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Restructuring primary health care in Australia

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When appropriately resourced, medical homes can deliver the system-wide benefits of truly integrated primary care

For patients with chronic and complex conditions, optimal care involves a range of clinical skills other than those provided by doctors (eg, a social worker, a clinical nurse specialist or a home care team), some of which are generally not available through Medicare. Patients experience fracturing of their care — such as the need to obtain referrals to consult other health practitioners — and significant out-of-pocket expenses, on which Australians spent around $27.5 billion dollars in 2013–14.1

If both doctors and patients are dissatisfied2 with the current primary care system, what do we wish to offer in the future? Imperatives include a highly personalised service that improves the patient’s health literacy and capacity to better care for themselves and their dependants; continuity of care, important for early detection of problems before they become chronic and complex; the availability of in-house teams to provide most of the services required to efficiently manage chronic, complex illness; and care in a community setting for many patients who would currently be sent to hospital.

In the international setting, the evidence suggests that primary care delivered via the medical home model has been most successful…