hsc core 1: health priorities in australia · 2018. 3. 10. · health care in australia (cont’d)...

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HSC Core 1: Health Priorities

in Australia

HSC Core 1: Health Priorities in

Australia

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Health Care in Australia

What role do health care facilities and Services

play in achieving better health for all

Australians?

“Health care in Australia now involves a strong

partnership between public health initiatives and medical

care. Because the major causes of sickness and death

relate to lifestyle, the aim is to improve quality of life

through health promotion initiatives that establish

environments that enhance positive health behaviour.

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Health Care in Australia (cont’d)

The role of health care is to achieve a delicate balance

between resources for prevention and resources for

treatment. This changing emphasis towards prevention

has been seen in numerous national campaigns, for

example Breast Cancer.”

“The role of health care is no longer simply curative.

Instead it is concerned with ensuring an improvement

in the health of the population as a whole through a

combination of preventative strategies and clinical

medical care”. 4


“Traditionally the health care system has

provided:

Diagnosis

Treatment

Rehabilitation

Care for people with

long term illness or disability”

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Range and types of health facilities and services

The health care system involves a complex interrelationship

between:

Commonwealth & State Governments

Health Insurance Funds

Public & Private providers of health ie doctors

Institutions, ie Hospitals

Other Organisations, ie Community Health Care 6

INSTITUTIONAL

FACILTIES &

SERVICES

Hospitals

Nursing Homes

Psychiatric

Hospitals

NON-

INSTITUTIONAL

FACILTIES &

SERVICES

Medical Services

Health related

services

Pharmaceuticals


Health facilities and services provided in Australia

can be classified into two areas:

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Institutional Health Services

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Hospitals

“Hospitals provide general and specialised

healthcare. Patients in hospitals are

classified as public or private according to

their choice of service.

PUBLIC hospitals are operated and

financed by the government, and the

healthcare service is free of charge for

patients.

Institutional Health Services (cont’d)

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PRIVATE hospitals are owned and

operated by individuals and community

groups. Service must be paid for by the

patients, although Medicare and private

health insurance refund most of the

expense.


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PUBLIC HOSPITALS PRIVATE HOSPITALS

“Public hospitals provide more

highly specialised and complex

services, such as heart and lung

transplants in the large teaching

hospitals. They also provide same

day surgery and take most of the

non-admited patients

(outpatients).”

“Private hospitals provide same

day surgery and perform more

short stay day surgery, elective

procedures and less complex

procedures requiring less

expensive equipment, such as

operations on the eye, ear, nose,

mouth, throat, musculoskeletal

and breast”


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Public or Private – What is the difference?

“Patients in all hospitals are classified as being either private

or public, according to their choice of service. If they

choose to be in a public ward in a public hospital, then they

are allocated a doctor by the hospital and

provided with a bed – all free of charge.


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If they choose private treatment, either in a public or a private

hospital, then they may choose their own doctor but must

pay for the service and accommodation provided by the

hospital and the doctor. Medicare and any private health

insurance of the patient will refund much of this expense.”

The issue of equity of access to public hospitals has been debated

in recent years. Some evidence suggests that private patients have

more rapid access to elective surgery than do public patients.

Urgency categories have therefore been applied to patients

conditions.


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Nursing Homes

“Nursing homes provide care and

long term nursing attention for

those who are unable to look after

themselves, such as the

chronically ill, the elderly and

people living with disabilities.


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There are three types of nursing

homes in operation throughout

Australia:

Private charitable (such as

Anglicare)

Private for profit

State Government

The federal government funds the

running of all nursing homes through

taxes.


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Psychiatric Hospitals

“Psychiatric hospitals provide treatment for people with

severe mental disorders. They use a system of care that

integrates hospital services and community settings

Non-Institutional Health Services

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Medical Services

“Medical services are services provided by doctors,

specialists and other health professionals.

General Practitioners (GP’s) are the most

commonly used service, however, consultation

rates have increased.


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Medicare refunds patients payments for these services.

Specialists such as obstetricians, dermatologists, orthopaedic

surgeons, who have expertise in a particular field of medicine

are also used.”


(cont’d)

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Health-Related Services

“Health related services include other

services such as dentistry, optometry,

nursing, ambulance services and

physiotherapy”


(cont’d)

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Pharmaceuticals

“Drugs are supplied through prescription

from doctors or hospitals (PBS) or over

the counter from shops or pharmacies.

Pharmaceutical Benefits Scheme (PBS)

drugs are subsidised by the federal

government for people with special needs”

Health Care in Australia

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Responsibility for health-care facilities and

services

Health-care facilities and services in Australia are

provided by government organisations and a range of

private and community groups. There are five levels

of responsibility:

Health Care in Australia (cont'd)

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Commonwealth

Government State & Territory

Governments

Local

Government

Private

Sector Community

Groups


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Responsibility for health-care facilities and services: FEDERAL GOVERNMENT

“The formation of national health policies is the responsibility of

the federal government. They control funds obtained through

taxes and allocate these to state or local government health

sectors. The Australian Government operates assistance

programs such as Medicare and PBS; and coordinates approved

national health programs such as HIV/AIDS. They also support

special programs such as National Heart Foundation and Royal

Flying Doctor Service”.


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Community

Groups


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services: STATE OR TERRITORY GOVERNMENT

“The responsibility for providing funding for health and

community services, such as public hospitals, medical

practitioners, and family health services lies with the state of

territory. At this level, governments also regulate private

hospitals and provide immunisation programs”


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services: LOCAL GOVERNMENT

“At a local level, governments are responsible for

implementing state health policies and controlling local

environmental issues such as maintenance of recreational

facilities. They are also responsible for providing a range of

personal, preventative and home care services such as waste

disposal and meals on wheels.”


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Responsibility for health-care facilities and services: PRIVATE SECTOR

“The private sector is responsible for providing a wide range

of services, such as private hospitals and alternative health

services including dental, physiotherapy and chiropractic

services. These services are generally privately owned, funded

and operated through businesses, charity or religious groups,

such as Mayne Health. However, some private sector services

receive government funding such as NSW Cancer Council.”


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Responsibility for health-care facilities

and services: COMMUNITY GROUPS

“On a community level, these groups are

responsible for promoting health within a more

concentrated or focused area of health, for

example, the Asthma Foundation and Diabetes

Australia.


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Equity of Access to Health Facilities and Services

The pursuit of equity of access to healthcare is the central

objective of many healthcare systems.

There are two dimensions to equity of access to health

facilities and services:

Horizontal Equity

Vertical Equity


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Horizontal Equity

Horizontal equity refers to equal treatment for

comparable needs. One example is Medicare, the national

health insurance system, which aims to provide the

majority of Australians with equal access to basic

healthcare.


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“Another example is the Pharmaceutical Benefits Scheme

(PBS), where the service provided by the Australian

Government ensures a range of necessary prescription

medicines are made available at affordable prices to all

Australian residents.”


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Vertical Equity

“Vertical equity involves the priority treatment

of those groups with increased health needs and

reduced access to health facilities and services,

such as ATSI people, and people culturally and

linguistically diverse backgrounds.”


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Vertical & Horizontal Equity

“Horizontal and vertical equity are both essential aspects

of a comprehensive health system, however governments

and service providers find it easier to work on a

horizontal level of equity as it is less complex and does

not involve the issues associated with needing to prioritise

population groups.


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An example of a service addressing the vertically equitable

need of geographic disadvantage is the Royal Flying Doctors

Service of Australia.”


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“For geographic, social and cultural reasons, mainstream

services are not always accessible to, or the most appropriate

form of service for ATSI people.

Australian governments recognise this and apply the

principles of vertical equity to provide specific healthcare

services to meet their needs.


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Specific indigenous health services have funding provided at

federal, state and territory levels. In 2005-2006, OATSIH

(Office for ATSI Health) funded 151 services to provide or

facilitate access to primary healthcare for ATSI people.

Overall, 58 of these services (39%) were in remote or very

remote locations.”


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Health care expenditure versus expenditure on

early intervention and prevention - Health-care

Expenditure:

Health-care expenditure is the allocation of funding and other

economic resources for the provision and consumption of

health services. Health-care expenditure includes expenditure

by Australian state and territory governments as well as

private health insurance, households and individuals.


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Health expenditure is on the rise. In 2004-05, expenditure was

$87.3 billion, or $4319 for each person in the country. In the

2006-07 financial year, health expenditure was $94 billion,

which is 9% of the gross domestic product (GDP). For the

same period the average rate of expenditure per person was

$4507.

The Australian Government funded 41% of expenditure on

health in 2005-06 and the states and territories funded 50.6%,

thus together providing over 90% of the funding for health.


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Why is Health-care Expenditure rising?

Australia’s aging population

More expensive medical services and treatment

Ongoing research and development of sophisticated medical

equipment


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The high cost of pharmaceuticals

Increasing use of doctors and health care professionals

Litigation cases and insurance fees that need to be paid.


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Prevention Vs Health-care Expenditure: Is

prevention better than a cure?

“Health-care expenditure has steadily been increasing and

will continue to do so while the focus is on ‘curative’

medicine, that is, the focus is on curing a disease or illness,

rather than preventing it.

For example, it costs more to ‘cure’ a disease such as

coronary heart disease once it has developed than it does to

fund measures to prevent the illness occurring.


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In this example, early intervention might focus on the

following things:

Education

Healthy eating practices

Weight control

Active lifestyle

In contrast, curative measures such as treatment of heart

disease, stroke, clogged blood vessels, kidney failure are

more costly and contribute considerably more to health

expenditure.”


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The new public health approach:

“The new public health model focuses on the

social factors that lead to ill health. This model

places the emphasis on health promotion as

the most cost-effective way in which to

address the social issues of health”.


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Preventative approaches:

“With Australia’s leading causes of death and illness being

lifestyle related , the argument that prevention will be more

cost effective that cure has gained considerable support.

Prevention programs that have been implemented include:

School medical and dental services

Immunisation programs

Fluoridation of water supplies

Anti-smoking campaigns


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The National Campaign Against Drug Abuse

National Mental Health Strategy

National HIV/AIDS program

“These programs often take time to show results.

However, preventative programs for CVD, Cancer and

traffic accidents have been visible over the past two

decades – for example, QUIT, SunSmart, National

Cervical Cancer and breast screening programs, stop

revive survive and drink driving campaigns,


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“Organisations such as the Heart Foundation, the Cancer

Council and the Asthma Foundation also make significant

contributions to illness prevention”.


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“Health-care expenditure in

Australia still far exceeds

expenditure on illness prevention

and health promotion. This is due to

an emphasis on medical treatments

to cure illness dominating the

allocation of public health

resources and spending”.

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“The reasons for increasing funding and support

for preventative and promotional health include:

Cost effectiveness

Improvement in quality of life

Improved access and education

Maintenance of social equity

Use of existing structures

Reinforcement of individual responsibility for

health (empowerment)

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Unfortunately, even though preventative health is

generally cheaper, the benefits often take years to translate

into a visible reduction in illness or death. Current

governments could spend money now on programs that

might be considered a risky political option.


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Impact of emerging new

treatments and technologies on

health care, eg cost and access,

benefits of early detection

Emerging new treatments and

technologies invariably enable a better

quality of life, are less invasive and

promote a faster recovery and

rehabilitation period.


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The range of emerging new

treatments and technologies has seen

a change in the way some procedures

are completed.

For example, while complex surgery

may require a team of surgeons and

staff, many treatments can now be

provided as day surgery in doctors

rooms.


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Almost daily, we hear of new

treatments and technologies that will

improve healing and health care.

Much of this relates to health

technologies used in dianostic

procedures, such as ultrasound, keyhole

surgery and magnetic resonance

imaging (MRI).

The new emergence of technology has

seen a reduction in hospital stays and a

quicker recovery.


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Some significant improvements through technology

can be seen in:

Minimal access techniques for interventions

including keyhole surgery, stent and grafts (e.g.

laproscopy and the use of nanotechnology to enable

cameras to see what is happening inside the body)

Gene technology and gene testing (e.g, for skin and

breast cancer)

Magnetic Resonance Imaging (MRI)


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Enhanced capacity for vaccinations such as against the human

papillomomavirus (HPV)

Digital equipment and internet technologies for managing

information and possibly treatment of patients in remote

locations

Improved transporters for organs

Rapid diagnostic procedures


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Hip and knee replacements, heart valves and

stents, lens implants for eyes and lightweight

interactive prosthesis

“Emerging new treatments and technologies

should decrease the cost of health care and

provide an opportunity to reach a broad range

of people. We can only imagine what will

emerge in the next five to ten years, because the

current research and development around the

world is prolific.


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Unfortunately, all new technologies come at a price. In the

context of a largely publicly funded health-care system,

balancing the cost of new technologies, limited resources and

the need to maintain health at an acceptable level is difficult.

Research, development, testing, medical and specialists fees and

highly sophisticated equipment amount to millions of dollars,

making some technologies unaffordable unless privately donated

or subsidised by government.


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“Unfortunately, access may prevent some people from

participating in detection and treatment programs.

Socioeconomic circumstances and geographic location may

influence health care to the point where the diagnostic ,

treatment and/or rehabilitation process are not fully

utilised. For example, cardiac patients may have limited

access to exercise facilities in some areas”.


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Health Insurance: Medicare and Private

Boyd, A., Eussen, A., Lumley, D., O’Halloran, M., Sculley, L. (2010).

PDHPE in Focus. The McGraw Hill: Sydney.

Browne, S., Clarke, D., Henson, P., Hristofski, F., Jeffereys, V., Kovacs,

P., Lambert, K., Simpson, D. (2010). PDHE: Application and inquiry

Buchanan, D., & Nemec, M. (2010). Macquarie revision guides: HSC

Personal Development,Health and Physical Education. 2nd Edition.

Macmillan: Sydney

Ruskin, R., Proctor, K., Neeves, D. (2010). Outcomes: Personal

development, health and physical education, HSC Course 4th edition.

John Wiley & Sons: Sydney

References

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hsc core 1: health priorities in australia · 2018. 3. 10. · health care in australia (cont’d)...

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