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Australia is the only country of the world to govern an entire continent and the islands around it.

Out of this, the main land is the smallest continent and the largest island of all. It is 6 th largest country of the world with an area of 7,692,024 sq km but with a fairly low population distribution. Its the driest continent on the earth with its interior recording one of the lowest rainfalls on earth. The population of Australia surpassed 23 million in April 2013. The healthcare system in Australia is a universal system. It has an element of both Beveridge model of healthcare and the Bismarck model. Though it has private sector providers, majority of the payment comes from the government led insurance program that every citizen pays for in terms of taxes. This system is cheaper than the other models of healthcare. The universal system of healthcare means the government aids to provide financial and healthcare protection to its all of its citizen. Within Australia there are public and private healthcare providers with multiple setting. The responsibility lies within the hands of the government, non government organizations and on the individuals. Services are provided by medical practitioners, nurses, health professionals, clinics and other non government clinics. The government, non-government charitable organization, health insurers and the individuals are the one that are responsible for funding the healthcare.

The total expenditure in healthcare in the year 2009-2010 was 121.4 billion dollar with a GDP of around 9.4% out of this 2/3rd is given by the Australian government and the rest by the territory government or the state government. The government has two major healthcare schemes which include MEDICARE BENEFIT SCHEME involving the doctors, optometrists, psychologist etc and the PHARMACEUTICAL BENEFIT SCHEME that includes a subsidy on the highly prescribed drugs. According to WHO, Equity is the absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. In simpler sense it is concerned with the health disparity and the fairness and the effectiveness of the procedure. Health inequities in other words means the inequality with respect to health determinants, access to the resources needed to improve and maintain health or health outcomes. Australia has been strongly influenced from the countries of Europe. The concept of universal health incepted in the developed nations around the time period of World War II. The plan was to provide essential healthcare to every individual even if they lack financial stability to support themselves. However as the cost of healthcare soared a big question was raised on the efficiency the scheme. This would create a sense of inequality. So the Australian healthcare over the period of time has evolved in a way that it bounds to provide equality in the healthcare over a spectrum of social group such as the poor, aboriginals, disenfranchised racial, ethnic, religious women etc. The healthcare framework ensures that it covers the socially disadvantaged, marginalized foreign nationals and the poor. The healthcare is accessible to people depending on their health not on the ability to pay. The health system is shaped according to the needs of the individual, his family and the community. The aim of the government is provide equal access and adequate healthcare to all the individuals. This also includes a larger rebate to family and individuals with unemployment and disability Increased funding in the healthcare doesnt necessarily result in the equity and efficiency of the system. Thought the government has been trying hard to evaluate its healthcare taking the parameters of the effectiveness, efficiency and equity, at times the inequity always prevails. At times there is not just inequality at financial level but inequality also prevails within the experiences of the health ,diseases ,sickness and their determinants .there exist inequality in the extent to which people adapt the health lifestyle that contributes against fighting the disease experiences. Differences are also seen at the level of psycho-social attributes such as emotional stability, self esteem, self confidence, values, attitude, beliefs that contribute indirectly to build the health of the individual. Tackling this inequality ideologically is problematic and technically very expensive. In order to fight this inequality, it is essential to get engaged with other policy sectors such as the education system and the employment. It is important to identify the people with special needs such as the marginalized and the regional (aboriginals). Unique approach needs to be undertaken to close the gap between the indigenous health status and that of the rest of the Australia. In order to provide long term health benefits, the funding and the healthcare system should be balanced and organized. The demand for health services change along the different course of life. Hence a greater emphasis has been laid by the government to wellness, prevention of diseases and promoting a healthy lifestyle so that people can live with an optimal health.

The efficiency of any given healthcare system is associated with the degree of success achieved along with the effectiveness. It is a highly relative term. The perspective in case of efficiency decides what factor of healthcare is considered. Efficiency is different for the purchasers, payers, plans, consumers and providers. Efficiency can be technical, productive or social. Some of the efficiency contradicts the basic values of healthcare such as at times general practitioner prioritizes the need of the individual to that of the society. It is always a dilemma as to how much healthcare inputs would be necessary to generate the greatest of the efficiency with least of the risk and the highest of the benefits. In the best of measuring the efficiency, it can be considered into hospital efficiency and physician efficiency. Efficiency measures how well a program has done by comparing it with the actual plan. Talking about smoking, the Australian government has taken a school based initiative to curb the smoking habits in school children. This has delayed the commencing of smoking in the school children by around two years. However increasing the taxes on cigarettes and prosecuting those who serve cigarettes to the minors has even increased the efficiency and the effectiveness of their plan. Effectiveness is concerned if the intervention in the health care has been successful or not and efficiency defines as to till what extent it has been successful. In other words it is all about evaluating the relationship between the healthcare and the resources required to produce them. The primary aim of an effective healthcare system includes maximizing the health outputs with minimum of inputs with maintaining the healthcare output quality. It is very important to maintain the effectiveness in the system along with the efficiency. The quality in healthcare is multidimensional entity. It can be interpreted in a varied manner. One can categorize it into safe, timely, effective, efficient, and equitable and patient oriented.

Accreditation and various quality improvement standards have been adapted in Australia to improvise the healthcare system. However literature shows that that in spite of the compliance of the hospital with this grading system being satisfactory, their delivery of healthcare arent effective. The factor of patient safety which plays a significant role in effectiveness is always neglected. According to WHO the main aim of any healthcare system should be to improve the health of population served, responding to the rational expectation of the people (responsiveness) and providing financial assistance against the cost of the ill health. In simple words a healthcare system that fulfills these goals under the available resources can be taken as an efficient system. Here it is important to understand the inputs that are given in the health provisions and the delivery of health interventions. Thought the main role of any healthcare system is delivery of health services, the effectiveness depends on what services are provided and how well are they organized. Effective coverage can be determined from the proportion of people in need of the health services who have effectively received it. Its a detrimental measure in knowing the impact of the health care. Effectiveness helps in the judgment of the managerial practices and the policy changes made in the healthcare system. The inclusion of horizontal and vertical integration of performance measures helps to measure the effectiveness of the healthcare system. Here, vertical integration connects various departments to the organization strategies whereas the horizontal connects various departments each other.

There are various guidelines and programs with the healthcare organization. However the problem is the adoption of effective healthcare practices with no significant incentive and the existing barriers that separate the healthcare from the places in which people work, eat and habituate themselves. Neither the public nor any private organization can solve the problem of effectiveness by themselves. A collaborative approach across various groups through public private partnership is required to increase the effectiveness. As a fundamental need of all health system, the patient safety should be promoted. Monitoring of the drugs administered, medical technology, medical equipments are all part of it. Efforts should be made to design norms for patient safety all over Australia which will give rise to the quality in the healthcare system. The main aim of the cost effective analysis or efficiency is an interim assessment of the health resources and the health outcomes of the health interventions so that one can understand the effectiveness of the measures taken to improve the health. When any decision is taken related to increasing the effectiveness of the healthcare the equity and the efficiency should be kept at the heart of it.

In the current scenario owing to the increased medical technology advancement its not possible to provide free medical healthcare to the people. As the time cruises by the problem is just going to go more intense as the advancement rises. So it becomes extremely essential to priorities.

The other important concerns include the decreasing supply of skilled health workers, e.g. doctors and nurses; the geographical size and nature of Australia; long waiting lists for elective surgery in public hospitals; increased numbers of people suffering from chronic disease; and a growing and ageing population.

There are some essential treatments and some quality-of-life treatment that need to be considered within the available resources. It depends on the perspective of an individual which one is a priority. Sometimes the concept of equity comes along to interfere with the effectiveness and efficiency. A geriatric patient with the need of a knee replacement and a sports person who injured his knee in the rugby match are both considered equally. However the important point here to think is the player might be an asset to the country along with a young age whereas the senile person is more or less a liability. In a healthcare system where the peoples contribution empowers the healthcare, does it give them a right to neglect the healthy lifestyle? The duty of healthcare should be inclusively divided amongst the individual and the health service provider. Clinical practice guidelines (CPG) and the Health Impact Assessment (HIA) provide the Australian to achieve the equity in healthcare. Perhaps equity, efficiency and effectiveness become a nightmare to the Australian government when it comes to healthcare to the aboriginals in the northern territory. There are a lot of documentation suggesting how these people have always been left out and how little of resources are allocated to them. The inequity and the inefficiency cannot be merely corrected by allocation of funds in the budgets. The geographical terrain is a hindrance to assessment of health services. So, most of the aboriginals avoid taking medical services. Other than that, cost of rendering the non administrative services, medications, low availability of the general practitioners are also barrier. The inputs in the healthcare system are reasonably high than the outputs resulting into poor efficiency in the healthcare system. A need based survey of the region be carried out amongst the various aboriginal communities and then thoroughly assessed. The problem should be assessed from the roots and attention should be paid to their needs in order to bring about equity. Educating the aboriginals and increasing the level of awareness will bring about the equity, efficiency. Other thing is that affects the efficiency in the urge to maintain the equity is the long waiting periods for the elective surgery. With just limited resources on hand, it becomes a tough choice to figure out the right individual who needs them compromising the equity and effectiveness. For example, if we have a resource to treat a one in a hundredth condition, how does the physician realize which patient gets that resource. How if another patient arises with a similar condition arises? In this case, the idea of equity would be nothing more but a misnomer. A need based survey of the region be carried out amongst the various aboriginal communities and then thoroughly assessed. The problem should be assessed from the roots and attention should be paid to their needs in order to bring about equity. Educating the aboriginals and increasing the level of awareness will bring about the equity, efficiency. In order for the most effective healthcare system, it is very important that Australia puts in the right incentives in place and smartly decides where the healthcare invests the money. For example in

order that the fight against the chronic diseases is for eminent a paramount amount of money is invested in the prevention of the practice such as smoking rather than treating the outcomes of it.

Another chronic disease to be dealt with is diabetes, hypertension and obesity. Educating people over the large scale is an effective, efficient and equitable solution to the problem rather than spending on treating it. Expecting from just the medical system to treat the disease from the core when the etiology is so widespread is highly irrational. A broader awareness in the school and the people with sedentary lifestyle is will drive more efficiency in the healthcare along with equity. Driving in the incentives and kicking out the disincentives helps to drive the equity and the efficiency together in the healthcare. At last I would like to conclude that with the base of equity, the Australian healthcare system faces a tough task to maintain the effectiveness and the efficiency. At times the decisions are not rational under the tag of equity as the health requirements of different people differ and treating them with equal approach is not possible. T he government also needs to consider the problems of the aboriginals and bring about efficiency in the healthcare delivery to them. The aim of the government should be to keep the equity and the effectiveness parameter constant and acting on increasing the efficiency. REFRENCES
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