Health Care System of Australia and the US - Essay Example

HEALTHCARE PROVISION Student’s Name Institutional Affiliation Date Comparing the health care system of Australia and the US health care system: Health Insurance provision Introduction Australia and the United States are members of the OECD and as such there are a number of things they share. Healthcare provision is very fundamental for all people in the world. Among this group of nations, it is important to note that healthcare provision ranks as one of the most important priorities for any government in place. Australia has been ranked as one of the best countries to live in as far as quality of healthcare is concerned (OECD, 2012). However, it does not mean that the system is the best in the world. In this report, I seek to make a comprehensive comparison of the Australian and the US health system by focusing on the provision of health insurance in the two countries, both in the private and public areas. The report endeavours to provide similarities and differences on how health insurance is done and examine strengths and weaknesses of the two systems. Again, peer reviews will form the most critical part of the comparison analysis. Through this, it will be possible to understand the role of the government and the private sector in health insurance. A number of similarities and differences exist between health insurance provision in Australia and the United States. Similarities in the provision of health insurance It is true that in the two nations, provision of insurance is not entirely a public function but rather the private sector also plays a significant role. Of the OECD nations, Australia and United States are among the nations that fund health care through provision of medical insurance schemes (OECD, 2013). In Australia, the health care system is funded through a universal public health insurance scheme called Medicare. The system has three parts that include hospital, medical and pharmaceutical. Through the scheme Australian citizens can access health care services in public hospitals, get rebates in professional health services and have subsidised costs on a wide range of prescriptions under the Pharmaceutical Benefits Scheme. The Medicare cover offers more than just what been highlighted here (AIHW, 2010). Patients are allowed to select different options where they will have their treatment, either in a public or private hospital. Patients who seek for treatment are reimbursed their charges. Essentially, Medicare covers over 90% of all citizens and residents of Australia (Medicare, 2009). In the US, about 56% of the residents are covered by medical insurance from the government. This cover is meant to work through the Medicare and Medicaid. Hospital are expected to accept Medicare funds so as to stabilize patients with emergency conditions and even some undocumented immigrants to get emergency coverage that goes beyond stabilization level (Aiken et. Al., 2012). Another similarity that exists between health insurance in the two countries has to do with role of the private sector insurance provision. In Australia, there are two main types of private health cover (AIHW, 2011). There are private hospital insurance covers that cater for hospital inpatient charges in the private facilities. Another type of private insurance cover is derived from the Medicare where there is a 25% refund for the patients who access and pay for their treatment in private facilities by the government. However, there are no refunds for private ancillary on services like dental care, physiotherapy, glasses as these are subjected to cost sharing (AIHW, 2012b). In the American system, the private sector plays a significant role in the provision of health insurance as the two types of public insurance covers do not meet the needs of many US citizens and even residents. The Affordable Care Act has made it care that the private sector can continue playing the role it does but the public must be cushioned against high insurance costs and be able to access medical care in the best way. In this way, over 40% of Americans rely on private insurance coverage that is provided by private insurance companies, hospitals and employers (Keehan, Kuckler & Sisko, 2012). Others enjoy both the public insurance that is compulsory through employer contribution along the private covers. But as this may be the case, there are a number of stack differences between health insurance provision in the US and Australia. These differences have enabled Australia to provide better healthcare as compared to US in the OECD group (OECD, 2013b). Health care insurance is a government function and as such, 70% of health care expenditure in Australia is funded by the government through the tax payers. The Medicare in Australia, that is similar to the US Medicare covers all ages as opposed to the US one that limits itself to a certain age, above 65 years (Medicare, 2009). The Australian model has been accepted and supported by all sections of the population and largely covers entirely the whole population as opposed to the US model that leaves out more that 40% of eligible people to be enrolled on the program. The provision of health insurance has had an impact on the quality of life for the Australian citizen as those covered are able to access medical services whenever they need the services (Davis et al., 2010). In the US, health insurance has been a huge issue that has made many argue that the government Affordable Care Act will not meet the intended objectives of roping in all the citizens by 2020 (Healy, Sharman & Lokuge, 2006). The cost of medical insurance in the two countries is of major concern in enabling many to access medical services. While many private health insurance providers get refunds through the MBS program on Medicare in Australia, the same does not apply to the medical insurers in the US. The concept of cost sharing is therefore well developed in the Australian system as compared to the American one (Fox & Duggan, 2013). Medicare in Australia reimburses 85-100% of ambulatory fees and 75% of the fee schedule for in-patient hospital services. In the US, cost sharing provisions among private insurance and government Medicare and Medicaid vary. There are copayments that are done for physician visits and a range of services and there are required deductibles on hospital stays and ambulatory care. From this perspective, system does not allow providers to balance-bill patients (Keehan, Kuckler & Sisko). What is more fundamental is the American health insurance system does not have provisions that will allow outpatients to access prescriptions and as such it denies the patients essential medicines that go along with the treatment. Another difference can be seen in the area of safety net for vulnerable groups like those not insured or those underinsured. About 29 Million Americans that are insured are underinsured and therefore are vulnerable to high out-of-pocket expenses in relation to their income (Keehan, Kuckler & Sisko, 2013). Therefore, these groups are catered by variable and patchwork mix of organizations and programs that are meant to deliver care to the uninsured, low-income and vulnerable patients. In Australian, there is an extended Medicare Safety Net that provides additional payment for patients that may incur high health care expenses once the out-of-pocket threshold is reached (Department of Health, 2013). Again, concessional patients are not required to make copayment when they exceed the PBS levels. This ensures that all people are covered with a structured program so that they are able to access health care. As indicated, there are strengths and weaknesses in the systems as analysed. The American system has a number of strengths. One of the strengths is the ability to allow the private sector to provide health insurance services so as to complement what the government is doing. This allows the government to focus on policy formulation so as to guide the health care sector (Davis et al., 2010). Again, the American system provides different options for the patients and as such they are free to choose who will offer medical services to them and if they can afford it. But the major weakness of the American system is the failure to provide accessibility and affordable health care in contrast to the amount they spend per capita. Many private players are providing insurance services that should complement what the government at both levels is doing to ensure that all people access health care services (Healy, 2010). This may lead to the collapse of the whole system. On the other hand, the Australia system has strength in the fact that there is universal access to health care. Secondly, the Medicare ensures that there is a structured safety net and cost- sharing concept is well developed and understood by all stakeholders (Fox & Duggan, 2013). The reimbursement of funds and rebates is an indication of a health care system that understands that quality health care is very important to quality life. This is evident through the health stats that Australia enjoys in comparison to the US. However, health insurance should not be left to the government alone but a significant participation of the private sector is required so as to offer options and good innovative ideas to thrive in health care provision. Conclusion From this report, it is clear that health care provision and in particular, insurance is very important in ensuring that there is quality life for citizens. The analysis points out clearly that Australia is well placed in health insurance provision as compared to US, despite the fact that she spends less per capita as compared to the US that spends more. Australia fairs favorably among the OECD nations though lags behind in a number of indicators as shown in the OECD reports. References Aiken, L. H., Sermeus, W., Van den Heede, K., Sloane, D. M., Busse, R., McKee, M. & Kutney- Lee, A. (2012). Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States. 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