Coordinating Health, Extended Care and Community Support Services: Issues for Policy Makers and Service Providers in Australia

Under pressure to maximise the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This paper reviews recent experience in two related fields: the coordination of different community care services for older people and people with disabilities funded by the HACC program; and the attempt to enhance links between community and residential care services, hospitals and other health care provid. The paper considers why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian Government now terms health and family services. Following this, a number of measures that have been introduced or are proposed to improve the coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gate keeping, case management and brokerage of services, to models involving the reconfiguration of organisational structures, linkages and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. Most discussions of service coordination focus largely on the issue of coordination at the level of direct service provision. It is argued that coordination at this level is difficult if government policies which direct services lack coordination.