U.S. HEALTH CARE SYSTEM COMPARED TO AUSTRALIAN
The United States and the Australia follow very contrasting healthcare system. To highlight their best, and to learn from their shortcoming, it useful to compare and contrast the system. It will be useful to compare them according to their: accessibility; cost structure; quality; types and availability of the health care settings and services; healthcare quality and outcomes; and health care personnel.
Like the rest of the world, United States has both private and public insurers in their health care system. What makes is unique is the dominant role played by private insurers over public funding. “In 2003, 62% of non-elderly Americans received private employer-sponsored insurance, and 5% purchased insurance on the private non-group (individual market). 15% were enrolled in public insurance programs like Medicaid and 18% were uninsured. Elderly individuals aged 65 or over almost uniformly enrolled in Medicare” (Chua Kao-Ping 2006).
In contrast, “Australia’s health care system is funded and administered by several levels of government (national, state/territory and local) and is supported by private health insurance arrangements.” Australia’s Medicare consists of: medical services; prescription drugs and hospital treatment as a public patient. The Australian government is primarily responsible for funding of healthcare services, regulation and policy leadership. The individual states and territories are responsible for the “delivery and management of public health services, and the regulation of health care providers and private health facilities. Local government fund and deliver some health services such as environmental health programs.” ("Health care delivery," 2012). The Australian government funding is made available through National Healthcare Agreement and the National Health Reform Agreement. These agreements are between the Australian and the state/territorial governments.
As stated, among the public insurance, Medicare covers individuals aged 65 and over, as well as disabled under certain categories. The benefits include hospital services, physician services and prescription drug benefits. Though there are some gaps such as: incomplete coverage for skilled nursing facilities; incomplete coverage for preventive care; and no coverage for hearing, vision and dental. Along the same lines, the Medicaid covers the low-income group and the disabled. The individual states must cover very poor pregnant women, children, elderly, disabled, and parents. At the same time childless adults are not covered. Also, individual states have the option of expanding eligibility based on their own criteria and assessment. It offers comprehensive benefits that include prescription drugs. The downside is that it is difficult to find the providers as the due to low reimbursement rates. Similarly, The State Children’s Health Insurance Program (S-CHIP) was devised to cover those children whose families don’t qualify for Medicaid but are unable to purchase individual health insurance. The most importantly, The Veteran’s Administration program for military veterans. Among the private health insurance you have: employer-sponsored and private non-group. The employer-sponsored insurance is the major way the Americans receive insurance coverage. These private insurance companies can be both for-profit and non-for-profit. As a special case, there are big companies that that subcontract their insurance plan to a third party. The private non-group insurance is catered for self-employed or retired. In comparison to group insurance, here the insurance companies can deny people coverage based on their own criteria. In the United States, the hospitals are mostly private. They also have public hospital network, which acts as an informal hospital insurance. It is particularly useful for uninsured people or those in transition between jobs.
The Australian government has the responsibility for the following: Medicare Benefits Schedule (MBS), which provides rebates for medical and hospital services; the Pharmaceutical Benefits Scheme. In addition, there are also private insurance for services on voluntary basis. Depending on the plan, the private health insurance can cover part or whole of the services.
In the year 2003, the United States spent 15% of its GDP on healthcare, which is the highest %age among the OECD countries. The average of all the OECD countries stands at 8.6% of their GDP. This automatically makes US the highest per capita spender on healthcare at $5,635, which is almost double that of average of OECD countries. Also, public sector is the main source of healthcare funding except United States, Mexico and Korea. In the United States, the payer that is the government and the private insurance companies are involved in both the collection of money for healthcare as well as for the reimbursement. That makes the United States a multi-payer healthcare system. In short, individuals and businesses pay government via taxes and to private insurers are premium. The government in turn pays the insurers for coverage of public employees’ premium and reimburses providers for Medicare, Medicaid, CHIP & VA. The insurers also reimburse the providers for those who are covered. Also, for those services that are not covered, the individuals or the businesses, make direct out-of-pocket payments. At the same time the employers get tax benefit for what they pay as premium for employee health insurance.
In Australia, in 2004-2006, almost 70% of total health revenue came from public funds such as taxes. And the remaining 30% came from private sources (Healy, Sharman & Lokuge, 2006). Similarly, in the year 2004-06, out-of-pocket payments by individuals formed 20.3% of total healthcare expenditure. In the year 2004-06, approximately 63.3% of non-government funding was out-of-pocket. This is up from 50.4% in 1993-1994.
In United States, between 1960 and 2002, the life expectancy increased by 7.3 years. Though in 2002/3, the life expectancy was 77.2 years, which was below the OECD average of 77.8 years. The infant mortality rate in the United States has come down over the years, but not as much as in rest of OECD countries. In 2002, the infant mortality rate in the US was 7 deaths per 1,000 live births, as against the OECD average of 6.1. As for smoking, the proportion of smokers among adults has come down from 33.5% in 1980 to 17.5% in 2003. Regarding adult obesity, the United States has among the highest rate, which is 30.6% in the year 2002.
In Australia, tobacco smoking is one of the major health risks. In 2007-08, around one in five people (20%) over 15yrs of age reported to be current smokers ("Health risk factors," 2012). Also, almost three in five Australians (62%) over 18 years of age drank alcohol on weekly basis. And almost 22% drank high levels on long-term basis. Also, obesity is on the rise among Australians. From the year 1995 to 2007-8, the obesity increased from 57% to 61%. In Australia, the life expectancy has improved for the past 125 years. As per 2008-10 data, life expectancy of males is 79.5 years and that of females is 84 years. Also, Australia ranks sixth highest amongst OECD countries for both males and females.
Australia’s public health system makes available free access to hospital care for its public. They are jointly funded and run by Australian and state/territorial governments. The Australian government funding is made available through National Healthcare Agreement and the National Health Reform Agreement. These agreements are between the Australian and the state/territorial governments.
In the year 2002, the United States had 2.3 practicing physician per 1000 population, which is below the OECD average of 2.9 per 1000 population. Similarly there were 7.9 nurses per 1000 population in the United States in the year 2002. It is below the OECD average of 8.2 per 1000 population. Also, the acute care hospital beds in the United States in the year 2003 was 2.8 per 1000 population, which is below the OECD average of 4.1 per 1000 population.
In Australia, in the year 2002, there were 2.5 practicing doctors per 1000 inhabitants, 10.4 practicing certified nurses and .7 practicing pharmacists on the same scale (Healy, Sharman & Lokuge, 2006).
It is apparent from the above discussion that U.S.’s healthcare system is more complex and expensive to run as compared to that of Australia. At the same time, the health care outcomes have been consistently been inferior. Also, in case of Australia there isn’t an issue with uninsured.
References
Chua, K. (2006, Feb 06). Overview of the U.S. health care system. Retrieved from http://www.amsa.org/AMSA/Libraries/Committee_Docs/HealthCareSystemOverview.sflb.ashx
Health care delivery and financing. (2012, May 05). Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by Subject/1301.0~2012~Main Features~Health care delivery and financing~235
Health risk factors. (2012, May 05). Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by Subject/1301.0~2012~Main Features~Health risk factors~233
Mortality, life expectancy and causes of death. (2012, May 05). Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by Subject/1301.0~2012~Main Features~Mortality, life expectancy and causes of death~231
Healy, J., Sharman, E., & Lokuge, B. (2006). Australia health system review. Health System in Transition, 8(5), 82. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0007/96433/E89731.pdf
Healy, J., Sharman, E., & Lokuge, B. (2006). Australia health system review. Health System in Transition, 8(5), 57-60. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0007/96433/E89731.pdf
