Innovations in Australian Healthcare System - Essay Example

Introduction This brief is a synopsis of the Australian Healthcare System as it currently stands and the proposed reforms that the government proposes to make. A thorough SWOT analysis shall be reviewed on the current system, the proposed reforms and recommendations that will arise from it. There are certain bottlenecks that choke the health system as it stands now. These will be evaluated and possible solutions proposed. Australia is a Commonwealth state which operates under the Westminster system. The commonwealth provides leadership in formulating policies to do with public health, research, and national information management. Delivery of these services is largely left to individual states and territories, which deal with psychiatric, community and public health services. Funding is also divided between the state and the commonwealth with the former funding a range of health services while the latter fund mainly extra-hospital services and health research. Both entities together provide funding for public hospitals and social care of the aged and disabled (Armstrong et.al, 2007). The private health care services are dynamic, extensive and subsidized by the government i.e. individuals who acquire private health insurance get 30% subsidy from the commonwealth government as well as other incentives to maintain that insurance. The third player in the health care system is the Non-governmental, religious, and altruistic groups that contribute significantly to this sector. Australia’s health care is highly regarded amongst global contemporaries, with a high life expectancy on average and an infant mortality rate that is relatively low (ABS, 2006). However, there is a looming threat to the system in form of an ageing population, the increasing incidence of chronic illness, and the health care system does not keep up with the needs of the population. (Armstrong et.al. 2007) The gap in health between the most and least well-to-do continues to widen and this calls for immediate action. There is widespread consensus that the focus of health care should be on deterrence and more effective management of chronic illness (DoHA, 2006) & (WHO, 2005). What this involves is identifying communities who require the most assistance, particularly the indigenous peoples, tightening the networks that link principal, acute, and rehabilitative services, as well as finding inventive ways to deliver services to areas with limited access to it. The system as is has limited leeway to cater for any such contingencies system constraints that focus on service-for-fees, with clients paying more from their own pockets and lack of sufficient staff (Armstrong et.al, 2007). Health care funding is supposed to provide complete health care to all, while giving the choice to the client as to type of healthcare by involving the private sector in health care delivery and funding. This health care system is known as Medicare and its aim is to provide quality care at no cost. Financing is mainly through taxation with the Commonwealth chipping in, in terms of; Subsidised prescriptions, and practitioner’s consultation fee. It may even be free of charge in cases of chronic medications and some consultations. Grants awarded to states and territories to subsidise hospital visits. Grants awarded for very particular purposes to the states and territories. There are challenges in funding and delivering the health care. These stem from the following; The aging of populations as well as the rise in chronic illnesses. Rising expenditure in progressing therapeutics, and the accompanying verification techniques to ensure quality. Staffing difficulties where supply does not meet demand. Continual questions about the calibre and safety of medical services. Ambiguity on how to create equilibrium in public/private funding. A growing realisation in the need to devote more funds to the welfare of the young. Recognition that urban planning is crucial to public health and sustainability of the society. Perception that equitable health care especially for indigenous peoples means more than the provision of medical services. (Armstrong et.al, 2007). Key Reforms We as the Australian government instituted an independent commission to make recommendations on what possible reforms could be undertaken to better our health system. The National Health and Hospital Reform Commission (NHHRC), was constituted with ten people led by Christine Bennett in 2008. The group specialities ranged from making policies to the practise of medicine; in both public and private sectors. They arrived at some key points as laid out below: i. Strengths: Fostering accountability (recommendations 1-15) These recommendations outline the concept that good health takes more than effective health services; as a community and as individual persons, it is necessary to live a lifestyle that is conducive to good health. Dissemination of these messages was to be through educating clients at the primary healthcare level, and through public health drives. The goal of this initiative would be to enhance patients’ understanding on how they can best take care of their health. Under the National Health and Hospitals Network Agreement, sixty percent of the cost of service will be footed by the commonwealth at every public hospital. Beginning first of July, 2011, the criteria for funding will hinge on the hospital’s activity (AMA, 2010). Linking HealthCare (recommendations 16-57): This theme aspires to promote a lifetime of health by reinforcing the relationship between primary health care, avoidance of disease, and sub acute treatment. The aim is ensuring that health is fostered from the start and going on right up to the welfare of senior citizens. The Commonwealth undertook to finance public hospitals in the states and territories to the tune of 4.8 billion dollars in November 2008. They also injected a once only 750 million dollar stimulus for 2008-09The aim of this, according to then Prime Minister, was to facilitate three thousand, seven hundred and fifty more beds in the coming financial year, this increasing to seven thousand eight hundred beds as of 2012-13 financial year.(Press Release, 2008). Unfortunately, this translated to a practical increase of only eleven available beds in public hospitals, according to the State of Our Public Hospitals Report, (2009 & 2010). Confronting Disparities (recommendations 58-87): There are various disparities to access to health care in the categories of ethnicity, locality, or psychiatric health. There is also a deficiency in oral health systems. One hundred and fifty million dollars was provided in 2008 by the commonwealth to fund states and territories in a ‘blitz’ that was supposed to eliminate hospital waiting lists countrywide. In line with this, the states and territories undertook to maintain their rate of conduction of elective surgeries, while also carrying out twenty-five thousand more procedures. This was announced as having exceeded expectations at the Australian Health Ministers’ conference in March, 2009, that is 41,584 more elective procedures conducted in ’08 compared to the previous year – 64% higher than was targeted by the ‘blitz’. In December of the same year, it was reported by the Minister for Health that 62,000 electives had been done since 2008. (Press Release, 2009; Hansard, 2010). Motivating excellence (recommendations 87-123): Finally, we intend to handle the control of the current system including the input of both commonwealth and states/territories with the aim of enhancing quality. Personnel in the health field will also be required to be more competent and effectual. The agreement signed in November 2008 on National Healthcare was a commitment to adhere to performance standards that state that by the financial year 2012-13, all presentations to the emergency room would be attended to within the Australoasian College for Emergency Medicine endorsed triage time. In 2008-09 there was a 4% improvement on urgent cases seen within 30mins, but it failed to meet the target of 80%. ii. Weaknesses: Clearly there are issues in the Australian system of health services that need to be addressed, they include: The discrepancy in mortality rate between Aboriginal and non-Indigenous populations: Even as we plan the way forward guided by targets and objectives designed to foster better health, the process can be bogged down by procedural and developmental processes that are part and parcel of the course of action. It may be helpful to possess accurate statistics which may be an impractical goal on a national level, but useful especially when dealing with issues of framework (Nutbeam & Wise, 1996). An over-reliance on medics trained elsewhere: It behoves the all state organs to strategise for the future by ensuring that adequate facilities are available for the training of medical scholars, interns, prevocational and vocational apprentices as these are inadequate to meet national needs. A joint statement vocalising the necessary steps to be taken to address this bottleneck was issued on the same on December 29th, 2010 by the AMA, Australian Medical Students’ Association, Medical Deans Australia & New Zealand and the Confederation of Postgraduate Medical Education Councils (AMA, 2010). Difficult or sometimes impossible inaccessibility to doctors and hospitals: The attainment of the goal of treatment of emergency cases within triage times is obstructed by ‘access block’. This is described and calculated by the amount of time patients wait in emergency rooms for admission to the ward, i.e. more than eight hours. The estimated mortality rate from ‘access block as arrived at by a large consensus is 20-30% (Forero & Hillman, 2008). While the impossibility of meeting short waiting times one hundred percent of the time is acknowledged, due to the capricious nature of emergencies, it is also noted that too often hospital indicators fail to even achieve minimum standards. The ultimate reason behind the occurrence of access block is the incapacity of public hospitals to cater to the requirements of its patients. The treatment of what should be in-patients in emergency departments is what leads to congestion, thus taking away resources from the stated purpose of the emergency services – the precipitate handling of incoming emergency situations. Huge difference in health status between rural and urban populations: The Health for All Australians report of 1988 outlined the country’s first attempt to address this situation by constructing a goal-oriented, target-linked strategy for the improvement of national health status. This report was unique in that it included a cost analysis linked to the recommendations made on the main concerns slated for review. Five areas of concern were identified and endorsed by the Ministers for health. This led to the establishment of an initiative, the National better health programme mandated to come up with the way forward to accomplish their aims, which was given funding for 4 years. There were advances made in some areas, specifically infrastructure and health promotion. In 1991-92, there was a review done (Nutbeam et.al, 1993) in order to bring into the forefront the basic socio-environmental factors that influence health and bring clarity to the concept of developments necessary to foster a more equitable distribution of care. A more concerted effort was used to come up with parameters for screening and answerability, while the stakeholders viz, the health care system were more intensively involved. An undertaking was signed to ensure implementation and attainment of the revised goals and this was incorporated in the Medicare Agreement that legislates support of the public health system (Nutbeam &Wise, 1996). All these issues are dealt with in the NHHRC recommendations (McLachlan, 2010). Comparison with Other Health Systems Australia is a member of the Organisation for Economic Cooperation and Development (OECD). In the immediate past there have been huge advances in care and prevention of chronic illnesses such as cardiovascular disease, malignant disorders, and prematurity amongst others. The advent of new and better management techniques from drugs to surgery have meant that outcomes have improved tremendously. Non-invasive surgery is now a possibility that enables previously illegitimate candidates to be treated and make a quicker, less painful recovery. The availability of universal health care in many nations; both public and private sector funded means that patients are assured of accessing treatment at a cost that is not prohibitive; and this promotes good health by ensuring treatment and preventive care compliance. By the year 2001, over 66% of OECD countries had attained a better than 90% rate in measles immunisations for children; contrasted with just 30% of countries a decade earlier. This brings about a longer life expectancy; however, these advantages come with a cost. Expenditure on health systems was on average greater than 8% of the GDP; in the U.S, Switzerland and Germany that figure went up to 10% (See figure 1; Appendix I). In 1970, in comparison, this figure was just 5%. This almost doubling of costs is due to advances in the medical field and a concomitant increase in patient expectations (OECD 2004). It is obvious that the United States is the number one investor in health care as measured by gross domestic product or even by expenditure per capita; as of 2008, that figure was at 16% OECD, (2007). The cost of health care has outstripped the GDP growth with Americans spending less on accommodation, sustenance, national security and cars than the $1.8 trillion spent (Borger et.al 2006). These statistics may reflect the relative wealth of the U.S pre-economic crisis, as the health care payments was positively linked with earnings. (Reinhardt, et.al, 2004). The systems by which these costs are divided are taking a toll on enterprises and individuals. According to the Kaiser Family Foundation (2007), premiums rose at a faster rate than remunerations by slightly more than six per cent. The government programs for health i.e. Medicare and Medicaid are accumulating alarming amounts of debt with the non-financed burden topping $50 trillion. It is projected that Medicaid is set to hit a fourfold increase if left unchecked in the next hundred years (Gokhale 2007). Conversely, according to the Washington U.S census bureau (2005), it is estimated that about forty-seven million Americans are uninsured. Although a significant number of these are eligible for government programs and others are youthful and vigorous, some not insured for a limited period, there is no doubt that it is a significant difficulty (Levy & Meltzer, 2001). Lastly, while not denying the superiority of the health care system in the United States, the access to quality care is irregular. Forty-four to ninety thousand deaths annually are attributed to medical blunders according to the Institute of Medicine (Nordenberg, 2000). Just slightly more than half of patients obtain the recommended standards of care according to a study done in The New England Journal of Medicine. (McGlynn et.al. 2003) The Spanish mindset to their health system is a majority consensus that change is needed. The main issue is waiting times. However, the number of people who are disapproving of the system has halved in the last fifteen years as of 2007. Although there is a belief that more spending is necessary for the sector, there is reluctance for an increase in taxes to achieve this. Interestingly, it was discovered in the survey that medical personnel are some of the most trusted as compared to other professions and institutions in Spain (Jovell, et.al. 2007). During the fifteen years, it was found that clients registered a slight progress in their health care experiences which suggests a general appearance of equable distribution nationwide. There are no significant differences in data between different demographics with the important exception of the youth displaying a more disapproving attitude to the system. The world’s oldest uninterrupted culture is undoubtedly China. In the past three decades, it has evolved into a significant international player. Domestically, China’s growth has been remarkable, registering 100% GDP growth between 2002 and 2006. Twenty per cent of the world’s population resides in China, yet its significance to global health remains under-acknowledged. The magnitude of Chinese population undergoing fast and important shifts in health is significant from a global perception. It contributes profoundly to any medical situation of note; with the incidence of chronic illnesses of cardiovascular nature, endemic infections such as avian flu, changes in diet and exercise, as well as ecological and behavioural pressure (Lancet 2008). Whatever takes place in China vis a vis these threats affects the global dynamic. Furthermore, China is a reservoir of medical knowledge and innovation both traditionally and technologically. Artemisinin which is a first-line treatment for malaria stems from Chinese. Recommendations The following are appropriate recommendations to correct the state of healthcare in Australia: The Prime Minister, Mr Kevin Rudd, has outlined a radical strategy to grab administration of the defunct hospital structure in order to resolve the ongoing dispute with the states. The plan will involve a $50 billion stripping of the GST earnings from the states and territories, taking over as the main financier of all public hospital facilities and administering the provision of health services and general practitioners countrywide. In other words, the government will debut direct payment to hospitals for delivery of services to patients and mostly wholly subsidise the cost of primary outpatient services from public hospitals. To do this will require the creation of inter-hospital networks at the local level in order to be able to have effective service delivery by pooling resources. (The Australian, 2010) Secondly, the government could include local communities in policy planning of expenditure in health care. This would entail a visionary health minister with the accompanying political weight collaborating with respected independent professionals. These would chair autonomous organisations that would evaluate policy structure reform, using wide consultation to come to recommendations that would be pertinent. These recommendations would then be adopted by the government which would delegate implementation to outside professionally heavy entities who would have the wherewithal to achieve reform (Van Der Weyden, 2003). The main driving force for this would of course be the political will to get the process started. My recommendation would be institution of the direct payment to the hospitals as and when it becomes financially viable but with as much expediency as can be managed. This would ensure access to medical help in the short term as an independent committee is debating upon and consulting widely on the most viable alternative going forward. (The Australian, 2010). Once the direct funding is up and running, applications should be invited from the public for highly qualified eminent professionals to form a brain trust that will brainstorm together to create a policy plan for the implementation of a comprehensive, effective and equitably distributed health care system reform. Once this is done, further interviews will be conducted to appoint professionals to implement these policies in the most effectual, cost-effective manner, independent of bureaucratic interference. (Van Der Weyden, 2003) Bibliography Armstrong, B.K, Gillespie, J. A, Leeder, R.S Rubin G.L and Russell, L.M. (2007) Challenges in health and health care for Australia Medical Journal of Australia; 187 (9): 485-489 Australian Government Department of Health and Ageing, DoHA. (2006). National chronic disease strategy. Canberra: Australia Parliament. (2010). Hansard Questions on Notice, 3 February 2010, p 114 Census Bureau. (2000). 2000 Census (Washington: U.S. Census Bureau). 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Lancet Wang SY, Li YH, Chi GB, et al. (2008). Injury-related fatalities in China: an under-recognised public-health problem. Lancet Washington: U.S. Department of Health and Human Services. (2005). “Overview of the Uninsured in the United States: An Analysis of the 2005 Current Population Survey” World Health Organization. (2010). Health Systems Financing; the path to universal coverage. Summary Report. Geneva. WHO. World Health Organization. (2005). Preventing chronic diseases: a vital investment. Geneva: WHO, Yang G, Kong L, Zhao W, et al. (2008). Emergence of chronic non-communicable diseases in China. Lancet Appendix I Figure 1: Expenditure on Health in OECD countries; 1970 & 2001 Read More