Making the connection: a qualitative study of brokerage in Aboriginal health in a metropolitan area of Victoria and a regional area of New South Wales

Abstract

Objective. Health brokerage is one method being employed by government health agencies in an attempt to improve Aboriginal and Torres Strait Islander people’s access to primary healthcare. This qualitative study explores key stakeholders’ understanding and acceptance of the health brokerage model, prior to the implementation of brokerage services. Methods. Semistructured interviews and focus groups were conducted with key stakeholders. The resulting data was analysed using a grounded theory approach. Results. Qualitative analysis of the interviews and focus groups revealed five major themes. These were: (1) the perceived limitations of brokerage as a service delivery model; (2) the benefits of health brokerage such as increased flexibility; (3) issues relating to patient independence; (4) the necessity for broker independence; and (5) a mistrust of health brokerage and the authority handling the brokerage funds. Conclusions. Since this study was conducted in 2008, ongoing funding for urban brokerage services has been suspended. Although the reasons for this are unclear, our study suggests that barriers to the acceptance of brokerage services by the community may have existed even before such services were implemented, thus highlighting the need for transparency when launching new health initiatives that hope to engage the Aboriginal community. What is known about the topic? Brokerage models have previously been described in the areas of mental health and aged care. In these examples, brokerage agencies have provided patients with a key entry point into the healthcare system. Benefits of the brokerage model, such as flexibility, have been contrasted with its limitations, such as a heavy reliance upon existing services. What does this paper add? This paper provides insight into the acceptability of health brokerage, as a service delivery model, to the Aboriginal community. Although findings from the study reinforce many of the benefits and limitations already described in the literature, they also introduce the new and important themes of patient empowerment and mistrust. What are the implications for practitioners? This study provides vital information about community perceptions of health brokerage. It is important that policy makers take heed of such insights when planning attempts to close the gap in Aboriginal health.