Bill Bowtell (Comment, April) almost hits the nail on its head when he asserts there should be one single funder (the federal government) allocating health dollars to a series of separate providers. But then he completely misses the mark with his suggestion that “the state and territory governments should be bypassed entirely”.

This proposition is unsound for many reasons. First, because it looks at the health system in isolation from its interface with other state government agencies that will remain under state administration: community services (child welfare), ageing, disability and home care, housing and education.

Second, there is an assumption inherent in the language of “primary care” that all of these community-based services are generalist, walk-in-off-the-street services, which are easily planned and administered at a local level. This is a mistaken view as many of the state-government-funded services are highly specialised, and implemented, monitored and evaluated in line with state-wide policies and procedures, which must comply with relevant state legislation. Eliminating the role of the states and territories and vesting this policy-setting authority in the Commonwealth would be problematic because of the legislative differences that such policies would need to take into account.

Finally, eliminating the role of the states and territories would impede the development of ‘supra-regional’ networks linking similar services for particular client groups.

Graham Vimpani

Newcastle, NSW