Donato Ronald, Segal Leonie
School of Commerce and Centre for Regulation and Market Analysis, Adelaide, Australia.
Aust Health Rev. 2013 May;37(2):232-8. doi: 10.1071/AH12186.
This paper provides an analysis of the national Indigenous reform strategy - known as Closing the Gap - in the context of broader health system reforms underway to assess whether current attempts at addressing Indigenous disadvantage are likely to be successful. Drawing upon economic theory and empirical evidence, the paper analyses key structural features necessary for securing system performance gains capable of reducing health disparities. Conceptual and empirical attention is given to the features of comprehensive primary healthcare, which encompasses the social determinants impacting on Indigenous health. An important structural prerequisite for securing genuine improvements in health outcomes is the unifying of all funding and policy responsibilities for comprehensive primary healthcare for Indigenous Australians within a single jurisdictional framework. This would provide the basis for implementing several key mutually reinforcing components necessary for enhancing primary healthcare system performance. The announcement to introduce a long-term health equality plan in partnership with Aboriginal people represents a promising development and may provide the window of opportunity needed for implementing structural reforms to primary healthcare. WHAT IS KNOWN ABOUT THE TOPIC? Notwithstanding the intention of previous policies, considerable health disparity exists between Indigenous and non-Indigenous Australians. Australia has now embarked on its most ambitious national Indigenous health reform strategy, but there has been little academic analysis of whether such reforms are capable of eliminating health disadvantage for Aboriginal people.WHAT DOES THE PAPER ADD? This paper provides a critical analysis of Indigenous health reforms to assess whether such policy initiatives are likely to be successful and outlines key structural changes to primary healthcare system arrangements that are necessary to secure genuine system performance gains and improve health outcomes for Indigenous Australians.WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? For policymakers, the need to establish genuine partnership and engagement between Aboriginal people and the Australian government in pursuing a national Indigenous reform agenda is of critical importance. The establishment of the National Congress of Australia's First Peoples provides the opportunity for policy makers to give special status to Indigenous Australians in health policy development and create the institutional breakthrough necessary for effecting primary healthcare system change.
本文在更广泛的卫生系统改革背景下，对国家原住民改革战略——即“缩小差距”战略——进行了分析，以评估当前解决原住民劣势问题的举措是否可能取得成功。本文借鉴经济理论和实证证据，分析了实现能够减少健康差距的系统绩效提升所必需的关键结构特征。对综合初级卫生保健的特征给予了概念性和实证性关注，综合初级卫生保健涵盖了影响原住民健康的社会决定因素。确保健康结果真正改善的一个重要结构前提是，在单一管辖框架内统一澳大利亚原住民综合初级卫生保健的所有资金和政策责任。这将为实施若干相互强化的关键要素奠定基础，这些要素对于提高初级卫生保健系统绩效至关重要。宣布与原住民合作推出一项长期健康平等计划是一个有希望的进展，可能为实施初级卫生保健的结构改革提供所需的机会窗口。关于该主题已知的情况是什么？尽管先前政策有此意图，但澳大利亚原住民与非原住民之间仍存在相当大的健康差距。澳大利亚现已启动其最雄心勃勃的国家原住民健康改革战略，但对于此类改革是否能够消除原住民的健康劣势，几乎没有学术分析。本文补充了什么内容？本文对原住民健康改革进行了批判性分析，以评估此类政策举措是否可能成功，并概述了初级卫生保健系统安排的关键结构变革，这些变革对于实现真正的系统绩效提升和改善澳大利亚原住民的健康结果是必要的。对从业者有何影响？对于政策制定者而言，在推行国家原住民改革议程时，在原住民与澳大利亚政府之间建立真正的伙伴关系和互动至关重要。澳大利亚第一民族全国大会的成立为政策制定者提供了机会，使其能够在健康政策制定中给予澳大利亚原住民特殊地位，并创造实现初级卫生保健系统变革所需的制度突破。
