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March 4, 2010
The authors of Putting Health in Local Hands at the Centre for Policy Development rightly argue that the health care system is more fragmented and duplicative, inequitable and less efficient than it might be.
They then suggest that "shifting health care governance and funding to regional agencies that are more responsive to the needs of communities would improve both equity and effectiveness in Australian health care."
They propose that all current health care funding from local, state and federal governments be pooled within a national agency and equitably distributed to local Regional Health Organisations (RHOs ) on the basis of evidence about health care needs.
They argue that the current emphasis on hospital care, rather than primary and preventive care, is increasingly recognised as inefficient and that there is broad agreement that effective primary care reduces health care costs and that improved access to primary health care services in the community would reduce unnecessary admissions to hospitals. However, our current system of primary care does not deal well with chronic diseases, nor does it work effectively with the acute sector.
To achieve more efficient and equitable outcomes it is not enough simply to shift resources from hospitals to health centres; we must address the social determinants of health and the inequalities of health in that the rich, urban, and healthy access more health care resources and services than the poor, rural, and sick.
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The Rudd Government's proposal to appoint local clinicians and community leaders to the boards of new ''local hospital networks''.
The tendency is for boards to pursue local interests at the expense of overall capacity to fund projects.