This paper provides an analysis of the national Indigenous reform strategy – known as Closing the Gap – in the context of broader health system reforms underway to assess whether current attempts at addressing Indigenous disadvantage are likely to be successful.

Drawing upon economic theory and empirical evidence, the paper analyses key structural features necessary for securing system performance gains capable of reducing health disparities. Conceptual and empirical attention is given to the features of comprehensive primary healthcare, which encompasses the social determinants impacting on Indigenous health. An important structural prerequisite for securing genuine improvements in health outcomes is the unifying of all funding and policy responsibilities for comprehensive primary healthcare for Indigenous Australians within a single jurisdictional framework. This would provide the basis for implementing several key mutually reinforcing components necessary for enhancing primary healthcare system performance.

The announcement to introduce a long-term health equality plan in partnership with Aboriginal people represents a promising development and may provide the window of opportunity needed for implementing structural reforms to primary healthcare.