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    Dr Di Natale is right – not enough attention (or money) has been given to the provision of primary care services at the community level e.g. via Community Health Centres and to Health Promotion which is also a focus for Community Health Centres. Community Health Centre staff are also able to work with other service providers to better coordinate services for people who have chronic health and/or social problems like the elderly and people with mental illness. More money and focus on this area would assist with the prevention of these people using the emergency department of Acute Care Hospitals to find the services they require. Community Health Centres also provide easier, non-stigmatised access to appropriate services for all people in that community, and not just the wealthy or confident.

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    Blended payments are nothing new. The PHCAP/Coordinated Care Trials have applied varying multiples of average Medicare per capita spending alongside fee for service reimbursements. In some cases this results in improvements, in others it does not. The key issues are organisation and infrastructure. How are we set up to provide a health service that meets a need and how can we change the determinants of poor health. Tennant Creek is an interesting example. Apparently, the health of the white population is as bad as that of the black population. I agree that prevention and primary care are a good use of resources. I’m not convinced that it should all be channelled through the health system though. (But don’t get me started on SIHIP!)


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