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Comprehensive primary health care under neo-liberalism in Australia

Author

Listed:
  • Baum, Fran
  • Freeman, Toby
  • Sanders, David
  • Labonté, Ronald
  • Lawless, Angela
  • Javanparast, Sara

Abstract

This paper applies a critical analysis of the impact of neo-liberal driven management reform to examine changes in Australian primary health care (PHC) services over five years. The implementation of comprehensive approaches to primary health care (PHC) in seven services: five state-managed and two non-government organisations (NGOs) was tracked from 2009 to 2014. Two questions are addressed: 1) How did the ability of Australian PHC services to implement comprehensive PHC change over the period 2009–2014? 2) To what extent is the ability of the PHC services to implement comprehensive PHC shaped by neo-liberal health sector reform processes? The study reports on detailed tracking and observations of the changes and in-depth interviews with 63 health service managers and practitioners, and regional and central health executives. The documented changes were: in the state-managed services (although not the NGOs) less comprehensive service coverage and more focus on clinical services and integration with hospitals and much less development activity including community development, advocacy, intersectoral collaboration and attention to the social determinants. These changes were found to be associated with practices typical of neo-liberal health sector reform: considerable uncertainty, more directive managerial control, budget reductions and competitive tendering and an emphasis on outputs rather than health outcomes. We conclude that a focus on clinical service provision, while highly compatible with neo-liberal reforms, will not on its own produce the shifts in population disease patterns that would be required to reduce demand for health services and promote health. Comprehensive PHC is much better suited to that task.

Suggested Citation

  • Baum, Fran & Freeman, Toby & Sanders, David & Labonté, Ronald & Lawless, Angela & Javanparast, Sara, 2016. "Comprehensive primary health care under neo-liberalism in Australia," Social Science & Medicine, Elsevier, vol. 168(C), pages 43-52.
  • Handle: RePEc:eee:socmed:v:168:y:2016:i:c:p:43-52
    DOI: 10.1016/j.socscimed.2016.09.005
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    References listed on IDEAS

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    1. Cornia, Giovanni Andrea & Rosignoli, Stefano & Tiberti, Luca, 2007. "Globalisation and health: impact pathways and recent evidence," Center for Global, International and Regional Studies, Working Paper Series qt2358z815, Center for Global, International and Regional Studies, UC Santa Cruz.
    2. Toby Freeman & Frances E. Baum & Gwyneth M. Jolley & Angela Lawless & Tahnia Edwards & Sara Javanparast & Anna Ziersch, 2016. "Service providers' views of community participation at six Australian primary healthcare services: scope for empowerment and challenges to implementation," International Journal of Health Planning and Management, Wiley Blackwell, vol. 31(1), pages 1-21, January.
    3. Coburn, David, 2000. "Income inequality, social cohesion and the health status of populations: the role of neo-liberalism," Social Science & Medicine, Elsevier, vol. 51(1), pages 135-146, July.
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    Cited by:

    1. Toby Freeman & Sara Javanparast & Fran Baum & Anna Ziersch & Tamara Mackean, 2018. "A framework for regional primary health care to organise actions to address health inequities," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(5), pages 567-575, June.
    2. Baum, Fran & Ziersch, Anna & Freeman, Toby & Javanparast, Sara & Henderson, Julie & Mackean, Tamara, 2020. "Strife of Interests: Constraints on integrated and co-ordinated comprehensive PHC in Australia," Social Science & Medicine, Elsevier, vol. 248(C).

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