Australia has been experimenting with fundholding in primary care for nearly a decade. When the concept was floated in 1992,1-4 the debate was heavily influenced by the problems experienced in the United Kingdom with fundholding in general practice, including lack of measurement of improvement in quality of care.5 Fundholding still engenders disquiet because of its potential for a primary focus on cost savings, increased control of clinicians by management,6 and a reduction in quality of care7 and equity of access.8
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- 1. National Health Strategy. The future of general practice. Canberra: Common-wealth Department of Health, Housing and Community Services, March 1992. (National Health Strategy Issues Paper No. 3.)
- 2. Pritchard D, Beilby J. Issues for fundholding in Australian general practice. Med J Aust 1996; 164: 215-219.
- 3. Rosenthal D. Fundholding: a rural perspective. Med J Aust 1996; 164: 219-221.
- 4. Saltman D. General practice reforms: in search of the lowest common denominator. Med J Aust 1996; 164: 196-197.
- 5. Audit Commission. What the doctor ordered. A study of GP fundholders in England and Wales. London: HMSO, 1996.
- 6. Komesaroff P, Patterson C. Managed care – managed ethics? Med J Aust 2000; 172: 609-610.
- 7. Himmelstein D, Woolhandler S, Hellander I, Wolfe S. Quality of care in investor-owned vs not-for-profit HMOs. JAMA 1999; 282: 159-163.
- 8. Bevan G. Taking equity seriously: a dilemma for government from allocating resources to primary care groups. BMJ 1998; 316: 39-43.
- 9. Commonwealth Department of Health and Aged Care. The Australian Coordinated Care Trials: Final Technical National Evaluation Report on the First Round of Trials. Available at: http://www.health.gov.au/hsdd/primcare/acoorcar/pubs/index.htm (accessed February 2002).
- 10. Centre for Health Service Development. The Care Net Illawarra Coordinated Care Trial – what is was and how it was managed. Report 1 of the Final Evaluation of the Care Net Illawarra Coordinated Care Trial. Wollongong: University of Wollongong, April 2000.
- 11. National Centre for Epidemiology and Population Health. Final Report on Processes, Impacts and Outcomes in the ACT Coordinated Care (Care Plus) Trial. Canberra: Australian National University, March 2000.
- 12. Centre for Public Management and Policy. Final Report of the Careworks Local Evaluation. Hobart: University of Tasmania, March 2000.
- 13. Centre for Health Care Evaluation. Evaluation of SA HealthPlus Coordinated Care Trial, Final Report. Adelaide: Flinders University, March 2000.
- 14. University of New South Wales Consortium, Social Policy Research Centre and the Centre for General Practice Integration Studies. Local Evaluation Final Report to the National Evaluators, Linked Care Evaluation Hornsby Ku-ring-gai Coordinated Care Trial. Sydney: University of New South Wales, March 2000.
- 15. Bundoora Centre for Applied Gerontology, Final Evaluation Report Northern Eastern Coordinated Care Trial. Melbourne: La Trobe University, March 2000.
- 16. Centre for Health Program Evaluation, Report to the National Evaluator, Evaluation of the Southern Health Care Network Coordinated Care Trial, Final Report, Volume1, Executive Summary. Melbourne, Centre for Health Program Evaluation, Monash University, May 2000.
- 17. Paul Laris and Associates, Care 21, Final Local Evaluation Report, Volume 1. Adelaide: Paul Laris and Associates, January 2000.
- 18. Commonwealth Department of Health and Aged Care. The Aboriginal and Torres Strait Islander Coordinated Care Trials. National Evaluation Strategy. March 2001. Available at: http://www.health.gov.au/oatsih/pubs/coord.htm (accessed February 2002).
- 19. Maitland After Hours Primary Care Local Evaluation Final Report. Available at: http://www.hudgp.org.au/reports/afthrcare-ecoeval/index.asp (accessed February 2002).
- 20. Campbell H, Moss J, Beilby J, Pratt N. Shared Obstetric Care Business Plan Project. Adelaide: Department of General Practice, Adelaide University, October 2000.
- 21. Ware JE, Sherbourne DC. The MOS 36-Item Short-Form Health Survey SF-36: I. Conceptual framework and item selection. Med Care 1992; 30: 473-483.
- 22. Beilby J. GP clusters make economic and practical sense. General Practice Evaluation Program Conference Proceedings, Melbourne, May 1998. ISBN 1-875913149.
- 23. Malcolm L, Mays N. New Zealand's independent practitioner associations: a working model of clinical governance. BMJ 1999; 319: 1340-1342.
- 24. Bojke C, Gravelle H, Wlikin D. Is bigger better for primary care groups and trusts? BMJ 2001; 322: 599-602.
- 25. Enthoven A. Modernising the NHS. A promising start, but fundamental reform is needed. BMJ 2000; 320: 1329-1331.
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Justin Beilby was involved in the local evaluation of Health Plus, a South Australian Coordinated Care Trial. Brita Pekarsky was involved in the national evaluation of the General Coordinated Care Trials, the Aboriginal and Torres Strait Islander Coordinated Care Trials and the Maitland After Hours Trial while employed by KPMG.