Freeman Toby, Baum Fran, Lawless Angela, Javanparast Sara, Jolley Gwyn, Labonté Ronald, Bentley Michael, Boffa John, Sanders David
Southgate Institute for Health, Society, and Equity, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.
Institute of Population Health, University of Ottawa, 1 Stewart Street, Ottawa, Ontario K1N 6N5, Canada.
Aust J Prim Health. 2016;22(4):332-338. doi: 10.1071/PY14180.
Equity of access and reducing health inequities are key objectives of comprehensive primary health care. However, the supports required to target equity are fragile and vulnerable to changes in the fiscal and political environment. Six Australian primary healthcare services, five in South Australia and one in the Northern Territory, were followed over 5 years (2009-2013) of considerable change. Fifty-five interviews were conducted with service managers, staff, regional health executives and health department representatives in 2013 to examine how the changes had affected their practice regarding equity of access and responding to health inequity. At the four state government services, seven of 10 previously identified strategies for equity of access and services' scope to facilitate access to other health services and to act on the social determinants of health inequity were now compromised or reduced in some way as a result of the changing policy environment. There was a mix of positive and negative changes at the non-government organisation. The community-controlled service increased their breadth of strategies used to address health equity. These different trajectories suggest the value of community governance, and highlight the need to monitor equity performance and advocate for the importance of health equity.
公平获得医疗服务以及减少健康不平等是全面初级卫生保健的关键目标。然而，实现公平所需的支持较为薄弱，容易受到财政和政治环境变化的影响。在五年（2009 - 2013年）的重大变革期间，对澳大利亚的六个初级卫生保健服务机构进行了跟踪，其中五个在南澳大利亚州，一个在北领地。2013年，对服务经理、工作人员、地区卫生管理人员和卫生部门代表进行了55次访谈，以研究这些变革如何影响他们在公平获得医疗服务以及应对健康不平等方面的实践。在四个州政府服务机构中，由于政策环境的变化，先前确定的10项公平获得医疗服务和扩大服务范围以促进获得其他卫生服务并应对健康不平等社会决定因素的策略中，有7项目前在某种程度上受到损害或减少。在非政府组织中，既有积极变化也有消极变化。社区控制的服务机构增加了用于解决健康公平问题的策略广度。这些不同的发展轨迹表明了社区治理的价值，并突出了监测公平绩效以及倡导健康公平重要性的必要性。
