Comparing the primary care systems of Australia & the United States & relate their systems to health

outcome

Definition of health care system: A health care system is the organization of people,institutions, And resources to deliver health care services to meet the health needs of target populations. Introduction: Under national health reform, the Australian Government is aiming to shift health services from hospitals to primary care. Primary care is the part of Australias health system that people use most. It is the first primary point of health care delivered in, and to people living in their communities outside of hospitals.

Primary care includes a range of services provided by health professionals such as general practitioners, practice nurses, psychologists, physiotherapists and community health workers. A strong primary health care system is crucial to ensuring that people can get the health care they need, when they need it, where they need it. It helps people better manage their health and plays an important role in preventing disease.

The Australian Government is committed to strengthening the primary health care system, giving people access to the services they need locally. Primary care will help to keep people well and out of hospital.

The Australian Government is improving primary health care by:

establishing Medicare Locals (independent primary health care organisations) building over 60 GP Super Clinics;

trialling new approaches for the flexible delivery of treatment and management of diabetes through general practice;

increasing access to after hours services through the availability of the after hours GP helpline and by tasking Medicare Locals with a range of after hours primary care responsibilities; and

funding approximately 425 primary care infrastructure upgrades to general practices, primary care and community health services, and Aboriginal Medical Services to improve access to integrated GP and primary health care.

In February 2011, the Australian Government released the publication Improving Primary Health Care for All Australians.

Health care in Australia: In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. All legal permanent residents are entitled to government-paid public hospital care. Treatment by private doctors is also paid by the government when the doctor direct bills the Health Department (Bulk Billing). Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. There is an uncapped 30% subsidy on private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme under which listing and a government subsidy is dependent on expert evaluation of the comparative cost-effectiveness of new pharmaceuticals. In 2005, Australia spent 8.8% of GDP on health care, or US$3,181 per capita. Of that, approximately 67% was government expenditure.

Life Infant mortality Country expectancy rate Australia 81.4 Canada 81.4 France 81 Germany 79.8 Japan 82.6 Norway 80 Sweden 81 UK 80.1 USA 78.1

Physicians per 1000 people 4.2 3.9 4 3.8 2.6 3 2.5 4.8 6.7 2.8 2.3 3.4 3.5 2.1 3.8 3.6 2.5 2.4

Nurses per 1000 people 9.7 9 7.7 9.9 9.4 16.2 10.8 10 10.6

Adapted fromWorld Health Organization, the world health report 2000.

Health care in the United States: The United States currently operates under a mixed market health care system. Government sources (federal, state, and local) account for 45% of U.S. health care expenditures. Private sources account for the remainder of costs, with 38% of people receiving health coverage through their employers and 17% arising from other private payment such as private insurance and out-of-pocket co-pays. Health care reform in the United States usually focuses around three suggested systems, with proposals currently underway to integrate these systems in various ways to provide a number of health care options. First is single-payer, a term meant to describe a single agency managing a single system, as found in most modernized countries as well as some states and municipalities within the United States. Second are employer or individual insurance mandates. Finally, there is consumer-driven health, in which systems, consumers, and patients have more control of how they access care. Over the past thirty years, most of the nation's health care has moved from the second model operating with not-forprofit institutions to the third model operating with for-profit institutions. In the US, the social and political issues surrounding access to health care have led to vigorous public debate and the almost colloquial use of terms such as health care (medical management of illness), health insurance (reimbursement of health care costs), and public health (the collective state and range of health in a population). In the US, 12% to 16% of the citizens do not have health insurance. State boards and the Department of Health regulate inpatient care to reduce the national health care deficit. To tackle the problems of the perpetually increasing number of uninsured, and costs associated with the US health care system, President Barack Obama says he

favors the creation of a universal health care system. However, this view is not shared across the country (see, for example, quotes from New York Times opinion columnist Paul Krugman[ and Factcheck.org). A few states have taken serious steps toward universal health care coverage, most notably Minnesota, Massachusetts and Connecticut, with recent examples being the Massachusetts 2006 Health Reform Statuteand Connecticut's SustiNet plan to provide quality, affordable health care to state residents.[ The state of Oregon and the city of San Francisco are both examples of governments that adopted universal healthcare systems for strictly fiscal reasons. The United States is alone among developed nations in not having a universal health care system; the 2010 Patient Protection and Affordable Care Act provides for a nationwide health insurance exchange by 2014, but this is not universal in the way similar countries mean it. Healthcare in the U.S. does, however, have significant publicly funded components. Medicare covers the elderly and disabled with a historical work record, Medicaid is available for some, but not all of the poor, and the State Children's Health Insurance Program covers children of lowincome families. The Veterans Health Administration directly provides health care to U.S. military veterans through a nationwide network of government hospitals; while active duty service members, retired service members and their dependents are eligible for benefits through TRICARE. Together, these tax-financed programs cover 27.8% of the population and make the government the largest health insurer in the nation.

U.S. healthcare spending. Percent of GDP. From OECD Health Data 2011

AUSTRALIA: Australia has three levels of government: federal, state/territory, and local government and a complex PHC system with both public and private components. The Australian Government introduced the Medicare system in 1984. All Australian Government funding for health services comes from taxation through its general revenue. A Medicare Levy is

set at 1.5% of taxable earnings (for all but low income earners). A surcharge of an additional 1% is levied on high income earners who do not have private health insurance. While general practices are private businesses, Medicare covers general practice consultations although in many cases a co-payment is also charged by the practice. The Australian Government funds the Pharmaceutical Benefits Scheme (PBS) which substantially covers the cost of medications. Private healthcare financing is from out of pocket payments and optional private health insurance. Unlike many countries, Australia has no employer based health insurance schemes. The Australian Government also funds the Divisions of General Practice. These are located regionally around Australia and work with general practitioners, practices, other PHC providers and the community to improve quality and access to the PHC sector, implement government programs and run diverse health projects. The State Based Organisations provide leadership, representation and advocacy at state level, coordinate Divisions' activity in each state and liaise with the state government, and a peak body, the Australian General Practice Network located in Canberra which provides national leadership and governance. Boundary issues are among the greatest challenges to PHC in Australia, due to divided responsibility for health care between federal and state/territory governments, private and public systems, and community, hospital and long term care settings. Medicare, PBS and Divisions of General Practice are funded by the Australian Government but the hospitals are jointly funded and managed by the states. Both the Australian Government and the states run health programs and initiatives which are implemented in primary care and in practice this leads to duplication in bureaucracy, cost shifting and conflicting requirements. The GP workforce supply is a major issue in rural and remote areas and increasingly so in the urban fringes. As in other countries, increasing demand due to the changing demographics of the population, ageing of the population and the increasing need for services to manage chronic health conditions, are driving system reforms.

USA The USA government is a federal system. Federal government power is defined and limited by the Constitution, with health and education falling within the control of the States, resulting in considerable diversity. The United States does not have a universal health care system although a majority of its citizens have some sort of healthcare coverage. Primary Health Care is run through private enterprise with a major role played by insurance companies and managed care organisations which provide subscribed individuals access to their network of employed or contracted physicians and of healthcare services. In order to provide a safety net, the US purchases health insurance (Medicare) on behalf of those over 65 who have worked for at least 10 years in Medicare covered employment and those with specified illnesses or disabilities. The US Government also administers Medicaid which provides insurance for low income people who meet stringent eligibility requirements, purchases health insurance on behalf of government employees and the military and runs a health care system for military veterans. In addition, the Indian Health Service provides federally funded health services to over half the Native American and Native Alaskan populations. Some states are attempting to implement universal health insurance coverage. Other states provide supplementary funding for hospitals and providers are funded to cover healthcare expenses for the uninsured. The shape of the health system is a result of market forces rather than government led reforms. The market approach results in underinsurance, poor population health, and healthcare disparities. Moreover, capital investment is directed at delivering high-end lucrative products and services, rather than improving health outcomes.

References:

^ a b c d e f g h i j k l m n "WHO Statistical Information System". World Health Organization. http://www.who.int/whosis/data/Search.jsp. Retrieved 2008-09-23.

^ OECD Health Data 2009 - Frequently Requested Data. OECD. .^ CMS Annual Statistics, United States Department of Health and Human Services

^ The Time Has Come for Universal Health Care | U.S. Senator Barack Obama ^Krugman, Paul (February 4, 2008). "Clinton, Obama, Insurance". The New York Times. http://www.nytimes.com/2008/02/04/opinion/04krugman.html.

.^ Jess Henig (2008-06-15). "Obama's Inflated Health Savings". Newsweek.com.

http://www.newsweek.com/id/141829. Retrieved 2011-08-06.

^ "About.com's Pros & Cons of Massachusetts' Mandatory Health Insurance Program". Usliberals.about.com. http://usliberals.about.com/od/healthcare/i/MassHealthIns.htm. Retrieved 2011-08-06.

^ [2][dead link] ^ The Case For Single Payer, Universal Health Care For The United States.