Introduction: Australia is made of 6 state and 2 territories. It has one the best performing healthcare system in the world. At present, Australian healthcare system is a mix of public and private health care providers. The public health care system is funded by the government. Australia has a three tier government: the federal or commonwealth government, the state/territory government, and the local government. The health care system in Australia is complex. Given below is an overview of the system and its functions.
1. The structure of Australian Health Care System: The system of health care delivery is fragmented between different types and size of health care providers. While some public hospitals that offer super-specialty services in the country are managed by the state, others are managed by commonwealth funds. Likewise, there is ‘for profit hospitals’ and ‘not for profit’ hospitals. Based on geography, health care is fragmented into: metropolitan hospitals, community hospitals, rural hospitals, etc. (Willis, Reynolds, & Keleher, 2012)
There is a lack of uniformity in the quality of care across different health care settings. Funding is a major driver of health care infrastructure and quality. The system is highly segregated and lacks integrated activity. Though there are Medicare services, Pharmaceutical benefit schemes and public hospitals that provide equity and enable affordability to life-saving treatment, the lack of integration makes it difficult to coordinate care across different health settings ("Diagnosing Australia’s Health Care System - Australian Polity", 2016). Public care hospitals account for a major portion of the hospitals in Australia ("Australia's health system (AIHW)", 2016).
Australia healthcare receives both public and private funding. When compared to Australia, health care reforms in the U.S have led to integration of different health care providers and stakeholders ("DoctorConnect - Australia's health system – an overview", 2016). When compared to Australia, healthcare in U.K is largely funded by public bodies. The lack of uniform funding is observed across Australia health care system. While Medicare and pharmaceutical benefit scheme are funded by Commonwealth, public hospitals are funded by public funds. Private hospitals are funded by private funds. The primary health care providers like other healthcare providers, non-referenced medical services, dental services, community and public health services receive funding from miscellaneous sources and lack coordination with a central health care system ("Australia's health system (AIHW)", 2016). In fact, the health care governance is split across different private and public sector groups. There is a need to strengthen the primary health care system in the country. While hospitals may have sophisticated lifesaving technologies and other expensive services, it is the primary care providers that play an important role in the disease prevention and management of chronic diseases.
2. Funding model of Australian health care system: In 2013, health care spending in Australia accounted to $172 billion (i.e. 11.4% of the GDF). It is expected to increase in the coming years due to growing population size, and increase in the size of the aging population. Due to the segregated structure of the Australian healthcare system, the funding model is also segregated. The state and territories hold ownership for public hospital, community health centers and public health centers. They fund for public hospitals, community health centers, public health center, some public dental services, accident compensation and disability care. Private and NGO sector hold ownership for private practices, aged care centers and private hospitals. They are funded by healthcare insurance and hospital insurance. Commonwealth does not hold ownership for any health care sector, but funds some residential and community aged care, Medical benefit schemes, Pharmaceutical benefit scheme, Department of Veteran Affairs, state grants, indigenous public health centers and for 30% rebate on insurance. (Cadler, 2016)
Medicare is the backbone of national health care system. It provides affordable health care to all Australians. Pharmaceutical benefit scheme also covers all Australians. The services are provided free at the point of service. Medicare is financed by the revenue created from taxable income. There are also private health insurance providers. Competitive private insurance provides a number of added benefits like choice of hospital, doctor and time of service. Commonwealth government introduced measures like Federal government rebate, lifetime health cover and Medicare levy surcharges. These measure help to balance out the insurance between public and private providers. ("Health Care Funding In Australia | Health Insurance Consultants Australia", 2016)
Unlike in U.S, a bewildering array of funding programs are present in Australia. The eligibility, accountability and requirements of these program are variable. It is often confusing, even for an experienced healthcare provider to known the services that are eligible for funds. In U.S, the funding of health care is integrated into the care setting. The system is more organized and easy to manage than the Australian funding system. As the system is integrated, there is less chances of duplication of funds. Further, it is easy to identify the gaps and fund for the sectors that are in need of resources. (Lin, Smith, & Fawkes, 2014)
3. Health care outcomes: Advances in technology has been a major driver of healthcare change. It has created an opportunity for collecting data and standardizing health care information. Technology has also facilitated improvement in efficiency of Australian healthcare system. A number of health outcomes have improved, while others require improvement. Life expectancy in Australia is 82.2 years and this is the 6th highest among OCED countries (OECD.org, 2015). The cancer survival rate is highest in Australia, when compared to other countries. Australia has the lowest tobacco consumption rate. Healthcare expenditure is almost similar to other OCED countries (OECD.org, 2015). Vaccination rates in the country have improved. The present challenges that healthcare faces are the increasing number of aging population and increase in chronic diseases trends. In the coming years, Australia will have to face the challenge of increasing chronic diseases and the increasing cost of health system. The out of pocket expenditure for health care is highest in Australia, when compared to other U.S and OCED countries (OECD.org, 2015). This is because of the lack of a uniform integrated system. In U.S, the payment is taken care by the health insurance and the out of pocket expenditure is very low. On a comparative scale, Australia is doing good in many spheres of health. A significant gap is noticed in the health outcome of indigenous and rural people when compared to urban setting. Likewise, mental diseases, use of cholesterol-lowering drugs, use of antibiotics and antidepressant are on the rise. (AIHW, 2016)
4. Health care policies and the social impact of health care delivery to indigenous populations or minorities groups: Minorities and indigenous people are more likely to lack an insurance coverage when compared to other Australians. This can limit their access to health care system. Many from this underserved groups, belong to low socio-economic category and thus, could not afford the benefits of healthcare ("Social determinants and the health of Indigenous peoples in Australia – a human rights based approach | Australian Human Rights Commission", 2016). For these reasons, indigenous and minorities in Australia experience poor health outcomes when compared to rest of the group. A similar trend is seen in other developed countries as well. This is largely due to poor educational level and socio-economic status of the group. Differences in cultural practices and lack of cultural sensitivity of modern medical practice, could also discourage them from benefiting from opportunities provided by Australian healthcare system. Poor infant health, poor nutrition status, high-risk behavior like smoking, alcohol, and chronic diseases with poor outcomes, are high among the indigenous people (Duckett, 2011).
The indigenous people’s health policy in Australia is guided by National Strategic Framework for Aboriginal and Torres Strait Islander Health-2003-2013. The policy recognizes the ‘physical, spiritual, cultural, emotional and social well-being, community capacity and governance’ of these people, as a way to improve health care access. Human right consideration is key to addressing social determinants of health in the indigenous and minority group. The United Nations, Common Understanding of a Human-Rights Based Approach to Development Cooperation, emphasize people as key players in their own development, rather than passive recipients of services or commodities. Therefore, strategies that will empower people and encourage them to participate are required. Through education, skill enhancement and employment, minorities and indigenous people can overcome their socio-economic inhibitions that hinder their progress (United Nation, 2003).
5. Strength and weakness of both health care system: Australia has one of the high-quality health care systems in the world. It provides affordable health care that meets the needs of the patient throughout life. It is accessible and provides high-quality preventive and curative services. The healthcare system finds ways to prevent disease and promotes health.
A weakness of the system is the lack of good geographical coverage. There is a deficiency in outreach models and technologies that will enable better targeting of indigenous people and refugees. Lack of an integrated and uniform system can result in duplication of services, poor coordination and wastage of time and resources. The current funding arrangements lack efficiency. Workforce shortage and high demand for certain areas of health care services are also some of the weakness of the existing system. ("Department of Health | Strengths and weaknesses of the current ATAPS program", 2016)
When compared to Australia, countries like USA and U.K, offers faster medical appointments and wider access. High level of patient autonomy is reported in the U.S. There is hardly any study that has compared the health system of both countries. Thus, it is difficult to provide a comparative estimate of strength and weakness. Employer-based health insurance coverage, pays for most of the population (Cooper & Taylor, 2011) in the U.S. The rest are paid by the U.S. government. This helps to lower federal expenditure on healthcare. There is a strong private sector presence in U.S health care (Capretta, 2009). This is comparatively low in Australia. U.S is at the forefront of clinical research. (Cooper & Taylor, 2011).
The program will adopt orientation sessions, workshops, improvement activities and training that will improve the quality of primary health care services. The collaborative effort will also coordinate data collection from primary care providers. The program will have an expert reference panel that will provide research and clinical knowledge, as well as solutions on topics of concern. These ideas will be used to implement change in primary care set-up. General practitioners will be recruited for training and workshop sessions that will empower them to implement the necessary change. The progress in change will be measured by the data provided at monthly intervals to the program coordinators. The program will also offer a model for improvement that will enable developing, testing and implementing the ideas. ("Australian primary Health Care Collaborative", 2016)
This program is important, as the primary health care in Australia is largely run by general practitioners, who work in isolation from each other and are provided less opportunity to come together and work in a coordinated manner. The Australian Primary Health Care Collaborative program will create this opportunity.
Conclusion: In spite of the many challenges that lie ahead, Australian can pride itself on having one of the best healthcare systems in the world. The increase in chronic diseases is likely to add to the already high expenditure of healthcare sector. Strengthening primary health care and preventive activities are required to prevent chronic diseases in the future. These diseases are costly to treat. The risk of these diseases can be reduced by adopting a healthy lifestyle. This can be achieved only through community-level activities and awareness programs. Further, lack of coordination between the local hospitals and the public hospitals that offer high-end services, also adversely affect chronic diseases management.
References
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Australian primary Health Care Collaborative. (2016). apcc.org. Retrieved 14 August 2016, from http://The Role of the Expert Reference Panels The Expert Reference Panels consisted of a range of research and clinical experts in each particular topic area of the Program. Their job was to identify the topic aims, measures, change principles, develop strategies and ideas for implementing change and to suggest measures for tracking these changes. The change principles are milestones that the practice should aim to achieve, while change ideas are the practical steps that can be used to achieve them.
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