Stanton P
School of Public Health, Faculty of Health Sciences, La Trobe University, Melbourne, Victoria, Australia.
Soc Sci Med. 2001 Mar;52(5):671-9. doi: 10.1016/s0277-9536(00)00169-6.
Since 1992 there have been fundamental changes in health care policy in Victoria, Australia, as the state government moves to competitive market models of service delivery and the measurement of service provision through output based funding. The introduction of competitive relationships to the public health system has had a major impact in the primary health care sector, particularly on community health centres. Most community health centres in Victoria have traditionally been semi-independent agencies controlled by community based committees of management. Such policies have had huge implications for the management and organisation of these agencies, as they have led to different patterns of service delivery and different models of management practice, often devaluing traditional philosophical perspectives of 'primary health care practice'. Although many agencies have embraced change as providing opportunities for growth and development and to have more influence in the provision of mainstream public health care, primary health care models of practice should be supported for their intrinsic and increasing value.
自1992年以来，澳大利亚维多利亚州的医疗保健政策发生了根本性变化，因为州政府转向竞争性市场服务提供模式，并通过基于产出的资金投入来衡量服务提供情况。将竞争关系引入公共卫生系统对初级卫生保健部门产生了重大影响，尤其是对社区卫生中心。传统上，维多利亚州的大多数社区卫生中心都是由社区管理委员会控制的半独立机构。这些政策对这些机构的管理和组织产生了巨大影响，因为它们导致了不同的服务提供模式和不同的管理实践模式，常常贬低了“初级卫生保健实践”的传统哲学观点。尽管许多机构将变革视为增长和发展的机会，并在提供主流公共卫生保健方面拥有更大影响力，但初级卫生保健实践模式因其内在的和不断增加的价值而应得到支持。
