Department of Epidemiology and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.
Department of General Practice, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia.
J Health Organ Manag. 2021 Mar 30;ahead-of-print(ahead-of-print). doi: 10.1108/JHOM-04-2020-0160.
Comprehensive primary health care (PHC) models are seldom implemented in high income countries, in part due to their contested legitimacy in neoliberal policy environments. This article explores how merging affected the perceived legitimacy of independent community health organisations in Victoria, Australia, in providing comprehensive PHC services.
DESIGN/METHODOLOGY/APPROACH: A longitudinal follow-up study (2-3 years post-merger) of two amalgamations among independent community health organisations from the state of Victoria, Australia, was conducted. This article explores the perceived effects of merging on (1) the pragmatic, normative and cognitive legitimacy of studied organisations and (2) the collective legitimacy of these organisations in Victoria's health care system. Data were collected through 19 semi-structured interviews with key informants and subjected to template and thematic analyses.
Merging enabled individual organisations to gain greater overall legitimacy as regional providers of comprehensive PHC services and thus retain some capacity to operationalise a social model of health. Normative legitimacy was most enhanced by merging, through acquisition of a large organisational size and adoption of business practices favoured by neoliberal norms. However, mergers may have destabilised the already contested cognitive legitimacy of community health services as a group of organisations and as a comprehensible state-wide platform of service delivery.
Over-reliance on individual organisational behaviour to maintain the legitimacy of comprehensive PHC as a model of organising health and social care could lead to inequities in access to such models across communities.
ORIGINALITY/VALUE: This study shows that organisations can manage their perceived legitimacy in order to ensure the survival of their preferred model of service delivery.
综合初级卫生保健（PHC）模式在高收入国家很少实施，部分原因是其在新自由主义政策环境中的合法性受到质疑。本文探讨了在澳大利亚维多利亚州，将独立社区卫生组织合并对提供综合 PHC 服务的组织感知合法性的影响。
设计/方法/方法：对澳大利亚维多利亚州的两个独立社区卫生组织的合并进行了纵向随访研究（合并后 2-3 年）。本文探讨了合并对（1）所研究组织的实效、规范和认知合法性以及（2）这些组织在维多利亚州卫生保健系统中的集体合法性的感知影响。通过对关键信息员进行 19 次半结构化访谈收集数据，并进行模板分析和主题分析。
合并使各个组织能够作为综合 PHC 服务的区域提供者获得更大的整体合法性，从而保持实施健康社会模式的一些能力。规范合法性通过合并得到了最大程度的增强，通过获得较大的组织规模和采用新自由主义规范所青睐的商业实践。然而，合并可能破坏了社区卫生服务作为一个组织群体和一个可理解的全州服务提供平台的认知合法性，使其变得不稳定。
过度依赖个别组织行为来维持综合 PHC 作为一种组织健康和社会保健模式的合法性，可能导致社区之间获得这种模式的机会不平等。
原创性/价值：本研究表明，组织可以管理其感知合法性，以确保其首选服务提供模式的生存。
