Governments in many developed nations have recognised the need for health system reform, to address increasing demand related to ageing and chronic disease, system fragmentation, equitable access, efficiency, costs, safety and quality. 3-7 These challenges have contributed to the World Health Organisation (WHO) articulating the need for refocusing on a strong primary health care sector globally.8
In Australia, a number of key reasons have been identified for the need for reform with an emphasis on primary care. The first relates to the burden of disease and increasing rates of chronic disease and ageing, resulting in increased demand for a range of health services.9 The second relates to the need to reduce admissions and length of stay in hospitals by providing clinically appropriate care in the community. Aligned to the focus of WHO, the third reason relates to the need for greater geographical, financial and health condition equity in access to primary health care services.9,10 Further, an ageing and inequitably distributed health workforce continues to place pressure on the current primary health care system, requiring a focus on workforce capacity building as part of primary health care reform.9
3 Building a 21st Century Primary Health Care System: Australia's First National Primary Health Care Strategy. Canberra: Australian Government: Department of Health and Ageing;2010.
4 Imison C, Naylor C, Maybin J. Under One Roof:Will polyclinics deliver integrated care? London: King's Fund 2008.
5A Healthier Future For All Australians – Final Report of the National Health and Hospitals Reform Commission. Canberra: Australian Government National Health and Hospitals Reform Commission;2009.
6 Hutchison B, Levesque J-F, Strumpf E, Coyle N. Primary Health Care in Canada: Systems in Motion. Milbank Quarterly.89(2):256-288.
7 Romanow R. Health Care and Education Reconciliation Act of 2010: Building on Values: the future of health care in Canada - Final Report. Commission on the future of health care in Canada. 2002.
8 Browne G, Roberts J, Gafni A, et al. Economic evaluations of community-based care: lessons from twelve studies in Ontario. J Eval Clin Pract. 2008;5(4):367 - 385.
9 Primary Health Care Reform in Australia: Report to Support Australia's First National Primary Health Care Strategy. Canberra: Australian Government; Department of Health and Ageing;2009.
10 The World Health Report 2008: Primary care now more than ever. Geneva: WHO 2008.