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  1. 1

    Tim Senior

    It’s worth observing that the closest we get to this sort of model in Australia currently is the Aboriginal Community Controlled health Service model. We often look at Aboriginal and Torres Strait Islander health as if it’s a special case for difficult circumstances, when perhaps we should be looking at it as the model for the rest of the Australian health service.

  2. 2

    Vern Hughes

    The misuse and abuse of the concepts of ‘person-centred’ and ‘consumer-centred’ health care are now rife. The ‘patient-centred medical home’ model, to be trialled amongst 65,000 consumers, is a good example. This is a doctor-centred model, and not a patient-centred model. Under this scheme, doctors are to be remunerated by the Commonwealth for coordinating the care of illness-specific categories of consumers, seemingly based on the rationale that there are savings to be made by restricting fee-for-service payments to multiple practitioners and replacing these by lump-sum payments to single GPs to cover multiple episodes of care. The information, payment and service design features of this model are doctor-centred. Whatever the advantages of this approach, it cannot be called anything other than a doctor-centred model.

    Hijacking the language of ‘patient-centred’ for continuations of provider-centred systems is smart manoevring by medical industry interests, but there can be excuse for governments to collaborate in this hijacking. Consumer-centred health systems are simply systems in which information systems, financing systems, service design and governance are centred in consumers and not in providers. If you have a continuation of provider-centred information systems, then you do not have a patient-centred practice. If funding systems remain under the control and direction of providers, you have a provider-centred system and not a patient-centred system.

    Contests for control of the ‘patient-centred’ language will continue for the forseeable future. We await the emergence of some political leadership in health care that can honestly distinguish between consumer-centred systems of health care and provider-centred systems.


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