Why Community Health Systems Have Not Flourished in High Income Countries: What the Australian Experience Tells Us.
Why Community Health Systems Have Not Flourished in High Income Countries: What the Australian Experience Tells Us.
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DOI：
10.34172/ijhpm.2021.42
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发表时间：
2022-01-01
影响因子：
3.5
通讯作者：
Freeman, Toby
中科院分区：
文献类型：
--
作者：
Baum, Fran;Freeman, Toby
背景：尽管社区卫生系统很有价值，但它们在高收入国家并没有蓬勃发展，而且在高收入国家还没有全系统的例子，在那里社区卫生被视为主流模式。澳大利亚、加拿大、美国和英国确实存在的那些提供了综合初级保健(PHC)的例子，但对生物医学初级医疗保健来说是边缘的。本文的目的是以澳大利亚为例，考察高收入国家缺乏强有力的社区卫生系统的原因。方法：数据来自作者领导的两项澳大利亚PHC研究。其中一项审查了五年期间社区卫生服务的七个案例研究，这些研究见证了卫生系统的重大变化。第二项研究考察了地区性PHC组织。我们使用“三I”框架(利益、机构、想法)进行了新的分析，以检查为什么社区卫生系统在高收入国家没有蓬勃发展。结果：社区卫生服务为如何成为有效社区卫生系统的基础提供了见解的要素是：注重公平和可获得性、有效的社区参与/控制、多学科团队合作以及从护理到健康促进的战略。确定的关键障碍是：当全科医生(GP)被视为领导而不是团队的一部分；资助模式鼓励治疗服务而不是疾病预防和健康促进；以及专业和医疗主导地位，从而淹没了社区的声音。结论：我们对澳大利亚社区卫生系统的研究表明，在高收入国家建立这种系统需要系统的思想、政治和制度变革，以改变政府的总体政策环境，以及卫生部门的政策和做法，转向允许社区控制和多学科服务提供的卫生社会模式。
Background: Despite the value of community health systems, they have not flourished in high income countries and there are no system-wide examples in high income countries where community health is regarded as the mainstream model. Those that do exist in Australia, Canada, the United States and the United Kingdom provide examples of comprehensive primary healthcare (PHC) but are marginal to bio-medical primary medical care. The aim of this paper is to examine the factors that account for the absence of strong community health systems in high income countries, using Australia as an example. Methods: Data are drawn from two Australian PHC studies led by the authors. One examined seven case studies of community health services over a five-year period which saw considerable health system change. The second examined regional PHC organisations. We conducted new analysis using the ‘three I’s’ framework (interests, institutions, ideas) to examine why community health systems have not flourished in high-income countries. Results: The elements of the community health services that provide insights on how they could become the basis of an effective community health system are: a focus on equity and accessibility, effective community participation/control; multidisciplinary teamwork; and strategies from care to health promotion. Key barriers identified were: when general practitioners (GPs) were seen to lead rather than be part of a team; funding models that encourage curative services rather than disease prevention and health promotion; and professional and medical dominance so that community voices are drowned out. Conclusion: Our study of the community health system in Australia indicates that instituting such a system in high income countries will require systematic ideological, political and institutional change to shift the overarching government policy environment, and health sector policies and practices towards a social model of health which allows community control, and multidisciplinary service provision.
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影响因子：
2.7
作者：
Bentley, Michael;Freeman, Toby;Javanparast, Sara
通讯作者：
Javanparast, Sara
DOI：
10.1111/1753-6405.12284
发表时间：
2014-12-01
影响因子：
3.5
作者：
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通讯作者：
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