The future of community-centred health services in Australia – an alternative view
Paul A. Cunningham , FACEM , MMedEd and Emergency Physician Staff SpecialistEmergency Department, Ryde Hospital, Denistone Rd, Eastwood, NSW 2122, Australia. Email: pcunning@nsccahs.health.nsw.gov.au
Australian Health Review 36(2) 121-124 https://doi.org/10.1071/AH11013
Submitted: 19 February 2011 Accepted: 24 April 2011 Published: 4 May 2012
Abstract
Community-centred healthcare works in conjunction with hospital-centred healthcare. Both have strengths and limitations. Community-centred healthcare has been demonstrated to be a more cost-efficient and cost-effective alternative to hospital-centred care at best in a limited fashion. If hospital-centred services dominate healthcare services in Australia, as argued previously in this journal, then this has not extended to maintenance of inpatient bed provision. The author, as a hospital-based emergency specialist, has observed case load and models of care in hospitals and emergency departments for 30 years and is sceptical of promises to substantially further decrease emergency department demand and acute bed requirements. The real benefits of community, primary and preventive care should not be over sold.
What is known about the topic? Community-centred healthcare has not been widely demonstrated to be a more cost-efficient and cost-effective alternative to hospital-centred care for acute conditions, even when these conditions are superimposed on a chronic condition.
What does this paper add? The author makes a plea for a reasoned and evidence-based approach to the distribution of finite health resources. Experts in the fields of acute, chronic and preventive health measures should present plans that less knowledgeable decision makers can implement appropriately.
What are the implications for practitioners? Experienced health experts need to balance the argument, including advocacy for adequate acute care and hospital-based services. Practitioners who require acute hospital beds for the safe and humane management of their patients may need to argue for legislative definition of bed numbers per population size.
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