Learning from the past to ensure effectiveness, efficiency and equity in primary health care
In the past few years, Australian primary health care (PHC) has experienced a major system restructuring that has created tensions in relation to efficiency, effectiveness and equity, fundamental concepts used to evaluate health systems performance.1 Efficiency refers to making the most of available resources to maximise output,2 effectiveness is meeting the needs of target populations and achieving objectives,1 and equity concerns fairness in the delivery of services and outcomes.1 Our analysis of Medicare Locals (MLs) provides insights into the tensions faced by PHC policy makers and Primary Health Networks (PHNs) when planning for improved population health. Between 2014 and 2015, as part of a 3-year study funded by the National Health and Medical Research Council, we conducted an online survey and 50 individual interviews with ML senior staff, which provided in-depth understanding of the challenges and opportunities for the new PHNs. The link to the online survey was sent to the chief executive officers (CEOs) of 61 MLs for distribution among senior staff and board members. To calculate the response rate, we asked CEOs to report on the number of people the survey was sent to, but we did not receive an exact number from all CEOs to calculate the response rate. However, the spread of responses was high across MLs (120 responses from 52 MLs; 86%), which shows that representatives from different MLs participated in the survey.