Community Health Service Agreements 1992 to 1995: Changes in Practice and Purpose

Abstract

In Victoria, community health centres are undergoing major changes. In this paper, a study of service and funding agreements, their changed purposes, and how the practices surrounding them have also changed, is reported. The study provides some insights into the dynamics of the contractual model of health system management. The information was obtained from the service and funding agreements of community health centres, interviews with staff of the Department of Human Services, and interviews with community health centre managers. At the end of 1995, community health centres were still in a transitional phase. They were changing from being locally focused, multi-disciplinary organisations that approached health as a social and technical issue to ones that were centrally focused, still multi-disciplinary but increasingly attending to the technical provision of services. There were, however, many ambiguities in the system that allowed services to resist the changes that were considered least desirable. To a degree they de-coupled internal operations from the external presentation of them.