“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.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.”

• Health Care in Australia

“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”.

“Traditionally the health care system has provided:• Diagnosis• Treatment• Rehabilitation• Care for people with long term illness or disability”

• Health Care in Australia- Range and types of health facilities and services

The health care system involves a complex interrelationship between:

Health facilities and services provided in Australia can be classified into two areas:

INSTITUTIONALFACILTIES &

SERVICES

HospitalsNursing Homes

Psychiatric Hospitals

NON-INSTITUTIONAL

FACILTIES &SERVICES

Medical ServicesHealth related

servicesPharmaceuticals

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.

“Hospitals provide general and specialised healthcare. Patients in hospitals are classified as public or private according to their choice of service.

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”

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.

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.

1. Private charitable (such as Anglicare)2. Private for profit3. State Government

The federal government funds the running of all nursing homes through taxes.

“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. There are three types of nursing homes in operation throughout Australia:

“Psychiatric hospitals provide treatment for people with severe mental disorders. They use a system of care that integrates hospital services and community settings

“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. 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.”

“Health related services include other services such as dentistry, optometry, nursing, ambulance services and physiotherapy”

“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- 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:

State & Territory

GovernmentsLocal

Government

Private Sector

CommunityGroups

• Health Care in Australia- Responsibility for health-care facilities and services

“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”.

“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”

“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.

“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

“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.

• Health Care in Australia- 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:1.Horizontal Equity2.Vertical 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.

“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.”

“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.”

“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. An example of a service addressing the vertically equitable need of geographic disadvantage is the Royal Flying Doctors Service of Australia.”

“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. 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”

• Health Care in Australia- Health care expenditure versus expenditure on early intervention and prevention

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.

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.

There are a number of reasons why costs for health continue to increase:

• Australia’s aging population• More expensive medical services and treatment• Ongoing research and development of sophisticated medical equipment• The high cost of pharmaceuticals• Increasing use of doctors and health care professionals• Litigation cases and insurance fees that need to be paid.

“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 . 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.”

“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”.

•School medical and dental services•Immunisation programs•Fluoridation of water supplies•Anti-smoking campaigns•The National Campaign Against Drug Abuse•National Mental Health Strategy•National HIV/AIDS program

“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:

“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,

“Organisations such as the Heart Foundation, the Cancer Council and the Asthma Foundation also make significant contributions to illness prevention”.

“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”.

“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)

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.

• Health Care in Australia- 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. 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.

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. Some significant improvements through technology can be seen in:

• Minimal access techniques for interventions including keyhole surgery, stent and grafts (for example laproscopy and the use of nanotechnology to enable cameras to see what is happening inside the body)

•Gene technology and gene testing (for example, for skin and breast cancer)

•Magnetic Resonance Imaging (MRI)

• 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•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.

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.

“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”.

• Health Care in Australia- Health Insurance: Medicare and Private

References:

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