title: Collaboration across private and public sector primary health care services: benefits, costs and policy implications.
abstract: Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care. It involved a case study using qualitative methods. Forty-five participants from 20 organisations were purposively recruited. Data were collected through semi-structured interviews and from content analysis of documents. Thematic analysis was used employing a two-level coding system and cross case comparisons. The patterns of collaborative patient care were influenced by a combination of factors relating to the benefits and costs of collaboration and the influence of support mechanisms. Benefits lay in achieving common or complementary health or organisational goals. Costs were incurred in bridging differences in organisational size, structure, complexity and culture. Collaboration was easier between private sector organisations than between private and public sectors. Financial incentives were not sufficient to overcome organisational barriers. To achieve more coordinated primary and community health care structural changes are also needed to better align funding mechanisms, priorities and accountabilities of the different organisations.
authors.affiliation: Centre for Primary Health Care & Equity, University of New South Wales, Sydney, Australia. j.mcdonald@unsw.edu.au
authors.forename: Julie
authors.initials: J
authors.lastname: McDonald
authors.forename: Gawaine
authors.initials: G
authors.lastname: Powell Davies
authors.forename: Rohan
authors.initials: R
authors.lastname: Jayasuriya
authors.forename: Mark
authors.initials: M
authors.lastname: Fort Harris
mesh_terms: D002908:Chronic Disease; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated; D003924:Diabetes Mellitus, Type 2; D005246:Feedback; D017048:Health Care Costs; D006291:Health Policy / Q000191:economics* / Q000639:trends; D006801:Humans; D007400:Interprofessional Relations; D009937:Organizational Objectives; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D017149:Private Sector / Q000191:economics* / Q000458:organization & administration; D017150:Public Sector / Q000191:economics* / Q000458:organization & administration; D036301:Qualitative Research