Population health performance as primary healthcare governance in Australia: professionals and the politics of performance

ABSTRACT

A range of institutional and financial instruments has been used to drive population health outcomes in primary health care in Australia. However, GP sovereignty and the corporatized nature of general practice have generated major challenges. The core of government reform strategy since 1992 has been the creation and financing of Primary HealthCare Organizations (PHCOs), in various forms, to provide an organizational basis to connect GPs to population health performance, and a closer link between the state and GPs. The shift from Divisions of General Practice, the first PHCO, to Medicare Locals (MLs) in 2011 was notable. The latter constructed the object of performance as a raft of broader population health goals, which were framed in terms of accountability to communities through public reporting. Drawing on interviews with Federal government, health professional associations, ML executives and GPs, this paper examines the ways in which such performance instruments were imagined and understood, and areas of contestation. The findings show the different rationalities at play and how different actors seek control of the policy space. They also demonstrate the political precariousness of PHCOs, and the wider difficulty of steering market-based professionals in the achievement of population health objectives.

KEYWORDS:

• Primary Health Care Organization
• general practice
• performance measurement
• population health
• governance
• health policy
• Australia

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Michele Foster is Professor of Disability and Rehabilitation Research, School of Human Services and Social Work, Menzies Health Institute Queensland at Griffith University. Her research focuses on delivery system analysis and policy implementation in the areas of disability, rehabilitation and primary healthcare.

Paul Henman is an Associate Professor of Sociology and Social Policy in the School of Social Science at the University of Queensland. His work examines the nexus between social policy, public administration and digital technologies.

Alison Gable is a Research Fellow and Project Manager at The University of Queensland. Her research interests focus on the study of complex phenomenon, social policy, professionalism and interdisciplinarity.

Michelle Denton is a Research Fellow in the School of Nursing, Midwifery and Social Work at The University of Queensland. Her research interests include the impact of policy on the service user experience in health and mental health care.

ORCID

Paul Henman http://orcid.org/0000-0002-9923-6587

Notes

1. http://www.nhpa.gov.au/internet/nhpa/publishing.nsf/Content/Our-reports.

2. http://www.health.gov.au/internet/main/publishing.nsf/Content/phn-performance.

3. GP participant (GP1–6); PHCO participants (PHCO1–3); and Strategic policy participant (SP1–4).

Additional information

Funding

This work was supported by the Australian Research Council Discovery Project Program under Grant (DP110100803). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of Australian Research Council.