Cohealth Service Cutoff — Victorian Government Cannot Ignore

On October 16, Cohealth—one of Australia’s largest community health organizations and a non-profit medical institution—announced it would close three of its clinics. The news immediately sparked widespread public debate and criticism. The affected clinics are located in Collingwood, Fitzroy, and Kensington. The Fitzroy and Kensington clinics will cease general practitioner (GP) and consultation services this December, though they will continue providing specialized support for alcohol, drug, and domestic violence issues. The Collingwood centre is scheduled for full closure next June.

The closures will directly impact approximately 12,500 patients, resulting in 20 doctors losing their jobs and 44 nurses facing reassignment or redundancy. These clinics have long provided vital primary healthcare services to low-income individuals, the homeless, refugees, domestic violence survivors, and those with chronic illnesses, serving as an indispensable health support network within the community. However, due to insufficient funding, rising costs, and operational pressures, these services are now being forced to cease.

Nicole Bartholomeusz, CEO of Cohealth, stated that the cessation of services reflects “multiple and complex pressures, including decades of underinvestment, aging infrastructure, and funding models that don’t match actual needs or the type of care required.” She noted: “The funding we receive is only sufficient to provide standard care, but we actually serve high-need patients who often require extended appointments and comprehensive case management tailored to each individual.”

Cohealth’s current Medicare subsidy only covers physician salaries, failing to account for nurses, receptionists, and other operational costs. As wages and supply costs rise, the annual gap between clinic operating expenses and Medicare funding continues to widen.

Reforms Too Late, Support Too Little

In truth, Cohealth’s predicament did not emerge suddenly but resulted from years of accumulated challenges. Although the federal Labor government has pushed Medicare reforms in recent years to enhance the sustainability of the universal healthcare system—such as the upcoming Bulk Billing Practice Incentive Program (BBPIP) launching November 1st, which will expand Medicare coverage, encourage clinics to maintain bulk billing, and provide additional funding for facility upgrades and team expansion— This initiative aims to improve access and affordability of healthcare services, with approximately 4,800 clinics expected to benefit.

However, for Cohealth, this reform appears to have come too late. The root problem lies not solely at the federal level, but in the Victorian government’s long-standing neglect of the actual health needs within grassroots communities. The poverty, homelessness, addiction, and trauma issues plaguing local communities have long exceeded the capacity of standard clinics. Yet the Victorian government has failed to provide additional support or establish stable funding mechanisms to sustain non-for-profit healthcare providers.

Cohealth identifies two primary causes for the current crisis: First, insufficient Medicare funding from the federal government for managing complex patients; Second, the Victorian government has failed to fund upgrades for the aging facilities at the Collingwood clinic.

Cohealth has repeatedly called for government support over the years. As early as 2022, Cohealth issued a statement noting that while they supported the government’s health-focused budget, the community health model—which played a critical role during the pandemic—was once again being overlooked. At that time, Cohealth emphasized the need for comprehensive investment across the entire healthcare sector to strengthen the health system as a whole.

The clinic’s facilities have long been outdated, with roof leaks forcing appointment cancellations. Despite multiple funding applications to authorities over the years, no substantive response has been received. Infrastructure Victoria’s report highlights that government funding for community services is fragmented and inadequate. The federal government has yet to establish dedicated funding for community health infrastructure. Even though the Australian government allocated $117 billion to health and medical services for 2024-25, community health organizations received only 0.3% of Victoria’s annual health infrastructure expenditure of approximately $2 billion.

Amid chronic funding shortages and sluggish government reforms, the state government’s disregard for community needs and inaction ultimately sealed the fate of these clinics. This underscores the state government’s core responsibility in ensuring the continuity of primary healthcare services.

Who is accountable for healthcare quality and service delivery?

In fact, community healthcare systems did not originate from government initiatives but from charitable and faith-based traditions. Early hospitals were often founded by churches or charitable organizations with a simple mission: to provide basic care to the poor and vulnerable through empathy and compassion. Healthcare then embodied social conscience rather than being a product of policy or systems.

As society modernized and public health concepts emerged, governments gradually assumed responsibility, incorporating health into the realm of “public duty.” The original intent behind this shift was noble—to ensure equal access to healthcare for all. Yet the process of institutionalization and bureaucratization introduced new challenges: the original “people-centred” care became diluted by layers of administrative procedures and economic logic. Healthcare services increasingly emphasized efficiency and output, gradually losing its human warmth.

Non-profit medical institutions like Cohealth represent a continuation of this historical trajectory. They uphold the founding spirit of charitable healthcare—serving vulnerable communities while upholding the belief that everyone deserves the right to health and equal access to medical care. Yet in reality, these organizations rely on government subsidies and unstable funding sources to sustain their operations.

The contradiction lies in the fact that as societies grow wealthier, public healthcare systems should be better equipped to protect the vulnerable. Yet the opposite occurs: medical costs rise relentlessly, resource distribution grows increasingly unequal, and healthcare services become ever more commoditized. In this environment, doctors are forced to complete consultations within “six-minute appointments,” nurses and receptionists operate at breaking point, and patients slip through the cracks of the system, overlooked.

Yet when reflecting on responsibility, the question may extend beyond “Who is to blame?” to “Where should healthcare be headed?”

Should we pursue the endless quest to “cure every disease”? Or should we return to healthcare’s fundamental purpose—ensuring everyone accesses basic health protection?

When the wealthy pay more for faster, better care while the poor endure long queues, has the ideal of equality already been swallowed by market logic?

Take Hong Kong, for instance. As a low-tax society, its citizens enjoy public healthcare at minimal cost—subsidized for life simply by holding a Hong Kong ID card. However, with an aging population and healthcare staff shortages, the public system has been chronically overburdened, leading to months-long waits for emergency rooms and specialist appointments. Consequently, the affluent middle and upper classes turn to private clinics, trading money for efficiency. This creates a healthcare system that appears equitable on the surface but is fundamentally stratified: the government guarantees access to services but not equal speed or quality. In other words, everyone has the right to medical care, but whether you can get better quickly and where you receive treatment depends on how much money you have.

Canada’s public healthcare system, meanwhile, is more idealistic. All residents can access free public healthcare with a health card, free from concerns about high costs. However, long waiting times and uneven resource distribution transform “free” into another form of “cost.” When demand far exceeds supply, fairness and accessibility inevitably clash.

Moreover, should healthcare prioritize “universal access” or ‘quality’? Should governments provide “basic care” or “comprehensive coverage”?

Comparisons with China, Hong Kong, and Taiwan

From an international perspective, Australia’s public healthcare system (Medicare) differs significantly from those in mainland China and Taiwan, each with distinct advantages and disadvantages. Mainland China’s system, dominated by public hospitals, subsidizes basic care through social medical insurance (urban employee/resident insurance). However, due to its massive population and concentration of medical resources in major cities, primary community clinics often struggle to handle high-demand patients—particularly low-income groups and those with chronic conditions. This mirrors Cohealth’s current situation: “resource concentration leading to overflowing demand.”

Taiwan adopted a National Health Insurance (NHI) model emphasizing “one health insurance card, nationwide healthcare coverage,” ensuring basic medical services for all regardless of urban/rural location or income level. NHI strengthens primary care clinics through subsidies and incentives, stabilizing the family doctor system. Nevertheless, disparities in healthcare resource distribution between urban and rural areas persist, and wait times for specialist care can remain excessively long.

In contrast, Australia’s Medicare system pursues fairness and accessibility in theory. Yet in practice, non-profit primary care institutions face chronic funding shortages and aging facilities. While serving predominantly vulnerable populations, these clinics often shoulder service volumes exceeding subsidy coverage. This structural contradiction creates a significant gap between the system’s ideals and its actual service capacity, highlighting a common challenge faced by vulnerable groups under different systems: even with “systemic safeguards,” they may still be marginalized due to inadequate resource allocation.

Australia’s Core Healthcare Contradiction

Returning to Australia itself, the core issue of its healthcare system isn’t a lack of total funding, but rather structural contradictions arising from resource allocation, institutional design, and policy priorities. Medicare is primarily designed for “standard medical services” such as general consultations, basic tests, and medications. However, it does not provide corresponding subsidies for the time, labour costs, and interdisciplinary integrated care required for high-need or complex patients. This leaves vulnerable groups unable to access truly comprehensive healthcare under the existing system.

Non-profit community clinics like Cohealth exist precisely to fill this gap. They offer extended consultations, case management, mental health counselling, addiction and domestic violence support, and even multidisciplinary integrated programs—services standard GP clinics struggle to provide. However, these intensive services are not fully subsidized by Medicare. Combined with limited state investment in primary care infrastructure, clinics face chronic financial strain, ultimately forcing service reductions or partial closures.

Cohealth’s partial closures reflect a deep-seated contradiction within Australia’s healthcare system: equity and accessibility do not equate to substantive care guarantees for high-need populations. While everyone ostensibly has the right to medical care, those requiring prolonged attention and individualized management often survive only by navigating systemic gaps. The institutional design itself thus creates an “invisible inequity” for high-need patients.

Australia’s healthcare also grapples with the dilemma of balancing universal coverage and quality. On one hand, the system must ensure everyone receives at least basic treatment; on the other, complex patients require sufficient time, specialized support, and case management. In reality, however, insufficient government funding and a narrow subsidy structure make achieving both goals difficult. Doctors are forced to rush through consultations, nurses and receptionists operate at capacity, while vulnerable patients languish on waiting lists. Non-profit clinics like Cohealth strive to fill these gaps, but persistent financial pressures and policy constraints render “humanized healthcare” a luxury in practice.

In other words, the core issue with Australia’s public healthcare system isn’t merely about assigning responsibility, but whether the system can return to its founding principle: ensuring everyone accesses basic healthcare while providing high-need patients with adequate resources and compassionate support when required. Cohealth’s predicament serves as a stark warning: without structural adjustments to resource allocation by government and society, the ideal of fairness remains unattainable, and vulnerable groups will continue to be marginalized by the system.

The Victorian Government’s Indisputable Responsibility

While medical policy is set by the federal government, state governments bear responsibility for implementing it according to local realities. Cohealth’s inner-city service area has a population receiving government living subsidies that exceeds the Australian average by more than double, indicating many residents cannot afford private services. The Victorian Government’s refusal to provide financial support to institutions like Cohealth demonstrates a disregard for vulnerable communities.

A similar situation exists in elder care for multicultural communities. While federal funding supports aged care services, research indicates that non-English-speaking seniors benefit most from living in facilities that accommodate their cultural and linguistic backgrounds. Yet, emerging senior communities like the Chinese diaspora receive minimal Victorian government assistance to build suitable aged care facilities. Since 2014, Labor leader Andrews has repeatedly proposed policies to purchase four plots of land for the Chinese and Indian communities to build elderly care facilities. Yet to this day, the Victorian Department of Health continues to leave these sites vacant, failing to hand them over to community organizations to develop services. This demonstrates a dereliction of duty by government officials. This situation bears striking similarities to Cohealth Community Health Services ceasing operations today due to neglect. Should the Victorian Government conduct a thorough review of the Department of Health’s operations?

Editorial : Liz Li, Jenny Lun

Photo: Internet

Published in Sameway Magazine  24 October 2025