Professional Documents
Culture Documents
c h a p t e r
W h at r o l e d o h e a lt h c a r e fa c i l i t i e s a n d
s e r v i c e s p l ay i n a c h i e v i n g b e t t e r h e a lt h f o r
all Australians?
health care in Australia
evaluate health care in Australia by investigating issues of access and
adequacy in relation to social justice principles. Questions to explore
include:
how equitable is the access and support for all sections of the community?
Sample
student
answer
how much responsibility should the community assume for individual health
problems?
While Australia is a relatively healthy country in comparison to other nations, the healthcare system is
still extremely important. Its role is to provide quality health facilities and services to meet the needs of all
Australians.
Health services are organised, financed and delivered by both public and private sources. Healthcare
in Australia is dominated by medicine and is generally concerned with diagnosis, treatment, rehabilitation
and care of people with illness and injury.
Activity 1
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. 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. In Australia, hospital admissions have increased whilst length of
stay has decreased.
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 with disabilities. There are three types of
nursing homes in operation throughout Australiaprivate charitable (such as Anglicare), private for profit
and state government. The federal government funds the running of all nursing homes through taxes.
Psychiatric hospitals provide treatment for people with severe mental disorders. They use a system of care
that integrates hospital services and community settings.
55
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 the National Heart
Foundation and Royal Flying Doctor Service.
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, preventive and home care services such as waste disposal and Meals on Wheels.
Funding source
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56
ry
Australian
people
P riv at e
Med
Figure 3.1
Health services
Australian Government
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on
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P ri v a
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h e a lt h p r i o r i t i e s i n a u s t r a l i a c h a p t e r 3
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 the NSW Cancer Council.
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.
Activity 2
45
Number of services
40
35
30
25
Figure 3.2
20
Geographical
15
distribution
10
of Australian
Government-
Major cities
Inner regional
Outer regional
Remoteness area
Remote
Very remote
healthcare services,
20052006
Source: Department of Health and Ageing, Service Activity Reporting 20052006, unpublished data
57
F e a t u r e a r t i c l e
Figure 3.3
These services offer many types of care, including management of acute and chronic health conditions,
preventative health measures, such as immunisation and screening, health promotion activities, transport
services and assistance in accessing other appropriate community and health services.
58
Health expenditure is the allocation of funding and other economic resources for the provision and
consumption of health services. There are two types of expenditure:
Recurrent expenditureregular ongoing costs (salaries, bandages)
Capital expenditureinfrequent costs (buildings, equipment).
h e a lt h p r i o r i t i e s i n a u s t r a l i a c h a p t e r 3
Injuries
Respiratory
Neoplasms (including cancers)
Figure 3.4
An indigenous girl
receiving dialysis
Figure 3.5
Expenditure on
disease by area of
expenditure for
selected broad
disease groups,
20042005
Musculoskeletal
Mental disorders
Oral health
Cardiovascular
0
1 000
2 000
3 000
4 000
5 000
6 000
$ million
(a) Includes dental services.
Source: AIHW
Figure 3.6
8.3%
Government
expenditure on
public health
16.6%
11.9%
activities, 20052006
Organised immunisation
Environmental health
Cervical screening
Prevention of hazardous
and harmful drug use
16.9%
9.4%
2.5%
5.7%
21.6%
discourage unhealthy lifestyle choices. They also use multiple settings, such as schools, homes, work
places, through the media and via general practitioner consultations.
Early intervention and prevention strategies are carried out by federal, state or territory and local
governments, as well as non-government agencies, such as the Cancer Council and the Heart Foundation.
In 20052006, governments in Australia spent a total of $1476 million on public health activities
through programs administered by their health departments. This represented 1.8% of total recurrent
expenditure on health. Expenditure on organised immunisation accounted for $318 million (22% of all
government expenditure on public health activities) during 20052006 and was the largest single area
of such expenditure. Selected health promotion activities accounted for a further $250 million (17%)
and communicable disease control activities cost $245 million (17%). Activities directed at preventing
hazardous and harmful drug use accounted for $176 million (12%).
Its been seen so far that healthcare expenditure in Australia far exceeds expenditure on prevention and
health promotion. Programs aimed at prevention and health promotion, such as school education and
support programs, are efficient and increasingly accepted and used.
Nevertheless, governments still have not yet fully acknowledged health promotion as a cost-effective
method of reducing morbidity and mortality. The new public health approach focuses on shifting away
from medically dominated expenditure to health promotion expenditure.
The reasons for increasing funding and support for preventive and promotional health include:
cost-effectiveness (human and non-human resources)
improvement to quality of life
improved access and education
maintenance of social equity
use of existing structures
reinforcement of individual responsibility for health (empowerment).
Unfortunately, even though preventive 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 as risky political options if they are unsuccessful. Governments may
feel pressure to choose an option where results are short term and can be used as leverage for winning the
next election.
impact of emerging new treatments and technologies on health care eg cost and
access, benefits of early detection
Much of the rise in healthcare costs can be attributed to advances in medical technology. Diagnostic and
therapeutic advances, such as new radiological scanners, biological therapeutics, surgical procedures and
prostheses, come at a considerable cost. Listing these for subsidy through Medicare or the Pharmaceutical
60
h e a lt h p r i o r i t i e s i n a u s t r a l i a c h a p t e r 3
Benefits Scheme greatly increases their availability and use, and therefore the cost to
the community. Failing to subsidise them inevitably raises questions about why new
medical advances are not available to all Australians and generates political pressure.
Treatments and technologies have emerged that address the essential needs of
access and early detection. Two programs that have been effective in achieving
this are cancer screening and childhood vaccinations.
Cancer screening
There are national population screening programs in Australia for breast, cervical
and bowel cancers. Their goals are to reduce morbidity and mortality from these
cancers through early detection of cancer and pre-cancerous abnormalities and
effective follow-up treatment. These programs are:
BreastScreen Australiausing mammography for screening
National Cervical Screening Programusing Pap smear tests
National Bowel Cancer Screening Programusing faecal occult blood tests.
These programs provide screening services that are free to women in the target
age group (for breast screening) and to men and women invited to participate in
bowel screening, or if they are covered by a Medicare rebate (for cervical screening).
Childhood vaccinations
The National Immunisation Program Schedule covers childrens vaccinations for diphtheria, tetanus,
whooping cough (pertussis), polio, measles, mumps, rubella, meningococcal type C disease, varicella
(chickenpox), hepatitis B, rotavirus and, for females aged 12 years and over, human papillomavirus (HPV).
Additionally, for Aboriginal and Torres Strait Islander children living in high-risk areas, hepatitis A is covered.
In 20062007, nearly 3.7 million immunisations were delivered to children nationally (AIHW 2008).
Figure 3.7
Prostheses are
expensive to
develop
Activity 5
Medicare
Medicare is Australias universal healthcare system introduced in 1984 to provide eligible Australian residents
with affordable, accessible and high quality healthcare.
Medicare provides access to free treatment as a public (Medicare) patient in a public hospital, and free
or subsidised treatment by medical practitioners including general practitioners, specialists, participating
optometrists or dentists (for specified services only).
Medicare was established based on the understanding that all Australians should contribute to the cost
of healthcare according to their ability to pay. It is funded through the Australian Government, progressive
income tax and an income-related Medicare levy. Nearly everybody (except for those on welfare or very low
incomes) pays at least 1.5% of their earnings toward Medicare levy. It reimburses 85% of scheduled medical
fees for services provided outside hospital and 75% of scheduled fees for services provided inside a public
hospital. Individuals must pay the remaining 15%, commonly referred to as the gap. Bulk billing, which
eliminates the gap payment for patients, is also covered. This is where patients pay nothing and the medical
professionals bill Medicare to receive 85% of the scheduled consultation fee back.
The disadvantages to the individual and community in using Medicare include:
long waiting lists for surgery
additional costs and further strain for hospitals
additional costs to state government
patients may still be required to pay the gap amount left over from the general practitioners fee and the
amount paid by Medicare.
61
www.medicareaustralia.gov.au/
Private health insurance
Figure 3.8
Medicare provides
affordable
healthcare for
all resident
Australians
h e a lt h p r i o r i t i e s i n a u s t r a l i a c h a p t e r 3
policy holder who is eligible for this rebate; even if it is a dependent child or spouse who is covered by
the policy. However, the policy must cover people who are eligible for Medicare in order to be eligible
for the rebate. The 30% rebate was not means tested up until 2009, so it had been paid regardless of
individual or family income. During the 2009 federal budget, a decision was made to progressively
reduce the rebate for people earning over the threshold amounts, phasing it out completely for people
on high incomes.
The use of private health insurance initially decreased after the introduction of Medicare because
of large increases in premiums and general satisfaction with public insurance. This fall initially
created pressures on the public health system, particularly in terms of funding. To facilitate the
future expected increase of demands for an ageing population, the government has used several
strategies to encourage people to invest in private health insurance. These strategies have lead to
increased levels of cover.
Age group
H e a lt h
014
1524
2544
T o ta l
4564
65+
Males
Females
Persons
professional
Chiropractor
29.6
46.4
177.8
148.0
30.7
180.2
252.4
432.6
Naturopath
55.0
46.7
*7.9
35.6
97.9
133.6
*13.0
*11.1
(b)
*3.6
*14.2
82.3
76.4
24.8
68.5
132.7
201.2
Total(c)
44.5
69.5
297.4
253.4
57.8
271.6
451.0
722.6
Other
*Estimate has a relative standard error of 25% to 50% and should be used with caution.
(a)Consultations in the 2 weeks before 200405 National Health Survey interview. Excludes consultations in/at hospitals or day clinics.
(b)Includes acupuncturist, herbalist, hypnotherapist and osteopath.
(c)Totals will not necessarily be the sum of the rows, as some persons reported more than one type of professional.
ta b l e 3 . 1
Persons reporting
consultations with
complementary and
alternative health
professionals(a),
20042005 (000)
Complementary and alternative health services have been incorporated into the general healthcare
system to a varying extent. For example, acupuncture performed by a medical practitioner attracts a
Medicare rebate, for which a total of 589796 claims were made in 20062007, attracting benefits of
$21.1 million (PHIAC 2007).
64
Some of the more common complementary and alternative products used are herbal medicines. These can
be categorised as:
herbsleaves, flowers, fruit, seed, stems, bark, roots or other plant parts
herbal materialsherbs, juices, oils, resins and dry powders of herbs
herbal preparationsextraction and purification.
h e a lt h p r i o r i t i e s i n a u s t r a l i a c h a p t e r 3
Popular natural products used in Australia include fish oil/omega 3, which reduces the risk of heart
disease; glucosamine for managing arthritis; and Echinacea, which is used to increase activity of the
immune system.
Some examples of complementary and alternative services include:
Acupunctureinserting needles into the skin at points where the flow of energy is thought to be blocked.
Aromatherapythe use of oils extracted from plants to alleviate physical and psychological disorders such
as sleep disorders, stress, and anxiety.
Chiropracticbased on the theory that disease and disorders are caused by a misalignment of the bones,
especially in the spine, that obstructs nerve functions.
Homeopathya patient is given minute doses of natural substances that in larger doses would produce
symptoms of the disease itself.
Massagerubbing or kneading the muscles, either for medical or therapeutic purposes or simply as an aid
to relaxation.
Meditationthe concentration of the mind on one thing, in order to aid mental or spiritual development
and relaxation.
Naturopathyfounded on the belief that diet, mental state, exercise, breathing, and other natural factors
are central to the origin and treatment of disease.
Figure 3.9
Accupuncture and
Chinese medicine
are popular
complementary
products
Activity 8
65
Consumers need to be aware of people who set up illegal practices. The government has laws in place
to protect consumer rights. Individuals are allowed to ask for information about the purchase, complain
about false or misleading advertising and ensure that the product or service meets government safety
standards.
Activities
Activity 1 (Page 55)
Investigate the institutional and non-institutional facilities and services that exist within
your own community. Who do they cater for and are they easily accessible?
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h e a lt h p r i o r i t i e s i n a u s t r a l i a c h a p t e r 3
Review
Questions
1. Describe the difference between institutional and noninstitutional facilities and services.
2. Demonstrate how levels of responsibility can be
applied to health care in Australia.
3. Explain how horizontal and vertical equity is used by
governments.
4. Examine two treatments and technologies that have
emerged to address the essential needs of access and
early detection.
5. Evaluate healthcare in Australia by investigating issues
of access and adequacy in relation to social justice
principles. Explore:
how equitable is the access and support for all
sections of the community?
how much responsibility should the community
assume for individual health problems?
6. Assess the advantages and disadvantages of Medicare
and private health insurance, such as costs, choice and
ancillary benefits.
7. Outline reasons why complementary and alternative
health care approaches are increasing in popularity in
Australia.
8. Discuss the nature of illegal practices and marketing
campaigns set up to make money from consumers.
9. Assess the level of invasiveness attached with the use
of various complementary and alternative health care
services.
10. Critically analyse two complementary and alternative
health care approaches by exploring what you need to
help you make informed decisions.
Chapter
summary
67