What roles do health care facilities and services play in achieving better

health for all Australians?

HSC - Core 1 Chapter 3

Health Care in Australia

• Health care for a long time was seen as curative.• Little thought was given to the population or the

social factors that contributed to ill health.• Health care today is a partnership between public

health initiatives and medical care.• The major causes of sickness and death relate to

lifestyle therefore the aim is to improve the quality of life through health promotion.

• Health care is the responsibility of many organisations working with the private sector.

• Health care is no longer curative but rather preventative.

Range and types of health facilities and services

• A mix of public and private provides health services in Australia.

• These services are provided by – A range of doctors– Nurses– Other health professionals– Hospitals– Clinics– Government and Non-government agencies

Public Health Services

• Cancer Screening • Immunisation

Primary care and community health care services

• Primary health care for ATSI• Dental• Community health• Ambulance and Royal Flying Doctor Service• Complementary and alternative health

services

Hospitals

• Admitted patient care• Emergency department• Outpatient care and other non admitted care

Specialized health services

• Specialist medical practitioners• Specialized mental health services• Sexual and reproductive health• Alcohol and other drug treatment services• National diabetes services scheme• Hearing services• Palliative care services • Health services in the Australian Defense Force

Responsibility for health facilities and services.

• Public Sector - The Australian Government has primary responsibility for funding services provided by GPs, medical specialists and other health practitioners that are fully or partly covered by Medicare. It also funds the Pharmaceutical Benefits Scheme (PBS), health research and Aboriginal community controlled health organisations.

• State/territory governments have primary responsibility for public hospital services, community health services, patient transport, and public health activities such as health promotion.

• Private Sector - Non-government sources of funding include the payment of out-of-pocket expenses by individuals, benefits paid by private health insurance, third party motor vehicle insurance and workers compensation insurance.

• Among the responsibilities of the non-government sector are the provision of health aids and appliances, dental services, private hospitals and medications.

Equity of access to health facilities andservices

• Access in rural and remote areas– The continued funding of the RFDS, and programs

encouraging health professionals to work in rural and remote areas, are designed to support the access needs of people in these areas and reduce health inequities.

– However, despite these increases, people in rural and remote areas still only have proportionally half the supply of medical practitioners and dentists as people in major cities

• Language support– Language support strategies, such as th

translation services provided by the NSW Multicultural Health Communication Service, are designed to remove the language and cultural barriers that prevent some people from accessing medical care. These strategies have proven particularly beneficial for overseas-born people.

• Bulk-billing through Medicare– Bulk-billing is a feature of Medicare that helps to remove

cost as a barrier to receiving medical care. – It allows certain health practitioners to directly bill

Medicare for the amount payable under the Medicare Benefits Schedule for the service provided.

– There are no out-of-pocket expenses that need to be met by the patient.

– Bulk-billing helps promote equity for people who experience socioeconomic disadvantages.

– It also allows people living on limited fixed incomes and who need to access health services more frequently, such as older Australians, to access the services they need.

• Other access issues– the prohibitive costs associated with expensive,

government-provided or privately funded facilities and services that cater for only small numbers of people

– the extensive costs in time, distance and travel borne by people living in rural and remote areas when they require diagnosis or specialist treatment that is only available in larger urban areas

– health funding limitations that do not allow for important health services, such as dentistry, to be subsidised and therefore as accessible as other services

– entrenched social and cultural issues that need to be overcome so that people in disadvantaged population groups have the knowledge, skills and confidence to adopt health-promoting behaviours and seek early intervention when needed.

Health Care Expenditure vs early intervention and prevention expenditure

• In 2005–06, Australia spent $86.9 billion on health. This represents 9 %of our gross domestic product (GDP).

• After adjusting for inflation and population growth, this figure represents a 45 %increase in health spending per person compared to 1995–96.

• Preventative services– less than 2 per cent of Australia’s spending on

health was for preventative services or health promotion. (This is a very small proportion of the overall health expenditure.)

– The health benefits include:• reduced morbidity and mortality rates• increased life expectancy• enhanced quality of life• reduced impact on carers, family and friends.

– This approach can also be a cost-effective one. When people are prevented from getting ill or injured, substantial savings are made—in treatment costs, as well as in productivity at the workplace.

– Evidence also tells us that lifestyle-related conditions are the most significant causes of sickness, injury and death.

– The effects of risk behaviours are often cumulative and develop over time, so there is merit in allocating substantial resources to preventative approaches.

• Early intervention– Over time, significant improvements have been

made in the rate of early intervention and the survival rates for many causes of sickness and death.

– Research indicates that survival rates for cardiovascular disease, cancers, respiratory diseases and injury are improving. This is due to a combination of factors, such as earlier intervention, and improved treatment and recovery programs.

Impact of emerging new treatments and technologies on health care

• New treatments and technologies offer the potential for significant improvements in health care and health status.

• Education programs that promote positive behaviours (such as self-examinations, regular screening and check-ups for at-risk groups) have contributed to improvements, there is no doubt that emerging technologies have also contributed significantly. – For example, since the 1980s, advancements have been made in the

field of medical imaging that greatly enhance the capacity to detect many health concerns, including the presence of cancer.

• A natural concern that often accompanies emerging treatments or technologies is the associated costs.– For example, in the 1990s, the cost of MRI machines was

exorbitant; to fund their purchase, larger budgets were needed or cost savings needed to be made.

• When new treatments or surgical techniques are developed, there are often significant costs associated with accessing these, and issues in how the knowledge and skills are shared among practitioners.

– The development of drugs to treat the human immunodeficiency virus (HIV) was a highly expensive process. The extensive research had to be completed quickly, so the drugs themselves are also expensive, but they are critical to the long-term survival of people with HIV. In Australia the government places them on the PBS schedule, thus subsidising most of the substantial cost.

Health Insurance: Medicare and Private

• Health care is essentially provided in Australia in one of three ways:

• through the public health care system• through private health insurance • through out-of-pocket expenses paid for by the

individual directly

• All Australians have access to health care through the public health care system, -Medicare.

• Medicare is based on: • universality ･ equity ･ simplicity.

• People can choose to have a greater range of services and other privileges made available to them by also opting to take out a private health insurance premium with any of the private providers. – Examples of private health insurers include HCF, NIB and

Medibank Private.

• People who choose to take out private health insurance remain in the public health care system and are still able to access service through Medicare.

• They are also able to purchase medications through the Pharmaceutical Benefits Scheme (PBS).

• Medicare provides all Australians— regardless of their personal circumstances—with access to adequate health care at an affordable or no cost.

• Medicare is largely funded through general taxpayer revenue that includes a 1.5 per cent Medicare levy collected from all income earners who earn above a minimum amount in Australia.

• An additional levy of 1 per cent is imposed on high-income earners who choose not to take out private health insurance or who do not have an appropriate level of private health insurance hospital cover.

• Private health insurance– After 1984 the proportion of Australians choosing to have

private health insurance declined consistently from approximately 50 per cent of the population, to a low of about 30 per cent in the late 1990s.

– Reasons for this included:• a high level of satisfaction with the range and quality of

health care available under Medicare at little or no cost• perceptions that private health insurance did not offer

value for money• views that private health insurance was mainly a

priority at certain stages of life when medical services were accessed more frequently, such as when having a baby or when approaching older age.

• To arrest this decline and to help reduce the increasing pressure placed on Medicare, the Australian Government introduced three measures to help encourage people to continue with or adopt private health insurance.

• These measures included the following:• A 30 per cent government rebate is offered on private health insurance

premiums.• A lifetime rating, which becomes applicable after the age of 30 years, was

introduced. The government imposes a 2 per cent surcharge for each year a person does not take out private health insurance after the age of 30 years. So, if a person waits until the age of 60 years to take out private health insurance, they can expect to pay a surcharge of 60 per cent on top of their annual premium each year (i.e. 2% × 30 years = 60%).

• The standard 1.5 per cent Medicare levy that is payable by all income earners was increased to 2.5 per cent for those people earning comfortable incomes who do not take out private health insurance.

• As a consequence of these measures, in 2000 there was an immediate increase in the proportion of Australians with private health insurance.

• By June 2006, the proportion of Australians with private health insurance was 43.5 per cent of the population.

• What does private health insurance cover?– There are two types of private health insurance

cover available: hospital cover and ancillary (or extras) cover.

– Hospital insurance covers all or some of the costs of hospital treatment as a private patient, including doctors’ charges and hospital accommodation.

– Ancillary cover helps with the cost of services such as physiotherapy, dental treatment and optometry.

• Why do people take out private health insurance?

– People choose to take out private health insurance for many reasons, including:

» Ancillary benefits» Treatment as a private patient in either public hospitals or

private hospitals.» Superior standard of comfort» Peace of mind» A response to chronic disease, injury or mental health

problems» To avoid having to pay a higher Medicare levy surcharge

• Out-of-pocket expenses• Private health insurance may not always cover

the total cost of the doctors’ services provided in hospital, which in turn may result in out-of-pocket expenses having to be met by the individual.

• This difference between the scheduled fee, which is the amount covered by private health insurance, and the actual cost of the service is called ‘the gap’. The gap is met by the individual.

Complementary and alternativehealth care approaches

• Reasons for growth of complementary and alternative health care products and services– Complementary and alternative health care refers to

health-related treatments and services that typically fall outside the Western medical tradition.

– Common forms of complementary and alternative health care include acupuncture; chiropractic and osteopathic services; naturopathy; and various forms of massage such as shiatsu and reiki.

– It is a $2 billion dollar industry in Australia per year.

• Being embraced by both Medicare and private health insurance increases the legitimacy of these products and services in the eyes of the consumer, and also subsidises their cost, making them more appealing and more accessible.

• Reasons for the growth of complementary and alternative health care products and services in Australia

• the inclusion of several of them in the public health care system and private health insurance.

– These services include those provided by chiropractors, osteopaths and acupuncturists. Private health insurance packages sometime cover services provided by naturopaths chiropractors, osteopaths and acupuncturists.

• Formal qualifications• Greater authenticity

– relevant professional associations, such as the Chiropractors’ Association of Australia, often have codes of ethics or industry standards that members are expected or encouraged to meet.

• Persuasive marketing campaigns– they may emphasise the use of only natural or organic

products, promote non invasive techniques, or link health improvements to enhanced connections between mind, body and spirit.

• Changes in the demographic mix.• Attitudinal changes within the medical

community.– complementary and alternative therapies are increasingly

being viewed as approaches that can work alongside traditional medical approaches rather than instead of them.

• Attitudinal changes within the wider community.

– Behavioural choices and the use of products and services that promote health are increasingly well known and generally viewed as positive. Using complementary and alternative therapies is often viewed in this way; for many people, it reaffirms their commitment to their personal health and wellbeing.

Range of products and services available

• Females were more likely than males to access services provided by complementary and alternative health professionals,

• Other less common complementary products and services include:

• traditional Chinese medicine• rehabilitation therapies• iridology• aromatherapy• the use of herbal remedies.

How to make informed consumer choices

• The increasing use of complementary and alternative health products and services in Australia, means that it is critical that measures are put in place to ensure appropriate standards are met when these products and services are delivered.

• Making informed consumer choices about complementary and alternative health products and services involves similar skills and strategies as making any consumer choice,

• What do you need to make informed decisions?– Research– Select– Reassess

Sample Exam Questions

1. Outline the range and type of health care facilities and services in Australia? (5 marks)

2. Discuss reasons why more people are choosing to use complimentary and alternative health care approaches. (7 marks)

3. Explain why some people choose to take out private health insurance. (8 marks)