Search results

Comprehensive primary health care (PHC) models are seldom implemented in high income countries, in part due to their contested legitimacy in neoliberal policy environments. This article explores how merging affected the perceived legitimacy of independent community health organisations in Victoria, Australia, in providing comprehensive PHC services.

A longitudinal follow-up study (2–3 years post-merger) of two amalgamations among independent community health organisations from the state of Victoria, Australia, was conducted. This article explores the perceived effects of merging on (1) the pragmatic, normative and cognitive legitimacy of studied organisations and (2) the collective legitimacy of these organisations in Victoria's health care system. Data were collected through 19 semi-structured interviews with key informants and subjected to template and thematic analyses.

Merging enabled individual organisations to gain greater overall legitimacy as regional providers of comprehensive PHC services and thus retain some capacity to operationalise a social model of health. Normative legitimacy was most enhanced by merging, through acquisition of a large organisational size and adoption of business practices favoured by neoliberal norms. However, mergers may have destabilised the already contested cognitive legitimacy of community health services as a group of organisations and as a comprehensible state-wide platform of service delivery.

Over-reliance on individual organisational behaviour to maintain the legitimacy of comprehensive PHC as a model of organising health and social care could lead to inequities in access to such models across communities.

This study shows that organisations can manage their perceived legitimacy in order to ensure the survival of their preferred model of service delivery.

Shortly before the Second World War, a woman who had never accepted her orphan status, Gabrielle Bonheur Chanel, nicknamed ‘Little Coco’ by her father and known as ‘Coco’ to her relatives, became the first women in history to build a world-class industrial empire. By 1935, Coco, a fashion designer and industry captain, was employing more than 4,000 workers and had sold more than 28,000 dresses, tailored jackets and women's suits. Born into a poor family and raised in an orphanage, she enjoyed an intense social life in Paris in the 1920s, rubbing shoulders with artists, creators and the rising stars of her time.

Thanks to her entrepreneurial skills, she was able to innovate in her methods and in her trendsetting approach to fashion design and promotion. Coco Chanel was committed and creative, had the soul of an entrepreneur and went on to become a world leader in a brand new sector combining fashion, accessories and perfumes that she would help shape. By the end of her life, she had redefined French elegance and revolutionized the way people dressed.