The Australian and the US Healthcare System - Literature review Example

I strongly disagree with the claim outlined by Leeder (2003:197: 375) that the fundamental difference between the US and the Australian healthcare system is that the US healthcare system is based on the principles of opportunity while the Australian healthcare system is based on the principles of equity. The principles of equity advocate for equal and timely access to healthcare for all people regardless of financial, cultural and social status as observed by Braverman, (2003: 81: 539-545 ). The principle of opportunity healthcare according to Braverman (2003: 81: 539-545) on the other hand works on the policies of stratifying the society into financial and social classes such that healthcare need are potentially restricted to one’s ability to meet the cost. The forces of opportunity healthcare according to Braverman (2003: 81: 539-545) and equity healthcare in Australia are shaped by the political forces that forge for presence of private health insurance and private hospitals as opposed to the need to build a strong publicly funded healthcare. Therefore, for all practical situations, the Australian healthcare system does not adhere to the tenets of the principles of equity but services the ideologies of opportunity healthcare. Hall (1999: 8 (8): 653-660) observes that the objective of achieving equitable healthcare system in Australia has been failed by the need to service the interests of politicians. The goals and objectives that politicians deliver towards sustainable healthcare system are not translated into actions and amount to strategies to court the voters. The same views are shared by Gray (2004). Hall (1999: 8 (8): 653-660) puts forward that the Australian government has not done much to meet requirements of equity healthcare. The publicly funded healthcare system suffers from underfunding. Much of the funding according to observation of Hall (1999: 8 (8): 653-660) is not equitably distributed to service publicly funded healthcare instead much of it goes to service the private health insurance premiums. Dodson (1987: 2: 1-2 observes that the government justifies its support for the private health sector by using a model of distributive justice within whose domain, some people like ministers, assistant ministers, permanent secretaries and members of the parliament receive more healthcare priority than the other people in Australia as outlined by Wooldridge, (2000a:webpage). This move is questionable as it might not present the skeleton aims of ALP that were pioneers of the Medicare system. Basically, the redesigning and re-alignment of Medicare towards reversing trends on private health insurance was to create a prevailing environment for choice in healthcare system as this would have given the Australians more control over their healthcare as Wooldridge (1999a: 5753; 1999b: 5821 ) outlines. This is clear evidence that the publicly funded healthcare system had flaws and loopholes that could not have lead into a successful healthcare system. The Australian healthcare system is dominated by disparities that predispose marginalized and socially disadvantaged Australians to poor healthcare as outlined by Braverman (2003: 81: 539-545) meaning the Australian healthcare has handicaps that are brought about by social, cultural, ethnic, religious and educational overtones according to similar details by Mathews (2003: 15 (12): 16). The presence of this outcome affirms the observation that the Australian healthcare system is based on opportunity healthcare as opposed to equity healthcare that initially was the aim of Australia’s healthcare as agreed on by Howard (1996a:9 (webpage)) but its successful implementation was adversely re-modeled by political forces to adopt an opportunity care dimension. Political influence has led into poor healthcare leadership whose domain of authoritarian has affected the clinical leadership, managerial leadership and greatly affected the delivery of healthcare to all according to observations made by Swerissen and Duckett (1997). The management of hospices is at the discretion of the political climate and healthcare systems have taken to the wing to service the political interests. Political forces affect the distribution of government resources such that a fund meant for equipping hospitals and dispensaries in rural areas are not factored according to Cass and Brennan (2002: 37(3): 261-262). There are also no efforts to build more healthcare facilities in the rural and marginalized lands as observed by Cass and Brennan (2002: 37(3): 261-262). This in turn has led to hospitals or dispensaries in rural areas being neglected. They don’t have enough drugs, medical equipment and many have insufficient staff. The buildings are also old and no public funding to revitalize them. In some instances, the dispensing units are miles far. According to Mooney (2002), the marginalization of the poor and the less privileged has created an opportunity for establishments of private clinics that patients have to pay to get medical services. The healthcare of the rural poor like the aboriginal is compromised. The marginalization is also on the cultural lines for instance, the aboriginals are less likely to receive quality medical care from other hospices. This is also coupled with the discrimination of healthcare based on the level of education and tribal lines. Swerissen and Duckett (1997) are for view that political forces affect the funding of the hospices and consequently affect the quality of healthcare that is rendered. Politicians forge for the preserve of the private healthcare systems backed by private health insurance and private hospitals because they have no trust on the quality of the publicly funded healthcare systems. An observation by Swerissen and Duckett(1997) is congruent with Gray view (2000a: 18:4-14 ) that politicians service political interests of their immediate families and other privileged members of the society, leaving the bulk of the society residing in rural areas on inadequate medical healthcare. According to Sax (1984) the political factor influences the government’s ability to invest in publicly funded healthcare. It also influences where the health facilities are developed depending on the level the healthcare facility is likely to be of help to the political fraternity. This notion enables well equipped hospices to be set up in affluent areas where they are convenient to all politicians who vote for the same in the parliament. The revolution to increase private health insurance funding and support for the private healthcare observed by Gray (2000a: 18:4-14 ; 2000b: 72: 5-7) is a move towards opportunity healthcare system. The access to medical care therefore resides on whether a person is privately insured or not. This condition gives privilege of healthcare to those who have private health insurance membership or are wealthy and leaves those who are dependent on the publicly funded healthcare system receiving delayed healthcare services. The acquisition of the privately insured health insurance became like a value adding component towards fast and efficient access to healthcare according to Eliot (2003). This meant that even preference to specialized treatment had to come with an identity of being a member of a private health insurance. Many surgeries like the heart, dental services, treatment of terminal diseases like the diabetes were a preserve of the people who had private health insurance. According to Spencer (2001) the poor and illiterate are not in a position to receive these value based treatments. This strongly reflects absence of equity healthcare. According to Swerissen and Duckett (2000a) the public funded healthcare system in Australia is not in harmony with the guidelines of operation of the private health insurance and the private hospital. They used to operate as individual entities The government tried to reduce funding of the private health insurance and private hospitals by withdrawing subsidies from the commonwealth countries but the opposition parties in the coalition government worked hard and finally a balance was finally attained. The public funded healthcare and the private health insurance and the private hospitals began to work together following the agreements. The political forces in Australia were inclined towards serving the affluent personalities according to Sax (1984). This had an effect of public funds misappropriations as it did not serve the population equitably. This reflects the scope poor political leadership and structure can have on the quality of healthcare as observed by Eliot Peat et al (2000: 321 (7254): 137-141) observe that there is also a high billing rate of Australians living in the urban centers compared to their counter parts in the rural areas for equivalent healthcare services. This translates into a more opportunity cause than a trend towards equity healthcare according to Mooney (2002). According to Houston (2001) there is a problem of lack of interpreters in many hospitals. The nurses and support staff do not understand the language of the client or the patient. This poses a challenge of language barrier. This puts the illiterate in the community at a disadvantage because it limits their access to informed medical care. In such a scenario, the equity principle lacks its essence because medical care becomes a concept to be advanced appropriately to those that are well educated. The Australian government, under the Australian labour party, allowed those who were able to afford private health insurance to do so according to Hall (2001:7). According to Swerissen and Duckett (1997) and Wooldridge (2000a:webpage) the private health insurance scheme also pledged to offer more tax incentives to low and middle income earners to enable them to become private health insurance members, a move that was meant to cultivate a ground for the opportunity healthcare and not equity healthcare. According to Wooldridge (1997a: webpage) the healthcare system in Australia is a scenario of balance and choice and therefore a product of one’s ability to pay for the medical services or leave it. As a result, many Australians are members of the private health insurance industry. Many of the Australians were lured into the private health insurance following media articles that criticized the far public funded healthcare were likely to go according to Wooldridge (2000a: webpage) the articles that questioned the validity of the publicly funded healthcare system and corresponding high cost of private health insurance following the collapse of the publicly funded healthcare system made many to opt for the private health insurance. Wooldridge (2000a: webpage) underlines that the public seemed to have had no confidence on the publicly funded healthcare system. According to Houston (2001) healthcare may fail to be given appropriately due to presence of language barrier and this does not constitute to equitable healthcare. The Houston’s observation that Australian government has opened pharmaceutical benefit schemes and Medicare to the rural areas is a strategy that partly addresses equity, because it brings healthcare services near to the communities but the healthcare service comes at a cost. The rural communities are supposed to meet the cost of their healthcare needs and this does not add to equity care because most of the rural populations are poor, aged and without financial stability to afford the services. This concept of Medicare is only meant to exploit the rural communities. This is not application of equity healthcare. The Australian government introduction of pharmaceutical benefit schemes amounts to its efforts towards providing an array of healthcare choices. According to Badham and Bandrup (2000: 23 (3): 162-170); Shorten and Shorten(1999: 22 (1): 18-25 ); peat et al (2000: 321 (7254): 137-141), the provision of the healthcare choices poses as a strategy to improve private healthcare provision and this does not address the government commitment towards equitable healthcare services to all. According to Eliot (2005) the coalition health policies were meant to create an environment for blossoms of the private healthcare financing and private healthcare provision. The coalition managed to create avenues for unbalanced healthcare system and restriction for the healthcare choices to model their interests towards private healthcare system. The same sediments are observed by Cass (1999: 21:9-36); Cass and Brennan (2002: 37(3): 261-262). Cass and Brennan share the same feeling with Bishop (1999: 6425) that more preference to healthcare and healthcare facilities was given to those who were privately insured because they were able to meet the cost of healthcare services. This trend, according to Bishop (1999:6425) deprived the poor and those who could not afford the membership to the private health insurance industry a chance to healthcare. This in turn led to increase of waiting list as observed by Mooney (2002). Mooney (2002) adds that wealthy people could pay a surcharge so that they could receive first priority in healthcare. This adds up to a healthcare system that values the privileged as opposed to the value of the patient. In conclusion, the Australian government needs to get the rural community involved in the healthcare planning, increase funding, revive rural hospitals that have been neglected through poor management and create subsidized healthcare services for the old and the young in the population. There is need to improve on the infrastructure, construct more hospital and health centers in the rural areas, allocate enough money to run and maintain them. There is need for the Australian government to ensure clinical leadership is independent of the political influence and serve all patients or clients equitably. The need to set up hospitals and health centers should not be governed by ethnicity or cultural factors. There should be interpreters in the hospitals and dispensaries to address the problem of language barrier. This will ensure the patient get the most out of the healthcare. There is need for the Australian government to review the billing rates of Australians living in the urban centers to be uniform with their counterparts in the rural areas. There should be concrete plans to address the healthcare problems of the terminally ill patients. For instance the diabetic and cardiovascular patients are neglected on this area. The patients should be indentified and classified as terminally ill and have reimbursements towards their healthcare. This will enable the hospice staff to know what to do since they are the ones who handle the patients. A case mix model could also be adopted for funding. References Badham, J. And Brandrup, J. (2000) ‘Length of Stay Comparisons for Private and Public Hospitals ‘Australian Health Review 23 (3): 162-170 Bishop, J. (1999) House of Representatives, Debates Wednesday 9 June, Commonwealth of Australia: Canberra: 6424-6425 Braverman P., Gruskim S. Poverty, Equity, Human Rights and Health. Bulletin World Health Organ 2003: 81: 539-545 Cass, B. (1999) ‘Who Is Afraid of the Welfare State?’ Contemporary Debates about the State of Flexible Work/ Flexible Welfare Arts Associations 21:9-36 Cass, B. and Brennan, D. (2002) Communities of Support or Communities of Surveillance and Enforcement in Welfare Reform Debates’ Australian Journal Of Social Issues 37(3): 261-262 Dodson, L. 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(2000a) media release: national survey reveals massive support for life time health cover 21 march available athttp://www.health.gov.au/internet/wcms/publishing.nsf/content/health-mediarel-yr2000-mw-mw20025.htm Wooldridge, M., (1997a) Media Release and Advertising Puts Private Healthcare in The Fast Lane. July Available At: http://health.gov.au/internet/wcms/publishing.nsf/content/health-archive-mediarel-1997-mw6697.htm Wooldridge, M., 2000b) House of Representatives, Debates Tuesday11 April, Commonwealth of Australia: Canberra: 15661. Read More