Community Health Within the Context of Health Reform

Abstract

Recent health reforms in Victoria based on a market model characterised by competition and market control of health services, have radically changed the funding and management of community health organisations and the way health services are provided. Community health has sustained ongoing funding cuts, restructures, amalgamations, and corporatisation over the past decade. Within the context of reform community health has been forced to become competitive through improvement in the efficiency and effectiveness of services. At the same time organisations must collaborate to ensure a co-ordinated approach to health care and continue to provide services which are responsive to community needs. With diminishing government funding community health organisations must seek alternative funding sources through the tendering process. A 1998 study of one of the largest metropolitan community health organisations in Victoria gives some insights into the impact of these reforms. The findings of this study show that health reforms based on market principles are not compatible with the delivery of health care, and in particular with primary health care, the underlying philosophy of community health. Organisations are becoming more bureaucratic and hierarchical with decision making being driven by management rather than by consultation with community and staff. Resources are being diverted from health promotion and community development activities to direct services, that are individual and problem focused rather than community and prevention focused.