The last issue of AHR included in its Models of Care section an article highlighting some of the possible ways forward for health insurance coverage of its population. Before this time and since then, there has been ample debate and discussion around draft bills of legislation and the possible frameworks and principles that any eventual reform policy would incorporate. Likewise, in Australia, there is much occurring in health reform. The Rudd government commissioned a National Health and Hospitals Reform Commission in 2008 who provided their final report A healthier future for all Australians in June 2009.1 It has outlined 123 recommendations for long-term health care reform in Australia. The report is being dissected and discussed among the government, industry and to a lesser extent the public at large. The Rudd government?s decision to wait at least 6 months to digest the report and call for particular actions is both deliberate and strategic. Other federal government reports which have received considerable attention are Australia: the healthiest country by 2020 ? National Preventative Health Strategy,2 and a discussion paper around a future National Primary Health Care Strategy.3 The former was completed in June 2009 and released to the public in September 2009 and the discussion paper entitled Towards a National Primary Health Care Strategy was released in 2008. As of the time this Editorial is being written, a final draft National Primary Health Care Strategy has yet to be released to the public. I urge all readers of AHR to look at these documents to get a taste for the priority of reforms being discussed in the federal government. There are similarities and differences among the issues canvassed in both the US and Australian government health reform bills, policy discussion papers and reports. As in the topics of articles offered in AHR issues, areas of discussion include financing and governance, quality and safety, inequalities, health information, public versus private health, health service utilisation, workforce and many other areas concerning health care. As a key difference, Australia is not debating the universal coverage component. This is already valued among the majority of citizens in this country and has no intention of being changed. Yet, the financial structures and governance of health care in Australia are being hotly debated. A similarity among reforms in both countries is that they are largely battling with broader (and deeper) issues of ?values? and ?ideology?. It is important to distinguish this from the particulars of any report or bill of legislation and acknowledge that both countries are at important crossroads. Watch this space.
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Freeman, Toby, Fran Baum, Ronald Labonté, Sara Javanparast, and Angela Lawless. "Primary health care reform, dilemmatic space and risk of burnout among health workers." Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 22, no. 3 (February 17, 2017): 277–97. http://dx.doi.org/10.1177/1363459317693404.
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Health system changes may increase primary health care workers’ dilemmatic space, created when reforms contravene professional values. Dilemmatic space may be a risk factor for burnout. This study partnered with six Australian primary health care services (in South Australia: four state government–managed services including one Aboriginal health team and one non-government organisation and in Northern Territory: one Aboriginal community–controlled service) during a period of change and examined workers’ dilemmatic space and incidence of burnout. Dilemmatic space and burnout were assessed in a survey of 130 staff across the six services (58% response rate). Additionally, 63 interviews were conducted with practitioners, managers, regional executives and health department staff. Dilemmatic space occurred across all services and was associated with higher rates of self-reported burnout. Three conditions associated with dilemmatic space were (1) conditions inherent in comprehensive primary health care, (2) stemming from service provision for Aboriginal and Torres Strait Islander peoples and (3) changes wrought by reorientation to selective primary health care in South Australia. Responses to dilemmatic space included ignoring directives or doing work ‘under the radar’, undertaking alternative work congruent with primary health care values outside of hours, or leaving the organisation. The findings show that comprehensive primary health care was contested and political. Future health reform processes would benefit from considering alignment of changes with staff values to reduce negative effects of the reform and safeguard worker wellbeing.
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Robinson, Suzanne, Richard Varhol, Colin Bell, Frances Quirk, and Learne Durrington. "HealthPathways: creating a pathway for health systems reform." Australian Health Review 39, no. 1 (2015): 9. http://dx.doi.org/10.1071/ah14155.
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Inefficiencies in the co-ordination and integration of primary and secondary care services in Australia, have led to increases in waiting times, unnecessary presentations to emergency departments and issues around poor discharge of patients. HealthPathways is a program developed in Canterbury, New Zealand, that builds relationships between General Practitioners and Specialists and uses information technology so that efficiency is maximised and the right patient is given the right care at the right time. Healthpathways is being implemented by a number of Medicare Locals across Australia however, little is known about the impact HealthPathways may have in Australia. This article provides a short description of HealthPathways and considers what it may offer in the Australian context and some of the barriers and facilitators to implementation. What is known about the topic? Early evidence on HealthPathways suggests that the program does seem to be strengthening relationships between GPs and secondary care specialists. In New Zealand advances in efficiency and system integration have been noted. However, there is limited evidence on the effectiveness of HealthPathways in Australia. What does this paper add? It is one of the first published papers to provide a perspective around HealthPathways and draws existing evidence and research to explore some of the barriers and facilitators to the development and implementation of HealthPathways in Australia. What are the implications for practitioners’? Early evidence suggests HealthPathways could help GPs and other practitioners’ in the delivery of health services, it could also help to strengthen practitioner relationships.
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Roydhouse, Jessica K. "Becoming Australian? Two different approaches to health care reform in the United States." Australian Health Review 33, no. 2 (2009): 303. http://dx.doi.org/10.1071/ah090303.
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THE ?SUBSTANTIAL PRIVATE SECTOR?1 ROLE in Australian health care has sometimes given rise to fears of ?Americanisation? of the Australian health care system, particularly in the media. For example, in 2000 Kenneth Davidson wrote, ?The USstyle health financing route being taken by the Howard Government is mad and bad.?2 The US system is the ?leading example? of ?inferior system performance?3 and is often viewed as a system to be feared and avoided. Despite spending far more per capita than any other country on health care, the United States nonetheless fails to provide equitable health care for everyone. The system is ?a paradox of excess and deprivation?,4 spending far more than other systems without providing adequate care and treatment for all. Although the US system is seen as frightening in Australia, broad historical and political similarities such as the ?strong?5 role and ?long history?5 of private insurance and powerful, vocal physicians? groups1,5 make the Australian experience a useful comparative one for US policymakers. As Altman and Jackson note, the US system will probably not develop into a fully public system, but a system combining private and public aspects along the lines of the Australian model is possible.5 Furthermore, while politicians in the US at the state and local levels have attempted to address the issue of universal or near-universal coverage for some time, previous efforts sought to expand coverage using existing programs instead of establishing a new system.6 More recently, the state of Massachusetts and the county (municipality) of San Francisco have introduced near-universal health care programs. Although introduced nearly simultaneously, their development processes and structures differ. In addition, the Massachusetts plan in particular was viewed as a potential model for future sub-national and possibly national health reforms. Thus, this short paper examines the two plans as two different approaches to health care reform in the US and compares them to the Australian system, asking the question whether or not current reform efforts in the US make the system more like that in Australia, or are likely to do so in the future.
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Naccarella, Lucio, Donna Southern, John Furler, Anthony Scott, Lauren Prosser, Doris Young, Hal Swerissen, and Elizabeth Waters. "Reforming Primary Care in Australia: A Narrative Review of the Evidence from Five Comparator Countries." Australian Journal of Primary Health 13, no. 2 (2007): 38. http://dx.doi.org/10.1071/py07022.
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The need for reform of primary care is driven by health system inequity, inefficiency, sub-optimal quality of care and outcomes. In Australia, there has been no systematic analysis of the relevance and applicability of international reforms of differing models of primary care delivery and the implications for addressing these issues in the local context. We used a narrative review and synthesis approach to analyse evidence from four English-speaking comparator countries (New Zealand, Canada, United Kingdom, United States of America) and one European country (Netherlands). In this review the term "primary care" refers to the system of health care workers (predominantly general practice, nursing and allied health professionals) who provide locally-based first contact care in the community setting. The existing international evidence does not support the adoption of any specific model of primary care delivery that is suitable to the Australian context. However, the evidence does suggest four key mechanisms that should form the basis of future reform. This includes the funding of GP services, quality and performance frameworks, stronger regional structures to support primary care, and investment in practice infrastructure. This paper provides an overview of the review methods and findings. A full report and in-depth discussion of findings are available from http://www.anu.edu.au/aphcri/Domain/PHCModels/index.php
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Hall, Jane. "Health-care reform in Australia: advancing or side-stepping?" Health Economics 19, no. 11 (October 11, 2010): 1259–63. http://dx.doi.org/10.1002/hec.1652.
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McCann, Warren. "Redeveloping Primary Health and Community Support Services in Victoria." Australian Journal of Primary Health 6, no. 4 (2000): 36. http://dx.doi.org/10.1071/py00032.
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Why Primary Care Reforms?: It gives me very great pleasure to have been asked to speak at this major international Conference about redeveloping primary health and community support services in Victoria. While opening the Conference, the Victorian Minister for Health, the Honourable John Thwaites, launched the Primary Care Partnership Strategy which is one of the most ambitious and far reaching primary health and community support reform agendas in Australia.
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Hartz, Donna L., Jan White, Kathleen A. Lainchbury, Helen Gunn, Helen Jarman, Alec W. Welsh, Daniel Challis, and Sally K. Tracy. "Australian maternity reform through clinical redesign." Australian Health Review 36, no. 2 (2012): 169. http://dx.doi.org/10.1071/ah11012.
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The current Australian national maternity reform agenda focuses on improving access to maternity care for women and their families while preserving safety and quality. The caseload midwifery model of care offers the level of access to continuity of care proposed in the reforms however the introduction of these models in Australia continues to meet with strong resistance. In many places access to caseload midwifery care is offered as a token, usually restricted to well women, within limited metropolitan and regional facilities and where available, places for women are very small as a proportion of the total service provided. This case study outlines a major clinical redesign of midwifery care at a metropolitan tertiary referral maternity hospital in Sydney. Caseload midwifery care was introduced under randomised trial conditions to provide midwifery care to 1500 women of all risk resulting in half of the publicly insured women receiving midwifery group practice care. The paper describes the organisational quality and safety tools that were utilised to facilitate the process while discussing the factors that facilitated the process and the barriers that were encountered within the workforce, operational and political context. What is known about the topic? Caseload midwifery models of care have been established in a variety of community based and hospital settings throughout Australia with a reported reduction in clinical intervention rates while maintainning safety of mothers and babies. What does this paper add? This case study illustrates the strategies used to achieve a large sustainable clinical service redesign project based on the introduction of the caseload midwifery model of care. What are the implications for practitioners? Establishing midwifery group practice care within the mainstream maternity services has far reaching implications for the retention and recruitment of midwives and the improvement of clinical outcomes in childbirth.
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Rosenstreich, Gabi, Jude Comfort, and Paul Martin. "Primary health care and equity: the case of lesbian, gay, bisexual, trans and intersex Australians." Australian Journal of Primary Health 17, no. 4 (2011): 302. http://dx.doi.org/10.1071/py11036.
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The current period of health reform in Australia offers an opportunity for positive actions to be taken to address the significant challenges that lesbian, gay, bisexual, trans, intersex and other sexuality, sex and gender diverse (LGBTI) people face in the health system. This paper provides analysis of why this group should be considered a priority health group using a social determinants of health framework, which has, to date, largely been ignored within primary health care policy reform in Australia. Several key areas of the primary health care reform package are considered in relation to LGBTI health and well-being. Practical suggestions are provided as to how the primary health care sector could contribute to reducing the health inequities affecting LGBTI people. It is argued that care needs to be taken to ensure the reform process does not further marginalise this group.
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Rosenberg, Sebastian, and Carol Harvey. "Mental Health in Australia and the Challenge of Community Mental Health Reform." Consortium Psychiatricum 2, no. 1 (March 20, 2021): 40–46. http://dx.doi.org/10.17816/cp44.
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Australia was one of the first countries to develop and implement a national mental health plan, 30 years ago. This national approach belied the countrys federal structure, in which the federal government takes responsibility for primary care while state and territory governments manage acute and hospital mental health care. This arrangement has led to significant variations across jurisdictions. It has also left secondary care, often provided in the community, outside of this governance arrangement. This article explores this dilemma and its implications for community mental health, and suggests key steps towards more effective reform of this vital element of mental health care.
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Davison, Julia. "The Australian Health Care Agreements - a teaching hospital perspective." Australian Health Review 25, no. 6 (2002): 13. http://dx.doi.org/10.1071/ah020013.
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The Australian Health Care Agreements (AHCAs) are important for patients, health care professionals and hospital CEOs alike. The current agreements have not been fully effective in promoting necessary reforms, and this paper suggests priority areas for attention in the next round. Five areas for targeted reform are suggested. These are pharmaceuticals, workforce planning, continuum of care across settings, education and research, and safety and quality. It is time to give some radical thought to the role and scope of the AHCAs. Healthcare policy reform needs to be across the continuum of care.
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Dwyer, Judith, and Sandra G. Leggat. "Care coordination and health sector reform." Australian Health Review 28, no. 3 (2004): 253. http://dx.doi.org/10.1071/ah040253.
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THE PRODUCTIVITY COMMISSION (Productivity Commission 2004) has nominated nationally coordinated health sector reform as one of two top priorities (along with natural resource management) for extending the industry reform agenda under the aegis of National Competition Policy. This is in recognition of the importance of these areas for the wellbeing of Australians, and the level of resources they will require in future years. The Commission states that ?an independent review of Australia?s health system as a whole is a critical first step in achieving cooperative solutions to deep-seated structural problems? (p. XI). The fragmentation in health system governance that results from the national? state split is mirrored in the lack of coordinated care at many levels throughout the system. The Commission?s proposal has been welcomed by many in the health industry, no doubt with some nervousness, because of the broad and deep conviction that something has to change in the apparently intractable problem of split funding responsibilities. ?Today?s health-care delivery systems are not organized in ways that promote best quality. Service delivery is largely uncoordinated, requiring steps and patient ?hand-offs? that slow down care and decrease rather than improve patient safety? (OECD 2004). Improving care coordination is high on the list of issues to be addressed in any reform of the health sector. This issue of the journal features a collection of papers which address the sometimes jagged ?seams? in the current system. They offer insights into some of the consequences of the structural problems the Productivity Commission would like to see addressed, and document an energetic search for methods of enhancing the effectiveness of health care.
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Wise, Sarah, Jane Hall, Philip Haywood, Nikita Khana, Lutfun Hossain, and Kees van Gool. "Paying for value: options for value-based payment reform in Australia." Australian Health Review 46, no. 2 (November 16, 2021): 129–33. http://dx.doi.org/10.1071/ah21115.
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Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of ‘low-value’ interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement; all have occurred within existing payment structures. In this paper we describe options for value-based payment reform and highlight two challenges critical for success: attributing financial risk fairly and organisational structures. What is known about the topic? ‘Fee for service’ is the dominant payment method in Australia and creates incentives to increase service volume, rewarding inputs rather than improvements in longer-term health outcomes. There is increasing recognition that payment reform is needed to support the shift to value-based health care in Australia. What does this paper add? This paper describes the three main options for value-based payment reform: episode-based bundled payments chronic condition bundled payments and comprehensive capitation payments. Each involves some degree of funds pooling, and the shifting of risk from the funder to provider to stimulate the more efficient use of resources. What are the implications for practitioners? We conclude that local hospital authorities in the states, private health insurers and primary health networks could implement reform as payment holders, but that capacity development in coordination and risk adjustment will be required. Successful implementation of payment reform will also require investment in data collection and information technology to track patients’ care and measure outcomes and costs.
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Jowsey, Tanisha, Laurann Yen, Robert Wells, and Stephen Leeder. "National Health and Hospital Reform Commission final report and patient-centred suggestions for reform." Australian Journal of Primary Health 17, no. 2 (2011): 162. http://dx.doi.org/10.1071/py10033.
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The final report of the National Health and Hospital Reform Commission (NHHRC) called for a strengthened consumer voice and empowerment. This has salience for the development of health policy concerning chronic illnesses. This paper compares the recommendations for chronic illness care made in the NHHRC final report with suggestions made by people with chronic illness and family carers of people with chronic illness in a recent Australian study. Sixty-six participants were interviewed in a qualitative research project of the Serious and Continuing Illness Policy and Practice Study (SCIPPS). Participants were people with type II diabetes mellitus, chronic obstructive pulmonary disease or chronic heart failure. Family carers were also interviewed. Content analysis was undertaken and participants’ recommendations for improving care were compared with those proposed in the NHHRC final report. Many suggestions from the participants of the SCIPPS qualitative research project appeared in the NHHRC final report, including the need to improve care coordination, health literacy and the experience of Indigenous Australians. The research project also identified important issues of family carers, immigrants and people with multiple illnesses, which were not addressed in the NHHRC final report. More specific attention is needed in health reform to improve the experience of family carers, Indigenous peoples, immigrants to Australia and people with multiple illnesses. To align more closely with their needs, health reform must be explicitly informed by the voices of people with chronic illness and their family carers. The NHHRC recommendations must be supplemented with proposals that address the needs of these people for support and the problems associated with poor care coordination.
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Naccarella, Lucio, Jim Buchan, and Peter Brooks. "Evidence-informed primary health care workforce policy: are we asking the right questions?" Australian Journal of Primary Health 16, no. 1 (2010): 25. http://dx.doi.org/10.1071/py09060.
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Australia is facing a primary health care workforce shortage. To inform primary health care (PHC) workforce policy reforms, reflection is required on ways to strengthen the evidence base and its uptake into policy making. In 2008 the Australian Primary Health Care Research Institute funded the Australian Health Workforce Institute to host Professor James Buchan, Queen Margaret University, UK, an expert in health services policy research and health workforce planning. Professor Buchan’s visit enabled over forty Australian PHC workforce mid-career and senior researchers and policy stakeholders to be involved in roundtable policy dialogue on issues influencing PHC workforce policy making. Six key thematic questions emerged. (1) What makes PHC workforce planning different? (2) Why does the PHC workforce need to be viewed in a global context? (3) What is the capacity of PHC workforce research? (4) What policy levers exist for PHC workforce planning? (5) What principles can guide PHC workforce planning? (6) What incentives exist to optimise the use of evidence in policy making? The emerging themes need to be discussed within the context of current PHC workforce policy reforms, which are focussed on increasing workforce supply (via education/training programs), changing the skill mix and extending the roles of health workers to meet patient needs. With the Australian government seeking to reform and strengthen the PHC workforce, key questions remain about ways to strengthen the PHC workforce evidence base and its uptake into PHC workforce policy making.
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Patterson, Elizabeth, Heidi Muenchberger, and Elizabeth Kendall. "The role of practice nurses in coordinated care of people with chronic and complex conditions." Australian Health Review 31, no. 2 (2007): 231. http://dx.doi.org/10.1071/ah070231.
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General practice in Australia must cope with growing numbers of individuals with chronic and complex needs. The Australian Government has recognised the need to reform the primary health care sector to address this issue, with recent initiatives, such as coordinated care. The overall goal of coordinated care at a national level is to facilitate integrated care for people with chronic and complex conditions, by enhancing collaborative partnerships among general practitioners, primary health care providers, community service providers and clients. Interestingly, practice nurses (PNs) have not been identified as key stakeholders in the coordinated care service delivery model in Australia. In contrast, an expanded role for PNs has been in place in the United Kingdom and New Zealand for some time. This paper is based on focus group discussions with Australian PNs who have had a range of experiences in coordinated care models. The study identifies an important role for PNs, suggesting trial of a variety of models of coordinated care that include PNs in chronic disease management process.
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Ainsworth, Frank. "Foster care research in the US and Australia: An update." Children Australia 22, no. 2 (1997): 9–16. http://dx.doi.org/10.1017/s1035077200008130.
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This article reviews recent reform, research and trends in foster care (family foster care, kinship care and group care) in the US. In presenting this data attention is drawn to the lack of comparable Australian materials. Practitioners are also cautioned against embracing US initiatives too eagerly as the time lag in the transfer of information means that these developments may have been modified by research findings by the time they come to notice in Australia.
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Thoms, Debra. "The Health Care Reform Agenda in Australia: Opportunities for Nurse Leaders?" Nurse Leader 14, no. 6 (December 2016): 419–21. http://dx.doi.org/10.1016/j.mnl.2016.08.006.
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Blackwell, Scott, Kim Gibson, Shane Combs, Rowan Davidson, Carolyn Drummond, Helen Olsson, and Barbara O'Neill. "Great debate: how clinicians make their views heard in health reform." Australian Health Review 33, no. 1 (2009): 5. http://dx.doi.org/10.1071/ah090005.
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PUBLIC HEALTH SYSTEMS in Australia and internationally are faced with the need to implement significant reforms. These reforms are driven by the need to balance the delivery of best practice clinical care with rapidly spiralling cost pressures. With much of the agenda for reform driven by managerial, administrative and even political priorities, clinicians have often felt sidelined from the reform process. Indeed, there is some evidence that clinicians have had decreased enthusiasm for their work in recent years, coinciding with a greater role of nonmedical managers and more restrictions on resources.1 There is a wealth of experience and intelligence within the clinical workforce that can contribute to finding solutions to the many complex issues facing the health system.2 This experience and intelligence is expressed in advice on the clinician?s specific areas of expertise and often within their own environment. This may work against the clinician having an effective impact on the reform agenda at the macro level. In that context, the establishment of a Clinical Senate in Western Australia to inform the health reform process by debating major issues that impact across the system is innovative. The Clinical Senate requires that Senators adopt a broad view, set aside their particular clinical allegiances and debate the issues in the best interests of the community. The Clinical Senate is a forum that allows clinicians to influence statewide-level processes through formally recognised channels. This article examines the rationale, processes and operation of the Clinical Senate in WA as a mechanism for effective clinician input into health reform.
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McMillan, Margaret. "Health Care Reforms in Aged Care in Australia." Nursing & Health Sciences 2, no. 2 (June 2000): A7. http://dx.doi.org/10.1046/j.1442-2018.2000.41.15.x.
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Lavoie, Josée G., and Judith Dwyer. "Implementing Indigenous community control in health care: lessons from Canada." Australian Health Review 40, no. 4 (2016): 453. http://dx.doi.org/10.1071/ah14101.
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Objective Over past decades, Australian and Canadian Indigenous primary healthcare policies have focused on supporting community controlled Indigenous health organisations. After more than 20 years of sustained effort, over 89% of eligible communities in Canada are currently engaged in the planning, management and provision of community controlled health services. In Australia, policy commitment to community control has also been in place for more than 25 years, but implementation has been complicated by unrealistic timelines, underdeveloped change management processes, inflexible funding agreements and distrust. This paper discusses the lessons from the Canadian experience to inform the continuing efforts to achieve the implementation of community control in Australia. Methods We reviewed Canadian policy and evaluation grey literature documents, and assessed lessons and recommendations for relevance to the Australian context. Results Our analysis yielded three broad lessons. First, implementing community control takes time. It took Canada 20 years to achieve 89% implementation. To succeed, Australia will need to make a firm long term commitment to this objective. Second, implementing community control is complex. Communities require adequate resources to support change management. And third, accountability frameworks must be tailored to the Indigenous primary health care context to be meaningful. Conclusions We conclude that although the Canadian experience is based on a different context, the processes and tools created to implement community control in Canada can help inform the Australian context. What is known about the topic? Although Australia has promoted Indigenous control over primary healthcare (PHC) services, implementation remains incomplete. Enduring barriers to the transfer of PHC services to community control have not been addressed in the largely sporadic attention to this challenge to date, despite significant recent efforts in some jurisdictions. What does this paper add? The Canadian experience indicates that transferring PHC from government to community ownership requires sustained commitment, adequate resourcing of the change process and the development of a meaningful accountability framework tailored to the sector. What are the implications for practitioners? Policy makers in Australia will need to attend to reform in contractual arrangements (towards pooled or bundled funding), adopt a long-term vision for transfer and find ways to harmonise the roles of federal and state governments. The arrangements achieved in some communities in the Australian Coordinated Care Trials (and still in place) provide a model.
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Baum, Fran, Helen van Eyk, and Catherine Hurley. "Re-orientation of Health Services towards Health Promotion: An Australian Case Study of Aborted Health Service Reform." Australian Journal of Primary Health 12, no. 2 (2006): 24. http://dx.doi.org/10.1071/py06019.
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This paper examines a case study of local health care reform in Australia that had as one of its aims the desire to increase the health promotion and partnership work of the region. The case study highlights the pressures contemporary health systems are facing and the challenge of re-orientating health services towards health promotion in this environment. Qualitative research, including interviews, focus groups, a staff survey and policy analysis were used to identify health system professionals? perceptions of the impact of health care reform. The case study portrays a complex system that is subject to frequent change but little reform. Our case study indicates that features of health systems that encourage collaborative partnerships are those where there is: an environment that encourages trust; a common purpose among the key players; a supportive external environment; practical projects to work on; organisational stability; commitment from staff throughout organisations; willingness to commit resources; evidence that change is likely to improve outcomes for users; and an organisational environment in which learning from past experience is encouraged. A number of constraints and tensions that work against introducing a greater emphasis on health promotion and collaboration within the system studied are discussed, including tensions between central funding bureaucracies and health care agencies and the reform fatigue and increasing cynicism among staff resulting from continuous change. The paper concludes that against the chaotic background of contemporary health service reform it is very difficult to bring about genuine reform to achieve a shift to more emphasis on health promotion and partnerships.
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Austin, Marie‐Paule V., Philippa F. Middleton, and Nicole J. Highet. "Australian mental health reform for perinatal care." Medical Journal of Australia 195, no. 3 (August 2011): 112–13. http://dx.doi.org/10.5694/j.1326-5377.2011.tb03236.x.
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Swerissen, Hal. "Hints for Reforming Primary and Community Care in Australia." Australian Journal of Primary Health 14, no. 3 (2008): 68. http://dx.doi.org/10.1071/py08038.
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Considerable interest in reform for primary health care and health more generally has emerged recently. There are concerns that primary and community services are fragmented, inequitable and inefficient, particularly for people with chronic and complex conditions. The evidence suggests there will be a significant increase in demand for these services and that stronger primary health care systems lead to better health outcomes. This paper makes a number of suggestions about the development of funding, payment, governance and organisational arrangements that could be part of a National Primary Health Care Strategy for Australia.
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Clark, Alice, Andrew Gilbert, Deepa Rao, and Lorraine Kerr. "‘Excuse me, do any of you ladies speak English?’ Perspectives of refugee women living in South Australia: barriers to accessing primary health care and achieving the Quality Use of Medicines." Australian Journal of Primary Health 20, no. 1 (2014): 92. http://dx.doi.org/10.1071/py11118.
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Reforms to the Australian health system aim to ensure that services are accessible, clinically and culturally appropriate, timely and affordable. During the reform consultation process there were urgent calls from stakeholders to specifically consider the health needs of the thousands of refugees who settle here each year, but little is known about what is needed from the refugee perspective. Access to health services is a basic requirement of achieving the quality use of medicines, as outlined in Australia’s National Medicines Policy. This study aimed to identify the barriers to accessing primary health care services and explore medicine-related issues as experienced by refugee women in South Australia. Thirty-six women participated in focus groups with accredited and community interpreters and participants were from Sudan, Burundi, Congo, Burma, Afghanistan and Bhutan who spoke English (as a second language), Chin, Matu, Dari and Nepali. The main barrier to accessing primary health care and understanding GPs and pharmacists was not being able to speak or comprehend English. Interpreter services were used inconsistently or not at all. To implement the health reforms and achieve the quality use of medicines, refugees, support organisations, GPs, pharmacists and their staff require education, training and support.
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Young, Janette, and Richard McGrath. "Exploring discourses of equity, social justice and social determinants in Australian health care policy and planning documents." Australian Journal of Primary Health 17, no. 4 (2011): 369. http://dx.doi.org/10.1071/py11038.
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The Australian National Health Reform agenda includes aims to reduce health disadvantages and provide equitable access. However, this reform will be implemented through state and territory governments, and as such will be built on existing conceptualisations of health as a social justice concept (core to understandings of social determinants). A selection of state and territory health policy documents were analysed within a critical discourse framework focussing on their use of terms relating to social determinants. Analysis revealed that the understandings of social justice concepts vary across Australia and are generally apolitical, belying core concerns inherent in a social determinants understanding. Such differentiation bears recognition by reformers seeking to implement national consistency. This paper also considers how health professionals might become aware of their own cultural enmeshment in neo-liberal frameworks of understanding, recognising a social determinants framework as counter-cultural and hence requiring radical thinking.
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Swerissen, Hal. "Editorial: CoAG and Primary Health Reform." Australian Journal of Primary Health 12, no. 1 (2006): 6. http://dx.doi.org/10.1071/py06001.
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Chronic disease prevention and management, integration and community care continue to be key themes for primary health and community care as the papers in this issue of the Journal attest. Three quarters of Australians have an ongoing chronic illness (Australian Bureau of Statistics, 2006). The Council of Australian Governments has recently emphasised the importance of health promotion and disease prevention (Council of Australian Governments, 2006), but to date proposals for action have been disappointing. There is now a plethora of research on these issues and innovative policy and practice to deal with them. There is little doubt that primary health and community care programs are important for the effective delivery of chronic disease prevention. Yet, it remains difficult to get concrete progress towards a national policy framework for primary health and community care. Instead we have incremental, piecemeal attempts at reform. Why is this so?
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Gordon, Julie, Helena Britt, Graeme C. Miller, Joan Henderson, Anthony Scott, and Christopher Harrison. "General Practice Statistics in Australia: Pushing a Round Peg into a Square Hole." International Journal of Environmental Research and Public Health 19, no. 4 (February 9, 2022): 1912. http://dx.doi.org/10.3390/ijerph19041912.
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In Australia, general practice forms a core part of the health system, with general practitioners (GPs) having a gatekeeper role for patients to receive care from other health services. GPs manage the care of patients across their lifespan and have roles in preventive health care, chronic condition management, multimorbidity and population health. Most people in Australia see a GP once in any given year. Draft reforms have been released by the Australian Government that may change the model of general practice currently implemented in Australia. In order to quantify the impact and effectiveness of any implemented reforms in the future, reliable and valid data about general practice clinical activity over time, will be needed. In this context, this commentary outlines the historical and current approaches used to obtain general practice statistics in Australia and highlights the benefits and limitations of these approaches. The role of data generated from GP electronic health record extractions is discussed. A methodology to generate high quality statistics from Australian general practice in the future is presented.
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Newman, Stuart, and Jocalyn Lawler. "Managing health care under New Public Management." Journal of Sociology 45, no. 4 (November 24, 2009): 419–32. http://dx.doi.org/10.1177/1440783309346477.
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The drive to reform the public health care system became a common feature of Australia’s political and economic landscape from the early 1980s. Health care reform in Australia has been underpinned by New Public Management (NPM) which was promoted as providing more transparent policy and empowering managers to manage service delivery. However, these claims are a fallacy and nursing and nursing care have been affected adversely and severely. General (generic) management structures have replaced established nursing management structures and the distance between politics (politicians) and health service managers has narrowed to the extent that there is now an unprecedented level of political interference in the daily management of health services, in direct contrast to the tenets of NPM. This article reports on the ‘reformed’ health care environment as experienced by nurse managers. They reported that their ability to manage nursing services and provide professional and clinical leadership has been seriously diminished, as has their work satisfaction, motivation and commitment. They also report uncertainty about their future as well as the future of nursing itself.
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Lloyd, Chris, and Pam Samra. "Healthy Lifestyles: A Community Programme for Chronically Mentally Ill People." British Journal of Occupational Therapy 59, no. 1 (January 1996): 27–32. http://dx.doi.org/10.1177/030802269605900110.
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This article outlines a Healthy Lifestyles Programme (HLP) for chronically mentally ill people in the South Coast Regional Health Authority in Australia, in the area of integrated mental health services. This programme has provided practical community-based experiences for chronically mentally ill people, focusing on functional deficits in daily living skills. Major reforms in service delivery in mental health have resulted in a move to community-based care. The 1994 Queensland Mental Health Plan set out specific objectives and strategies for the implementation of mental health service reform. One of the immediate priorities for Queensland is the establishing of mainstream integrated services to promote continuity of care across service components. The HLP reflects this priority in providing a community-based service in an integrated mental health setting, using the principles of community-based integration, family support, collaboration, rehabilitation and case management, as outlined in the community care model.
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Rao, Hamna. "Reforms Needed in Aged Patient’s Care." International Journal of Frontier Sciences 2, no. 1 (January 1, 2018): 56–64. http://dx.doi.org/10.37978/tijfs.v2i1.34.
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Today’s health workforce is constantly engaged to enhance the standards of healthcare services and ensuring comprehensive healthcare standards to the community. Queensland’s health workforce is Australia’s second largest health workforce (1) and serving proportionately in all areas of QLD, making efforts to make health better by making research, surveys and developmental planning in rural and regional areas. Aged Care is currently the most concerned health issue among OECD countries (2) as aged population continues to grow and it’s challenging for Australian health sector to meet the standards of quality care in provision of aged care health services. As per Australian Institute of Health and Welfare statistics it is projected that Australia will constitute 22% of aged population in next 30 years (AIHW).
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Booth, Barbara J., Nicholas Zwar, and Mark Harris. "A complexity perspective on health care improvement and reform in general practice and primary health care." Australian Journal of Primary Health 16, no. 1 (2010): 29. http://dx.doi.org/10.1071/py10003.
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Health care improvement is always on the planning agenda but can prove frustrating when ‘the system’ seems to have a life of its own and responds in unpredictable ways to reform initiatives. Looking back over 20 years of general practice and primary health care in Australia, there has been plenty of planning and plenty of change, but not always a direct cause and effect relationship between the two. This article explores in detail an alternative view to the current orthodoxy of design, control and predictability in organisational change. The language of complexity is increasingly fashionable in talking about the dynamics of organisational behaviour and health care improvement, but its popular use often ignores challenging implications. However, when interpreted through human sociology and psychology, a complexity perspective offers a better match with everyday human experience of change. As such, it offers some suggestions for leaders, policy makers and managers in health care: that uncertainty and paradox are inherent in organisational change; that health care reform must pay attention to the constraints and politics of the everyday; and that change in health systems results from the complex processes of relating among those involved and that neither ‘the system’ nor a few individuals can be accountable for overall performance and outcomes.
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Keleher, Helen, Rhian Parker, and Karen Francis. "Preparing nurses for primary health care futures: how well do Australian nursing courses perform?" Australian Journal of Primary Health 16, no. 3 (2010): 211. http://dx.doi.org/10.1071/py09064.
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Health reform is increasingly targeted towards strengthening and expansion of primary health systems as care is shifted from hospitals to communities. The renewed emphasis on prevention and health promotion is intended to curb the tide of chronic disease and sustain effective chronic disease management, as well as address health inequities and increase affordable access to services. Given the scope of nurses’ practice, the success of Australia’s health system reforms are dependent on a nursing workforce that is appropriately educated and prepared for practice in community settings. This article reports on the results of an Australian national audit of all undergraduate nursing curricula to examine the extent of professional socialisation and educational preparation of nurses for primary health care. The results of the audit are compared with Australian nursing standards associated with competency in primary health care. The findings indicate that Australian nursing competencies are general in their approach to skills and knowledge, not specifying any particular competencies for primary health care, while undergraduate student preparation for practice in primary health and community settings is patchy and not keeping pace with reform agendas that promote expanded roles for nurses in primary health care, prevention and health promotion. The implication for nursing curriculum reform is that attention to achieving nursing graduate capacity for primary health care and health promotion is a priority.
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PAOLUCCI, FRANCESCO, PRZEMYSLAW M. SOWA, MANUEL GARCÍA-GOÑI, and HENRY ERGAS. "Mandatory aged care insurance: a case for Australia." Ageing and Society 35, no. 2 (November 13, 2013): 231–45. http://dx.doi.org/10.1017/s0144686x13000767.
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ABSTRACTThis paper assesses the feasibility and welfare-improving potential of an insurance market for aged care expenses in Australia. As in many other countries, demographic dynamics coupled with an upward trend in costs of personal care result in consumer co-contributions imposing a risk of expenses that could constitute a significant proportion of lifetime savings, in spite of the presence of a government-run aged care scheme. We explore issues around the development of an insurance market in this particular setting, considering adverse selection, moral hazard, timing of purchase, transaction costs and correlation of risks, as well as such contextual factors as longevity and aged care cost determinants. The analysis indicates aged care insurance is both feasible and welfare-enhancing, thus providing a gainful alternative to the aged care reform proposed by the Productivity Commission in 2011. However, while the insurance market would benefit the ageing Australian population, it is unlikely to emerge spontaneously because of the problem of myopic individual perceptions of long-term goals. Consequently, we recommend regulatory action to trigger the market development.
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Braithwaite, Jeffrey, and Johanna Westbrook. "America's Health Care Reforms." Health Information Management 24, no. 1 (March 1994): 32–33. http://dx.doi.org/10.1177/183335839402400114.
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President Bill Clinton is currently proposing the most sweeping changes to American social policy since the New Deal by Roosevelt in the 1930s. Major concerns about escalating health care costs, a mushrooming health care bureaucracy and a growing proportion of the American population who can no longer afford adequate health care insurance coverage have motivated Clinton's plan for health care reform. Ideas about telemedicine, the electronic medical record and more comprehensive and advanced information systems are already being canvassed during the course of the debate. Australian clinicians and policy makers are following the American debate closely. So too, should health information managers. America watching should prove interesting, stimulating and professionally rewarding.
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Hickie, Ian, and Grace Groom. "Primary Care-Led Mental Health Service Reform: An Outline of the Better Outcomes in Mental Health Care Initiative." Australasian Psychiatry 10, no. 4 (August 2002): 376–82. http://dx.doi.org/10.1046/j.1440-1665.2002.00498.x.
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Objective: To describe the key features of the ‘Better Outcomes in Mental Health Care’ initiative (2001-2005) and to detail some of the conceptual, community, professional and epidemiological forces that shaped its content. Conclusions: The ‘Better Outcomes in Mental Health Care’ initiative represents a major development in mental health care in Australia. It recognises the central role of primary care, promotes integrated medical and psychological care, rewards treatments that occur over an episode of illness, promotes active purchasing of non-pharmacological interventions earlier in the course of illness, and attempts to better link general practitioners, non-medical mental health specialists and psychiatrists to meet population-based mental health needs. Central to its development has been a commitment by general practitioners to develop progressively better mental health skills and measure both individual consumer and system-related outcomes.
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Bollen, Michael D., and Susan D. Whicker. "Complementary medicines regulatory reform." Australian Health Review 33, no. 2 (2009): 288. http://dx.doi.org/10.1071/ah090288.
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AUSTRALIANS ARE BEING encouraged to take greater responsibility for their own health care. The concept of self-care is being promoted widely, including the recent paper released by the National Health and Hospitals Reform Commission1 and, more commercially, by the Australian Self Medication Industry (ASMI).2 Self-care in health refers to the activities individuals, families and communities undertake with the intention of enhancing health, preventing disease, limiting illness, and restoring health. These activities are derived from knowledge and skills from the pool of both professional and lay experience. They are undertaken by lay people on their own behalf, either separately or in participative collaboration with professionals.3 To enable Australian consumers to assume this responsibility, they should have the right to know and have access to the evidence-based status of any treatment they are considering, to enable them to make well-informed choices. This especially applies to medicines.
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Buchanan, John. "Recasting Australian employment law: implications for the health sector." Australian Health Review 29, no. 3 (2005): 264. http://dx.doi.org/10.1071/ah050264.
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IN OCTOBER 2004 the Federal Coalition Government was re-elected with an increased majority and, from July 2005, control of the Senate. Between 1996 and 2004, while significant changes were implemented, most ?reform? proposals were blocked in the Senate. Now the government intends to implement these Bills and, in many cases, proposes further reforms. These initiatives come at a time when the health care system is experiencing profound pressures for change.1-3 This article discusses the proposed changes in employment law and the likely impact on the health care sector.
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Mcgorry, Patrick. "‘Every Me and Every You’: Responding to the Hidden Challenge of Mental Illness in Australia." Australasian Psychiatry 13, no. 1 (March 2005): 3–15. http://dx.doi.org/10.1080/j.1440-1665.2004.02143.x.
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Objective: To show that mental illness affects everyone in society, describe some of the main obstacles to better outcomes, and build confidence that they can be overcome. Methods: A review and analysis of relevant evidence and experience combined with personal advocacy. Results: Mental illnesses are common and seriously under-treated, reform of the system of care has completely stalled, and insidious reinstitutionalization of the modernized system is occurring. A number of contributing factors and possible solutions are identified, including mental health literacy and advocacy campaigns, a focus on young people and early intervention, and functional reintegration of the treatment of mental and substance use disorders. Conclusions: A new wave of reform and major financial investment in the treatment of mental and substance use disorders is overdue. This can be best achieved by combining the evidence-based health care (EBHC) paradigm with a direct appeal to the self-interest of members of the general community. A National Institute of Mental Health and Addiction should be a key element of such reform, which must be a continuing process with substantially increased federal and State funding.
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Degeling, P., D. Black, G. Palmer, and J. Walters. "Attitudes and Knowledge about Case Mix Reform among Hospital Staff in Australia." Health Services Management Research 9, no. 4 (November 1996): 223–37. http://dx.doi.org/10.1177/095148489600900402.
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This paper reports some of the findings of a national survey of staff in acute care hospitals about their knowledge of case mix and their attitudes towards it. Our findings suggest that, despite the range and scope of activities that have been pursued under the Australian Casemix Development Program (ACDP), knowledge of case mix among acute care hospital staff remains patchy. The evidence also shows that significant aspects of the DRG classification system and the uses to which it can be put are not accepted by many hospital staff, particularly medical staff. The paper concludes with a discussion of what some of these findings imply for future activity on case mix reform.
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Marceau, Raelene, Kathleen Hunter, Stephanie Montesanti, and Tammy O’ Rourke. "Sustaining Primary Health Care Programs and Services: A Scoping Review Informing the Nurse Practitioner Role in Canada." Policy, Politics, & Nursing Practice 21, no. 2 (May 2020): 105–19. http://dx.doi.org/10.1177/1527154420923738.
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Sustainability is a key concept in the politics and local policy of health care delivery, particularly during discussions on the principles of primary health care (PHC) and health care reform. In Canada, previous reforms in PHC were implemented with the goal of achieving long-term sustainable change in health systems across the country. However, insufficient resources and a changing environment have impeded the sustainability of many PHC programs and services. An example is the nurse practitioner (NP) role, which was introduced in Canada in 1967 but failed to be sustained. In the mid-1990s, in response to a call for PHC reform, the role was reimplemented with the support of government legislation, regulation, and remuneration mechanisms. However, despite evidentiary success of NP role effectiveness and efficiency in Canada’s health system, many barriers toward full implementation of the role continue to exist and sustainability remains at risk. This scoping review was undertaken to inform a research project exploring the closure of an NP clinic in a western Canadian province. The review searched relevant peer-reviewed and gray literature from Canada, United Kingdom, and Australia, to better understand and describe the factors influencing sustainability of the NP role and other PHC programs and services.
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Wood, Lisa, Trevor Shilton, Lyn Dimer, Julie Smith, and Timothy Leahy. "Beyond the rhetoric: how can non-government organisations contribute to reducing health disparities for Aboriginal and Torres Strait Islander people?" Australian Journal of Primary Health 17, no. 4 (2011): 384. http://dx.doi.org/10.1071/py11057.
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The prevailing disparities in Aboriginal health in Australia are a sobering reminder of failed health reforms, compounded by inadequate attention to the social determinants shaping health and well-being. Discourse around health reform often focuses on the role of government, health professionals and health institutions. However, not-for-profit health organisations are also playing an increasing role in health policy, research and program delivery across the prevention to treatment spectrum. This paper describes the journey of the National Heart Foundation of Australia in West Australia (Heart Foundation WA hereafter) with Aboriginal employees and the Aboriginal community in taking a more proactive role in reducing Aboriginal health disparities, focusing in particular on lessons learnt that are applicable to other non-government organisations. Although the Heart Foundation WA has employed and worked with Aboriginal people and has long identified the Aboriginal community as a priority population, recent years have seen greater embedding of this within its organisational culture, governance, policies and programs. In turn, this has shaped the organisation’s response to external health reforms and issues. Responses have included the development of an action plan to eliminate disparities of cardiovascular care in the hospital system, and collaboration and engagement with health professional groups involved in delivery of care to Aboriginal people. Examples of governance measures are also described in this paper. Although strategies and the lessons learnt have been in the context of cardiovascular health disparities, they are applicable to other organisations across the health sector. Moreover, the most powerful lesson learnt is universal in its relevance; individual programs, policies and reforms are more likely to succeed when they are underpinned by whole of organisation ownership and internalisation of the need to redress disparities in health.
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Stephenson, David. "Palliative care nursing in Australia in a time of national health and hospital reform." Progress in Palliative Care 18, no. 6 (December 2010): 330–34. http://dx.doi.org/10.1179/1743291x10y.0000000007.
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Hall, Jane. "Australian health care reform: Giant leap or small step?" Journal of Health Services Research & Policy 15, no. 4 (October 2010): 193–94. http://dx.doi.org/10.1258/jhsrp.2010.010090.
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Duckett, Stephen J. "The Australian health care system: reform, repair or replace?" Australian Health Review 32, no. 2 (2008): 322. http://dx.doi.org/10.1071/ah080322.
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A Festshrift gives us the opportunity to look both backwards and forwards. Ken Donald?s career stretches back to his intern days in 1963 and has encompassed clinical and population health, academe, clinical settings and the bureaucracy, and playing sport at state and national levels. There has been considerable change in the health care system over the period of Ken?s involvement in the sector with more change to come ? where have those changes left us? This paper discusses these changes in relation to performance criteria.
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Taylor, Michael J., and Hal Swerissen. "Medicare and chronic disease management: integrated care as an exceptional circumstance?" Australian Health Review 34, no. 2 (2010): 152. http://dx.doi.org/10.1071/ah09810.
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Chronic disease represents a significant challenge to the design and reform of the Australian healthcare system. The Medicare Benefits Schedule (MBS) provides a framework of numerous chronic disease management programs; however, their use at the patient level is complex. This analysis of the MBS chronic disease framework uses a hypothetical case study of a diabetic patient (with disease-related complications and a complex psychosocial background) to illustrate the difficulties in delivering appropriate multidisciplinary chronic disease care under the MBS. The complexities at each step – from care planning, service provision, and monitoring and review – are described, as are the intricacies involved in providing patient care under different MBS programs as well as those in the broader health and community care system. As demonstrated by this case study, under certain circumstances the provision of truly integrated care to this hypothetical patient would constitute an ‘exceptional circumstance’ under the MBS. Although quality improvement efforts can improve functioning within the limitations of the current system, system-wide reforms are necessary to overcome complexity and fragmentation. What is known about the topic?Chronic disease management requires optimal health system design to provide appropriate patient care. In Australia, the Medicare Benefits Schedule (MBS) provides chronic disease-focussed programs, but the multitude of available programs and items are administratively complex, overlapping and subject to claiming incompatibilities. What does this paper add? This paper illustrates the complexity of the various MBS programs for chronic disease management using a case study of the potential service response to a single diabetic patient with disease-related complications and a complex psychosocial background. This analysis illustrates the manifold problematic interactions and incompatibilities that may arise in relation to this hypothetical patient. What are the implications for practitioners?Under the current MBS framework, providing patients with optimum chronic disease management requires both clinical and administrative skill on the part of GPs. Time spent on administrative requirements is time away from clinical care. Although quality improvement efforts may improve functioning within the existing system to a certain extent, broader system reforms are necessary to support optimal chronic disease management in Australia.