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Key Topics
Write and essay on "Reforming the Australian Health Care System".
Part 1:
Using the WHO Health Systems Framework, provide a brief overview of Australia’s health care system.
Part 2:
Describe and discuss the most significant challenges currently confronting the Australian health care system.
Part 3:
Critically assess major barriers and enablers involved in responding to these challenges.
Introduction
The healthcare system of Australia is unique and has been shaped by the colonial history of the nation. The very first hospitals created in the country were by the colonial administrations and were shaped by the political principles and beliefs. Public funding, private funding and national and state governments all play a critical role in delivering healthcare to the Australians, and all of them are covered by this national, standard, tax financed scheme of healthcare insurance known as Medicare(Hall, 2015).
This Medicare scheme introduced in 1984 covers and ensures universal access to the free treatment in the public hospital and allows for subsidies in the medical services. Under half of the Australians have insurance for private hospitals, which provides a cover towards the treatment from private hospitals which are more focused on conducting elective procedures. Australia also has a Pharmaceutical Benefits Scheme which provides extensive subsidies for consumers who are discouraged from buying medications purely due to their price(Australian Institute of Health and Welfare, 2012). Though the structure is complex, still it has better outcomes than the OECD average. As per the study by Duckett, the system is effective but not perfect (Duckett, 2017).
Building from this, the purpose of this paper is to conduct an overview of the Health Care system of Australia, and identify the present challenges which dominate the national health care system. Subsequently, the major barriers and the enables will also be identified in response to such challenges. The main aim of this paper is to analyze the overall healthcare system and identify opportunities through which the system can be reformed and improved further.
This Medicare scheme introduced in 1984 covers and ensures universal access to the free treatment in the public hospital and allows for subsidies in the medical services. Under half of the Australians have insurance for private hospitals, which provides a cover towards the treatment from private hospitals which are more focused on conducting elective procedures. Australia also has a Pharmaceutical Benefits Scheme which provides extensive subsidies for consumers who are discouraged from buying medications purely due to their price(Australian Institute of Health and Welfare, 2012). Though the structure is complex, still it has better outcomes than the OECD average. As per the study by Duckett, the system is effective but not perfect (Duckett, 2017).
Building from this, the purpose of this paper is to conduct an overview of the Health Care system of Australia, and identify the present challenges which dominate the national health care system. Subsequently, the major barriers and the enables will also be identified in response to such challenges. The main aim of this paper is to analyze the overall healthcare system and identify opportunities through which the system can be reformed and improved further.
Analysis
Overview of Australia’s Health Care System
The World Health Organization has in place a systems framework which facilitates in understanding the various aspects of an adequate system of care. A sufficient health care system, as per WHO is built on six building blocks and these blocks ascertain that organizations, individuals and actions are all aligned together to promote, to restore and to maintain health(WHO, 2018). The six building blocks of a health care system framework promoted by WHO are as follows – effective health services which aim at delivering safe, quality and effective interventions to individuals who needs them with the minimum resource wastage; an effective workforce which operates in responsive, fair and efficient manner to promote the best of health; an efficient health information system (HIS) which ascertains provision of accurate and timely information of performance of health systems, status and determinants; an adequate access to the essential medical products, technologies and vaccines; effective health financing system which helps in providing required funds and lastly governance and leadership (WHO, 2007).
Governance / Leadership
The healthcare in Australia is governed by both government organizations and the private healthcare institutions. The Australian government focuses on the national policy of health along with key elements namely, the operation and management of hospitals done by the state governments. Medicare is the system which dominates the Australian healthcare and it is publicly tax funded which is applicable for all individuals in Australia, and along with this private health systems also exist.
Along with Medicare exists the PBS or the Pharmaceutical Benefits Scheme which provides medication at subsidized costs to the patients and this level of subsidy depends on the income level of the users. The Therapeutic Goods Administration is another regulatory body which provides medical devices and medicines in Australia and for the borders; the health is administered by the Australian Quarantine and Inspection Service. AIHW or the Australian Institute of Health and Welfare is the national governing body for the welfare and health statistics and information.
Financing of Health Care
Medicare is the national health care system which is publicly funded, and this takes care of the cost of the health services, specifically in public hospitals. Medicare is funded partially by a 2% Levy of Medicare, with exceptions for the low income generators and any gap if present is met with the general revenue of the government. This Medicare includes the health costs of the patients, concessions and also in certain cases further benefits. The government expenditure on the healthcare is approximate 67% of the total where the average of OECD countries is higher than such (Newswire, 2015). Often situations arise, when the whole cost is not covered by Medicare, and the rest is known as the Out of Pocket costs which are paid by the patient. Australian government charges a levy of 1% charge on high income earners who do not possess health insurance. Australian nationals can further take out health insurance, to cover such out of pocket costs and the government encourages individuals of high income to take out private health insurance and this private health insurance are provided by health funds. Medi-bank is the largest health fund with over 30% market share. Australian government has in place a number of incentives to encourage individuals take private health insurance namely – Lifetime health cover, surcharge of Medicare levy, rebate of private health insurance etc.
Workforce
The Healthcare workforce of Australia is efficient, knowledgeable and experienced. The government of Australia and individual state governments diligently follow the Workplace Safety and Health principles which promote a safe and productive workplace and workforce. The healthcare workforce delivers services through public and private organizations and combined, more than 1 million individuals are employed in the delivery of such welfare and health services in Australia. As per a report published by the Health Workforce Australia in 2012, shortage of doctors, nurses was predicted in the year of 2025 (Health Workforce Australia, 2012). As per a report published by Australian Productivity Commission Research Report, the country is experiencing shortages of talented workforce over a number of health professions in spite of a growing reliance on the overseas trained professionals of health (Productivity Commission Research Report, 2015). These shortages are more acute in rural and special needs sectors. It is very important to increase the effectiveness and efficiency of the available workforce in health and improvement must be achieved in its distribution around the country. The demand is likely to increase in future, and hence, this is one sector which Australian Health Industry needs to focus its attention in.
Technologies / Medical Products
Australia’s health care sector understands the importance of embracing technology in effectively dealing with the complex health issues, and hence invests significantly on obtaining highest technological solutions for improving its healthcare. As per a report by Healthcare Global, Australia is intending to invest $ 13 million in obtaining new technologies to support individuals with long term issues of mobility and chronic back pain (Sturman, 2017). It is part of its $ 500 billion BTF or the Biomedical Translation Fund, which will be dedicated on improving the healthcare industry and the research for clinical testing, building prototypes and other requirements.
The World Health Organization has in place a systems framework which facilitates in understanding the various aspects of an adequate system of care. A sufficient health care system, as per WHO is built on six building blocks and these blocks ascertain that organizations, individuals and actions are all aligned together to promote, to restore and to maintain health(WHO, 2018). The six building blocks of a health care system framework promoted by WHO are as follows – effective health services which aim at delivering safe, quality and effective interventions to individuals who needs them with the minimum resource wastage; an effective workforce which operates in responsive, fair and efficient manner to promote the best of health; an efficient health information system (HIS) which ascertains provision of accurate and timely information of performance of health systems, status and determinants; an adequate access to the essential medical products, technologies and vaccines; effective health financing system which helps in providing required funds and lastly governance and leadership (WHO, 2007).
Governance / Leadership
The healthcare in Australia is governed by both government organizations and the private healthcare institutions. The Australian government focuses on the national policy of health along with key elements namely, the operation and management of hospitals done by the state governments. Medicare is the system which dominates the Australian healthcare and it is publicly tax funded which is applicable for all individuals in Australia, and along with this private health systems also exist.
Along with Medicare exists the PBS or the Pharmaceutical Benefits Scheme which provides medication at subsidized costs to the patients and this level of subsidy depends on the income level of the users. The Therapeutic Goods Administration is another regulatory body which provides medical devices and medicines in Australia and for the borders; the health is administered by the Australian Quarantine and Inspection Service. AIHW or the Australian Institute of Health and Welfare is the national governing body for the welfare and health statistics and information.
Financing of Health Care
Medicare is the national health care system which is publicly funded, and this takes care of the cost of the health services, specifically in public hospitals. Medicare is funded partially by a 2% Levy of Medicare, with exceptions for the low income generators and any gap if present is met with the general revenue of the government. This Medicare includes the health costs of the patients, concessions and also in certain cases further benefits. The government expenditure on the healthcare is approximate 67% of the total where the average of OECD countries is higher than such (Newswire, 2015). Often situations arise, when the whole cost is not covered by Medicare, and the rest is known as the Out of Pocket costs which are paid by the patient. Australian government charges a levy of 1% charge on high income earners who do not possess health insurance. Australian nationals can further take out health insurance, to cover such out of pocket costs and the government encourages individuals of high income to take out private health insurance and this private health insurance are provided by health funds. Medi-bank is the largest health fund with over 30% market share. Australian government has in place a number of incentives to encourage individuals take private health insurance namely – Lifetime health cover, surcharge of Medicare levy, rebate of private health insurance etc.
Workforce
The Healthcare workforce of Australia is efficient, knowledgeable and experienced. The government of Australia and individual state governments diligently follow the Workplace Safety and Health principles which promote a safe and productive workplace and workforce. The healthcare workforce delivers services through public and private organizations and combined, more than 1 million individuals are employed in the delivery of such welfare and health services in Australia. As per a report published by the Health Workforce Australia in 2012, shortage of doctors, nurses was predicted in the year of 2025 (Health Workforce Australia, 2012). As per a report published by Australian Productivity Commission Research Report, the country is experiencing shortages of talented workforce over a number of health professions in spite of a growing reliance on the overseas trained professionals of health (Productivity Commission Research Report, 2015). These shortages are more acute in rural and special needs sectors. It is very important to increase the effectiveness and efficiency of the available workforce in health and improvement must be achieved in its distribution around the country. The demand is likely to increase in future, and hence, this is one sector which Australian Health Industry needs to focus its attention in.
Technologies / Medical Products
Australia’s health care sector understands the importance of embracing technology in effectively dealing with the complex health issues, and hence invests significantly on obtaining highest technological solutions for improving its healthcare. As per a report by Healthcare Global, Australia is intending to invest $ 13 million in obtaining new technologies to support individuals with long term issues of mobility and chronic back pain (Sturman, 2017). It is part of its $ 500 billion BTF or the Biomedical Translation Fund, which will be dedicated on improving the healthcare industry and the research for clinical testing, building prototypes and other requirements.
Research & Information
The key to an effective healthcare sector is research and information management which the Australian health care sector possesses in the form of Healthcare Information Management. The health information managers (HIM) help in planning, managing and sustaining the health information systems including the patient records, the clinical data, the administrative information etc. This system is made up of two components – the HIMs and the clinical coders and this system has become the heart of the entire health care landscape and brings together components of – documentation, data collection, dissemination, planning and initiatives of e-health (HealthTimes, 2016).
Apart from these, central databases exist which take care of the health information systems, namely, Medicare databases, cancer registers etc. As per Australian Government, a trend is now observed to shift the health information systems and in creating electronic records of health and this sharing and linking of information pertaining to health has the scope of achieving better private and public health outcomes by allowing the providers of health service gain better access to such information. However, this also gives rise to concerns of privacy of data and confidentiality issues. The Australian government aims to create a health information system which does not require legislative control but are in accordance to the Privacy Act. The Government proposes to create a SEHR (Shared Electronic Health Records) based on a system of UHI (Unique Healthcare Identifiers) which is to be developed separately (ALRC, 2018).
Delivery of Service
As per a report by OECD which evaluated the health care systems of nations under its governance, it was found that Australia’s health care is of remarkable quality in spite of operating in a complex set of institutions which could have made the patient care difficult. Though complications can arise from the split of control state and federal government has to its funding and responsibilities, the quality of services provided and the care is of high efficiency and quality(Australian Institute of Health and Welfare, 2016). The complications which may arise in healthcare would be presented in the subsequent segments of this paper.
Overall, the Australian health system is effective and efficient, facing challenges in keeping up with its workforce demands and in the overall system in which it operate.
Apart from these, central databases exist which take care of the health information systems, namely, Medicare databases, cancer registers etc. As per Australian Government, a trend is now observed to shift the health information systems and in creating electronic records of health and this sharing and linking of information pertaining to health has the scope of achieving better private and public health outcomes by allowing the providers of health service gain better access to such information. However, this also gives rise to concerns of privacy of data and confidentiality issues. The Australian government aims to create a health information system which does not require legislative control but are in accordance to the Privacy Act. The Government proposes to create a SEHR (Shared Electronic Health Records) based on a system of UHI (Unique Healthcare Identifiers) which is to be developed separately (ALRC, 2018).
Delivery of Service
As per a report by OECD which evaluated the health care systems of nations under its governance, it was found that Australia’s health care is of remarkable quality in spite of operating in a complex set of institutions which could have made the patient care difficult. Though complications can arise from the split of control state and federal government has to its funding and responsibilities, the quality of services provided and the care is of high efficiency and quality(Australian Institute of Health and Welfare, 2016). The complications which may arise in healthcare would be presented in the subsequent segments of this paper.
Overall, the Australian health system is effective and efficient, facing challenges in keeping up with its workforce demands and in the overall system in which it operate.
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Place Your OrderChallenges which presently confronts the Australian Health care system
The challenges which were identified while conducting the overview of the Australian Health Care system are mentioned as follows. Primarily, it was identified that Australia’s healthcare is governed by both federal and state government. This fragmentation can lead to a discontinuity in the patient care, and can also lead to duplication of services along with leaving of gaps in the provision of care. As different levels of governments are supervising the medical aspect, this can lead to several impediments namely, poor transfer of the health information, difficulties for patients in navigating the health system etc. Along with this, as the medical services are also provided in a mix of public and private sectors, this can create complexities in the system.
Secondly, another challenge which was identified was the growing pressure of trained and efficient workforce. With an aging population and growth of chronic diseases, Australian healthcare would require a vast number of registered and trained doctors and nurses to meet the demands of 2025 as per the report published by Health Workforce Australia (Health Workforce Australia, 2012). Along with this, a subsequent challenge is in meeting and providing for efficient and trained workforce in the rural areas of Australia which lacks such trained infrastructure to an extent.
Thirdly, as per Catherine King, a federal member of Ballarat, there exists health disparities between the indigenous population of Australia and the non-indigenous. Namely, the Torres Strait Islander individuals and the Aboriginals experience higher problems of ill health which are almost 2.5 times in comparison to other Australians of different origins. As per a 2014 report it was found that, the system of healthcare proves to be very difficult for navigation and understanding for certain people. Individuals with physical disabilities hailing from rural and remote areas have difficulties in accessing health services (Catherine King, 2016).
Secondly, another challenge which was identified was the growing pressure of trained and efficient workforce. With an aging population and growth of chronic diseases, Australian healthcare would require a vast number of registered and trained doctors and nurses to meet the demands of 2025 as per the report published by Health Workforce Australia (Health Workforce Australia, 2012). Along with this, a subsequent challenge is in meeting and providing for efficient and trained workforce in the rural areas of Australia which lacks such trained infrastructure to an extent.
Thirdly, as per Catherine King, a federal member of Ballarat, there exists health disparities between the indigenous population of Australia and the non-indigenous. Namely, the Torres Strait Islander individuals and the Aboriginals experience higher problems of ill health which are almost 2.5 times in comparison to other Australians of different origins. As per a 2014 report it was found that, the system of healthcare proves to be very difficult for navigation and understanding for certain people. Individuals with physical disabilities hailing from rural and remote areas have difficulties in accessing health services (Catherine King, 2016).
Major barriers & Enablers involved in responding to such challenges
The Australian healthcare system is an efficient and effective one, but repeatedly it has been commented by different studies, articles, that the structure is fragmented and complex(Duckett, 2017). And this structure issue only acts as a major barrier in responding to the challenges mentioned in the aforementioned segment. As per the “Commonwealth Fund’s International Health Policy”, Australia has the 2nd ranked healthcare system amongst 11 nations right after United Kingdom, and the study ranks Australia best on outcomes of health and efficiency.
The barriers to the challenges are – fragmented system of healthcare and governing of the same sector by both federal and state governments, disparities in the health of the aboriginal and Torres Strait Islander individuals and the other Australians, lack of infrastructure for these aboriginal individuals who cannot navigate through the complex healthcare system and thereby cannot leverage on the advantages of it, the growing shortfall in trained healthcare personnel in the remote areas and in overall Australian health sector etc.
The enablers which can help reduce the mentioned challenges are primarily to reduce such fragmentation and promotion of integrated services. As per the report by OECD, Australia should aim at developing a core national approach to performance and quality. The governance should be on the Federal government and the latter should be responsible for steering the funding, policies and priority setting. The individual states on the other hand, should adopt a more strengthened role of healthcare providers, and should bear the responsibility for providing effective primary care and should align their individual services with community and hospital care. The centre should adopt a more strategic function and this shall help in strategic development of the health at remote levels, regional levels and national levels (Australian Institute of Health and Welfare, 2016). This would also promote the innovation quotient and place importance on developing the healthcare infrastructure overall Australia including the remote areas as well.
Initiatives must be taken to reduce the disparities which exist between the aboriginals and Torres Strait individuals in comparison to other Australians. Ideally, specific health strategies must be developed to only focus on this category of individuals, and help must be provided to help them leverage on the host of medical facilities they would receive. Along with this, recruitment drives and special selection programs must be developed to help meet the growing demands of the healthcare sector for nurses and doctors. As per a report by PwC, five strategies were identified which would help Australia further improve their healthcare and bring about an overall reform. These are – empowerment of consumers and encouraging the Australians to take greater responsibilities of their health by improving the transparency and health literacy; prevention and wellness by placing importance on prevention measures and focus on areas of prescriptive analysis to help prioritizing interventions and planning of catchment areas; integration of funding and management, which focuses on moving to a single government funding instead of fragmented system and elimination of duplication and bureaucratic cost building; developing optimizing care pathways which will help in providing a basis for private and public reinvestment in a system which is more efficient and which consists of multidisciplinary approach to integrated care and lastly developing networks of information pertaining to health in order to empower the consumers, improve the outcomes of patients and embrace the power of analytics while ensuring privacy issues and protection from cyber security (Bartlett, et al., 2016).
The barriers to the challenges are – fragmented system of healthcare and governing of the same sector by both federal and state governments, disparities in the health of the aboriginal and Torres Strait Islander individuals and the other Australians, lack of infrastructure for these aboriginal individuals who cannot navigate through the complex healthcare system and thereby cannot leverage on the advantages of it, the growing shortfall in trained healthcare personnel in the remote areas and in overall Australian health sector etc.
The enablers which can help reduce the mentioned challenges are primarily to reduce such fragmentation and promotion of integrated services. As per the report by OECD, Australia should aim at developing a core national approach to performance and quality. The governance should be on the Federal government and the latter should be responsible for steering the funding, policies and priority setting. The individual states on the other hand, should adopt a more strengthened role of healthcare providers, and should bear the responsibility for providing effective primary care and should align their individual services with community and hospital care. The centre should adopt a more strategic function and this shall help in strategic development of the health at remote levels, regional levels and national levels (Australian Institute of Health and Welfare, 2016). This would also promote the innovation quotient and place importance on developing the healthcare infrastructure overall Australia including the remote areas as well.
Initiatives must be taken to reduce the disparities which exist between the aboriginals and Torres Strait individuals in comparison to other Australians. Ideally, specific health strategies must be developed to only focus on this category of individuals, and help must be provided to help them leverage on the host of medical facilities they would receive. Along with this, recruitment drives and special selection programs must be developed to help meet the growing demands of the healthcare sector for nurses and doctors. As per a report by PwC, five strategies were identified which would help Australia further improve their healthcare and bring about an overall reform. These are – empowerment of consumers and encouraging the Australians to take greater responsibilities of their health by improving the transparency and health literacy; prevention and wellness by placing importance on prevention measures and focus on areas of prescriptive analysis to help prioritizing interventions and planning of catchment areas; integration of funding and management, which focuses on moving to a single government funding instead of fragmented system and elimination of duplication and bureaucratic cost building; developing optimizing care pathways which will help in providing a basis for private and public reinvestment in a system which is more efficient and which consists of multidisciplinary approach to integrated care and lastly developing networks of information pertaining to health in order to empower the consumers, improve the outcomes of patients and embrace the power of analytics while ensuring privacy issues and protection from cyber security (Bartlett, et al., 2016).
Conclusion
A sustainable and smart health care system is in the interest of all individuals, as it can enable a more empowered and informed population and they can undertake better decision making when it comes to their health, and thereby reduce the occurrence of debilitating diseases. Australia’s healthcare sector was analyzed and it was found that though the system is effective and the quality of care provided is efficient, certain challenges exist – namely, fragmented system, disparities in the health of the aboriginal and other Australians, rising demand and shortfalls in trained doctors and nurses and systematic structural issues. The strategies which will help mitigating these challenges have been also identified in this paper. The scope of the paper lies in providing a comprehensive idea to the reader about the Australian healthcare sector, and how reforms can be taken to make it further improved.
Reference
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