Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
REVIEW

Are changes in Australian national primary healthcare policy likely to promote or impede equity of access? A narrative review

Matthew Fisher A B E , Fran Baum A B , Adrian Kay B C and Sharon Friel B D
+ Author Affiliations
- Author Affiliations

A Southgate Institute for Health, Society and Equity, Health Sciences building, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.

B NHMRC Centre of Research Excellence in the Social Determinants of Health Equity, c/o Southgate Institute for Health, Society and Equity, GPO Box 2100, Adelaide, SA 5001, Australia.

C Crawford School of Public Policy, Australian National University, Acton, ACT 2601, Australia.

D School of Regulation and Global Governance, Australian National University, Acton, ACT 2601, Australia.

E Corresponding author. Email: matt.fisher@flinders.edu.au

Australian Journal of Primary Health 23(3) 209-215 https://doi.org/10.1071/PY16152
Submitted: 24 November 2016  Accepted: 15 March 2017   Published: 6 June 2017

Abstract

Significant changes have occurred in Australia’s national primary healthcare (PHC) policy over the last decade, but little assessment has been made of implications for equity. This research aimed to identify key recent changes in national PHC policy and assess implications for equity of access to PHC. Academic literature was reviewed to identify issues affecting equity of access in national PHC policy, and grey literature was also reviewed to identify significant policy changes during 2005–16 with implications for equitable access. Equity implications of four areas of policy change, set against the existing Medicare system, were assessed. It was found that Medicare supports equitable access to general practice, but there is a risk of reduced equity under current policy settings. Four changes in PHC policy were selected as having particular implications for equity of access and these were assessed as follows: increased involvement of private health insurance presents risks for equity; equity implications of new models of coordinated care are unclear; and regional primary health organisations and current policy on Aboriginal and Torres Strait Islander health have potential equity benefits, but these will depend on further implementation.

Additional keywords: healthcare disparities, healthcare reform.


References

Alexander KE, Brijnath B, Mazza D (2014) Barriers and enablers to delivery of the Healthy Kids Check. Implementation Science 9, 60
Barriers and enablers to delivery of the Healthy Kids Check.CrossRef |

Alsharif AT, Kruger E, Tennant M (2014) Disparities in dental insurance coverage among hospitalised Western Australian children. International Dental Journal 64, 252–259.
Disparities in dental insurance coverage among hospitalised Western Australian children.CrossRef |

Ansari Z, Haider SI, Ansari H, De Gooyer T, Sindall C (2012) Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia. BMC Health Services Research 12, 475
Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia.CrossRef |

Australian Government (2014) ‘Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report.’ (Australian Government: Canberra, ACT, Australia)

Australian Healthcare and Hospitals Association (2015) Pathways to Reform: Health Funding and the Reform of Federation. AHHA Pathways to reform series report 4, Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW, Australia.

Banham D, Woollacott T, Gray J, Humphrys B, Mihnev A, McDermott R (2010) Recognising potential for preventing hospitalisation. Australian Health Review 34, 116–122.
Recognising potential for preventing hospitalisation.CrossRef |

Bar-Zeev SJ, Kruske S, Barclay L, Bar-Zeev N, Carapetis J, Kildea S (2012) Use of health services by remote dwelling Aboriginal infants in tropical northern Australia: a retrospective cohort study. BMC Pediatrics 12, 19
Use of health services by remote dwelling Aboriginal infants in tropical northern Australia: a retrospective cohort study.CrossRef |

Bath J, Wakerman J (2015) Impact of community participation in primary health care: what is the evidence? Australian Journal of Primary Health 21, 2–8.
Impact of community participation in primary health care: what is the evidence?CrossRef |

Baum F (2014) Community health services in Australia. In ‘Second Opinion: an Introduction to Health Sociology’, 5th edn. (Ed. J Germov) pp. 484–502. (Oxford University Press: Melbourne, Vic., Australia)

Baum F, Freeman T, Sanders D, Labonté R, Lawless A, Javanparast S (2016) Comprehensive primary health care under neo-liberalism in Australia. Social Science & Medicine 168, 43–52.
Comprehensive primary health care under neo-liberalism in Australia.CrossRef |

Bywood P, Katterl R, Lunnay B (2011) ‘Disparities in Primary Health Care Utilisation.’ (Primary Health Care Research & Information Service: Adelaide, SA, Australia)

Chrisopoulos S, Luzzi L, Brennan DS (2013) Trends in dental visiting avoidance due to cost in Australia, 1994 to 2010: an age-period-cohort analysis. BMC Health Services Research 13, 381
Trends in dental visiting avoidance due to cost in Australia, 1994 to 2010: an age-period-cohort analysis.CrossRef |

Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A (2015) Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes – a systematic review. BMC Health Services Research 15, 194
Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes – a systematic review.CrossRef |

Department of Health (2014) ‘Primary Health Networks: Grant Programme Guidelines.’ (Australian Government: Canberra, ACT, Australia)

Department of Health (2016) Health Care Homes: reform of the primary health care system. (Australian Government: Canberra, ACT, Australia) Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/health-care-homes#four [Verified 27 July 2016]

Department of Health and Ageing (2009) ‘Primary Health Care Reform in Australia.’ (Australian Government: Canberra, ACT, Australia)

Doran E, Henry D (2008) Australian pharmaceutical policy: price control, equity, and drug innovation in Australia. Journal of Public Health Policy 29, 106–120.
Australian pharmaceutical policy: price control, equity, and drug innovation in Australia.CrossRef |

Dutton P (2014) ‘Speech. Health Demand: Policy and Productivity Reforms.’ (Committee for Economic Development of Australia: Brisbane, Qld, Australia)

Foster MM, Mitchell M, Haines T, Tweedy S, Cornwell P, Fleming J (2008) Does enhanced primary care enhance primary care? Policy-induced dilemmas for allied health professionals. The Medical Journal of Australia 188, 29–32.

Freeman T, Baum F, Lawless A, Javanparast S, Jolley G, Labonte R, Bentley M, Boffa J, Sanders D (2016) Revisiting the ability of Australian primary health care services to respond to health inequity. Australian Journal of Primary Health 22, 332–338.
Revisiting the ability of Australian primary health care services to respond to health inequity.CrossRef |

Golenko XA, Shibl R, Scuffham P, Cameron C (2015) Relationship between socioeconomic status and general practitioner visits for children in the first 12 months of life: an Australian study. Australian Health Review 39, 136–145.
Relationship between socioeconomic status and general practitioner visits for children in the first 12 months of life: an Australian study.CrossRef |

Hajizadeh M, Connelly L, Butler J (2012) Health policy and horizontal inequities of health-care utilization in Australia: 1983–2005. Applied Economics Letters 19, 1765–1775.
Health policy and horizontal inequities of health-care utilization in Australia: 1983–2005.CrossRef |

Harris MF, Harris E, Roland M (2004) Access to primary health care: three challenges to equity. Australian Journal of Primary Health 10, 21–29.
Access to primary health care: three challenges to equity.CrossRef |

Harrison C, Britt H (2011) General practice: workforce gaps now and in 2020. Australian Family Physician 40, 12–15.

Harrison C, Bayram C, Miller G, Britt H (2015) The cost of freezing general practice. The Medical Journal of Australia 202, 313–316.
The cost of freezing general practice.CrossRef |

Hetzel D, Glover J, McDonald S (2015) ‘Health Systems of Australia and New Zealand.’ (Elsevier: Amsterdam, Netherlands)

Hurley C, Baum F, Johns J, Labonte R (2010) Comprehensive primary health care in Australia: findings from a narrative review of the literature. Australasian Medical Journal 1, 147–152.
Comprehensive primary health care in Australia: findings from a narrative review of the literature.CrossRef |

Javanparast S, Baum F, Barton E, Freeman T, Lawless A, Fuller J, Reed R, Kidd M (2015) Medicare local-local health network partnerships in South Australia: lessons for primary health networks. The Medical Journal of Australia 203, 219.e1–219.e6.
Medicare local-local health network partnerships in South Australia: lessons for primary health networks.CrossRef |

Kelaher M, Sabanovic H, La Brooy C, Lock M, Lusher D, Brown L (2014) Does more equitable governance lead to more equitable health care? Social Science & Medicine 123, 278–286.
Does more equitable governance lead to more equitable health care?CrossRef |

Kidd MR, Watts I, Saltman D (2008) Primary health care reform: equity is the key. The Medical Journal of Australia 189, 221–222.

Korda RJ, Banks E, Clements M, Young A (2009) Is inequity undermining Australia’s ‘universal’ health care system? Socio-economic inequalities in the use of specialist medical and non-medical ambulatory health care. Australian and New Zealand Journal of Public Health 33, 458–465.
Is inequity undermining Australia’s ‘universal’ health care system? Socio-economic inequalities in the use of specialist medical and non-medical ambulatory health care.CrossRef |

Laba T-L, Usherwood T, Leeder S, Yusuf F, Gillespie J, Perkovic V, Wilson A, Jan S, Essue B (2015) Co-payments for health care: what is their real cost? Australian Health Review 39, 33–36.
Co-payments for health care: what is their real cost?CrossRef |

Macdonald J (2007) Primary health care or primary medical care: in reality. Australian Journal of Primary Health 13, 18–23.
Primary health care or primary medical care: in reality.CrossRef |

McCann W (2012) ‘Review of non-Hospital based Services.’ (Government of South Australia: Adelaide, SA, Australia)

Meadows GN, Enticott J, Inder B, Russell G, Gurr R (2015) Better access to mental health care and the failure of the Medicare principle of universality. The Medical Journal of Australia 202, 190–194.
Better access to mental health care and the failure of the Medicare principle of universality.CrossRef |

Mejia G, Armfield J, Jamieson L (2014) Self-rated oral health and oral health-related factors: the role of social inequality. Australian Dental Journal 59, 226–233.
Self-rated oral health and oral health-related factors: the role of social inequality.CrossRef | 1:STN:280:DC%2BC2cjmt1KksQ%3D%3D&md5=4708f993f28e6606bd4a35ddd24b134fCAS |

Menadue J, McAuley I (2012) ‘Private Health Insurance: High in Cost and Low in Equity.’ (Centre for Policy Development: Sydney, NSW, Australia)

Muhunthan J, Eades A, Jan S (2015) Neglecting preventive health threatens child rights in Australia. Lancet 385, 415
Neglecting preventive health threatens child rights in Australia.CrossRef |

Newman L, Javanparast S, Baum F, Hutchinson C (2014) ‘Evidence Review; Settings for Addressing the Social Determinants of Health Inequities.’ (Southgate Institute for Health, Society and Equity, Victorian Health Promotion Association, Melbourne, Vic., Australia)

Panaretto KS, Wenitong S, Button S, Ring I (2014) Aboriginal community controlled health services: leading the way in primary care. The Medical Journal of Australia 200, 649–652.
Aboriginal community controlled health services: leading the way in primary care.CrossRef |

Parker EJ, Misan J, Shearer M, Richards L, Russell A, Mills H, Jamieson L (2012) Planning, implementing, and evaluating a program to address the oral health needs of Aboriginal children in Port Augusta, Australia. International Journal of Pediatrics 2012, 496236
Planning, implementing, and evaluating a program to address the oral health needs of Aboriginal children in Port Augusta, Australia.CrossRef | 1:STN:280:DC%2BC38nitlenuw%3D%3D&md5=0643acd72d9863090126e8f4d4624430CAS |

Plant NA, Kelly P, Leeder S, D’Souza M, Mallitt K, Usherwood T, Jan S, Boyages S, Essue B, McNab J, Gillespie J (2015) Coordinated care versus standard care in hospital admissions of people with chronic illness: a randomised controlled trial. The Medical Journal of Australia 203, 33–38.
Coordinated care versus standard care in hospital admissions of people with chronic illness: a randomised controlled trial.CrossRef |

Primary Health Care Advisory Group (2015) ‘Better Outcomes for People with Chronic and Complex Health Conditions through Primary Health Care.’ (Australian Government: Canberra, ACT, Australia)

Reeve C, Humphreys J, Wakerman J, Carter M, Carroll V, Reeve D (2015) Strengthening primary health care: achieving health gains in a remote region of Australia. The Medical Journal of Australia 202, 483–487.
Strengthening primary health care: achieving health gains in a remote region of Australia.CrossRef |

Roeger LS, Reed R, Smith B (2010) Equity of access in the spatial distribution of GPs within an Australian metropolitan city. Australian Journal of Primary Health 16, 284–290.
Equity of access in the spatial distribution of GPs within an Australian metropolitan city.CrossRef |

Senate Community Affairs Committee (2014) ‘Private Health Insurance Amendment (GP Services) Bill 2014.’ (Commonwealth of Australia: Canberra, ACT, Australia)

Starfield B, Shi L (2002) Policy relevant determinants of health: an international perspective. Health Policy 60, 201–218.
Policy relevant determinants of health: an international perspective.CrossRef |

Swerissen H, Duckett S, Wright J (2016) ‘Chronic Failure in Primary Medical Care.’ (Grattan Institute: Melbourne, Vic., Australia)

Thiede M, Akweongo P, McIntyre D (2007) Exploring the dimensions of access. In ‘The Economics of Health Equity’. (Eds D McIntyre, G Mooney) pp. 103–123. (Cambridge University Press: Cambridge UK)

UK Government (2014) Rapid evidence assessment guidelines. (National Archives: London, UK) Available at http://webarchive.nationalarchives.gov.uk/20140305122816/http://www.civilservice.gov.uk/networks/gsr/resources-and-guidance/rapid-evidence-assessment/what-is [Verified 21 November 2016]

Ward PR (2009) The relevance of equity in health care for primary care: creating and sustaining a ‘fair go, for a fair innings’. Quality in Primary Care 17, 49–54.

Wiese M, Baum F, Freeman T, Kidd M (2011) Australia’s systems of primary healthcare: the need for improved coordination and implications for Medicare Locals. Australian Family Physician 40, 995–999.

World Health Organization (2008) ‘The World Health Report 2008.’ (WHO: Geneva, Switzerland)



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