How Should We Organise Community Health Services?

Abstract

This paper reviews the organisation of Victorian community health services in the context of the general direction of reform for the Australian and Victorian health systems. It notes that the emphasis has shifted to a greater focus on improving the efficiency of the relationship between needs, resources, services and outcomes. Within this context, in addition to public health measures, national reforms have advocated the creation of funding and organisational arrangements around three service functions: general care, acute care and co-ordinated care. It is argued that the organisation of community services should be driven by these functional relations, not vice versa. The efficiency of vertical and horizontal integration and the creation of community health networks is considered in relation to transaction costs, organisational scale, transition costs and distributional equity. It is concluded that community health networks offer the most efficient model for the delivery of community based public health and general, acute and co-ordinated care services.