Current Healthcare in Australian Healthcare System - Literature review Example

Current Healthcare in Australian Healthcare system Student’s Name: Instructor’s Name: Course Code & Name: Date of Submission Abstract It is apparent that there exists a direct relationship between the health index in a particular country and the overall economic growth. This is founded on the fact that health plays a chief role in promoting the socio-economic and geo-political wellbeing in any given nation. This fact is supported by Mexican Commission on Macroeconomics and Health (2004) who cited a long-term study for England which was conducted by Robert Fogel, a Nobel Prize winner in Economics. This study clearly demonstrated the fundamental importance of health wellbeing in a country in promoting the socio-economic capacity. Against this background, many countries around the globe have embarked on resilient efforts to robust their healthcare systems by formulating and implementing diverse healthcare policies. Majority of these policies have been aimed at revolutionizing the healthcare systems to promote the provision of quality, accessible and sustainable healthcare to the populations towards elevated economic capacity. In addition, there has been an increasing cognition both in Australia and in the international scale of the fact that enhancement and constant strengthening of the rudimentary ways in which the provision of healthcare is conducted is an integral determinant of how satisfactorily the healthcare system will be empowered to effectively and efficiently respond to contemporary and emerging pressure in the word. This study is aimed at exploring the strengths and weaknesses of the healthcare system in Australia when juxtaposed with the international models as well as identifying the key issues confronting the Australian healthcare system. Moreover, the study will identify and briefly evaluate the proposals for reforms. Keywords: Healthcare, Healthcare systems, Issues and Reforms. Current status of Australian Health Care System As aforementioned in the preceding section, healthcare plays a paramount role in heightening the magnitude of economic growth in any given country. This has been evidenced by the diverse researches on healthcare systems worldwide. It is fundamental at this point to gain a comprehensive insight on the concept and context of healthcare. Overview of health and healthcare Kinney and Clark (2004) noted that the basic definition of health is laden with diverse controversies. This is best exemplified by the fact that the constitution of the World Health Organization broadly defines health as ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity’. On a more profound reflection, this definition is perhaps too broad in scope for the individuals or collectives making decisions at the governmental level who are mandated with the healthcare of a nation. On the other hand, the context of healthcare is confronted by diverse challenges, for instance, there exists no consensus on the ideal amount or what kind of healthcare services comprises adequate care. In addition, there is limited understanding of the actual cost or quality of those particular services. Nonetheless, scholars in this realm have made extensive efforts geared towards outlining the integral issue of the key tenets that the government ought to assure or provides in regard to healthcare and particularly what may be the morally feasible package of healthcare services (Kinney & Clark, 2004). Healthcare in Australia When compared to other nations, the population in Australia enjoys a good health which is characterized by heightening life expectancy and minimal incidences of diseases which are life threatening. According to the Australian Institute of Health (2000), the average life expectancy of men stood at 76 years while that of women reached an exemplary 82 years. This fact is supported by Korda, Butler, Clements and Kunitz (2007) who revealed that when the international standards are put into utility in assessing the health status in Australia, the latter country is considered a healthy nation with the life expectancy of both the males and females highest in the world. The Australian healthcare system is a complex one with the provision of diverse services which are offered by many providers and are supplemented by a wide range of funding and regulatory mechanisms. There is the involvement of all levels of government in this process with both the private and the public sectors funding and providing healthcare. The following system summarizes the healthcare system in Australia. Figure 1.1: Organizational chart of healthcare system in Australia Source: Hilless, M. & Healy, J. (2001). Health Care Systems in Transition: Australia. European Observatory on Health Care Systems, 3(13), 1-98. Nonetheless, despite the diverse efficiencies that are usually attributed to this healthcare system, it is apparent that it is confronted by diverse gaps. These gaps are evidenced by variance in accessibility of healthcare between different socio-economic groups and increased mortality rates among the least advantaged groups. This calls for different reforms in the healthcare system to supplement those already in existence. This will be analyzed in a later section. The subsequent analysis explores some of the strengths and weaknesses that are associated with the healthcare system in Australia when juxtaposed with international models. Strengths of Healthcare in Australia Despite some major issues being raised by various individuals and collectives criticizing the healthcare system in Australia, there are several strengths which are attached to it. General practice Hamley (2009) determined that one of the major strength of the health system in Australia is founded on its general practice. In this regard, the healthcare system is endowed with good general practitioners who have the capacity to work together with patients, a collaboration which is aimed at enhancing health and ensuring that there is high early detection of illnesses and risk factors which culminates in them being dealt with before the cause substantial damage. Decentralization of the healthcare practice There is immense decentralization of the Australian healthcare system, reducing overdependence on a singular entity. Hilless and Healy (2001) noted that the healthcare system in Australia is highly pluralistic whereby the states administer and deliver majority of the health services chiefly public hospital services and public health while the local government is restricted in terms of functions in healthcare. In addition, there is intensive inclusion of the large private sector which has advanced with privatization in the recent decades. However, this encompasses a range of strategies stretching from delivering of public health services in a more business-like fashion to vending of public facilities to private health providers. This has been instrumental in the instigation of a mix of private-public mandates which has substantially minimized the governmental role and elevated the dependence on private entities and non-governmental organizations. The instances of outsourcing have also heightened whereby non-core services like laundry, cleaning and catering among others have been increasingly been contracted out to the private sector (Australian Department of Health and Aged, 1999). When compared with other international models, there is a substantial involvement of the private sector in healthcare. In this regard, the private sector accounts for approximately one third of the overall expenditure in health and around two thirds in delivery of health services (Hilless & Healy, 2001). This is in contrast with healthcare models in countries like China whereby prior to year 2000, roughly all the institutions engaged in healthcare were state-owned, public and entirely non-profit. Despite the Healthcare Reform Act in 2000, the involvement of the private sector in healthcare practices has been minimal to date (The China Healthcare Group, 2000). Therefore, the decentralization of healthcare system in Australia has fundamental in not only reducing the overreliance on a particular entity as well as creating a formidable base of intellectual and knowledge capital which can be highly beneficial in advancing future healthcare delivery. Cost sharing According to the Commonwealth Fund (2010), Medicare in Australia repays 85-100% of the schedule fee for ambulatory services and 75% of the schedule fee for in-hospital services. There is also continued utility of bulk billing whereby there is no fixation of the doctor’s charge. Due to the declining rates in this area for general practice, there was the instigation of an incentive scheme in 2004 which aimed at providing additional payment for bulk billing concession card holders (elderly, children and lo-income class). In addition, the Medicare payment was elevated to 100% of schedule fee in 2005. This has continued to expand the accessibility of healthcare among people in the Australian population. This is contrary to several models in the international spectrum whereby in countries like Canada and Denmark, there is limited or no cost-sharing (The Commonwealth Fund, 2010). This adds a positive aspect in the Australian healthcare system. Performance measurement and management There is extensive assessment on the provision of healthcare in Australia which guarantees maximum output in this imperative sector. Hilless and Healy (2001) noted that several national bodies are engaged in the assessment and measurement of the performance in the health sector. These includes but not limited to Australian Council on Health Care Standards, national Health Committee and Australian Institute of Health and Welfare. There is also wide incorporation of budget systems and performance indicators in diverse processes in the health sector. This is integral in maintaining high levels of outcomes from the diverse initiated programs and policies in this sector based on the fact that there is a wide cognition of the validity of these methods in gap identification and rectification. In addition, performance assessment aids in elevating the levels of accountability and transparency in health practices. This contrasts other the models in other countries. Hurst and Jee-Hughes (2000) revealed that the measurement of the outcomes in the health sector remains non-embraced and difficult in other Organization for Economic Cooperation and Development (OECD) member countries. Weaknesses of healthcare in Australia Despite the aforementioned factors which make the healthcare system in Australia be perceived as more robust when compared with other international models, there are some inherent weaknesses which prompt questions in regard to its validity. Some of these weaknesses are analyzed below. Equity Duckett (2008) found out that since the 1960s, there have been widespread endeavors to solve the paradox of equity in the Australian health system which have been aimed at addressing two primary elements namely equity of access and equity of outcomes. This is best exemplified by the significant disparities which are evident when the rural-urban access to healthcare is analyzed. For instance, there are usually a fewer doctors per 1000 population in the rural areas when compared to the urban set-up. In addition, racial barriers are prevalent in the access to healthcare, mostly when the overall expenditure is considered. For instance, Duckett (2008) noted that the health expenditure for the indigenous people shows limited or no similarity with that of the non-indigenous people. Moreover, differences in healthcare access are prevalent between the low and the high income societal strata and between the employed and the non-employed. In this regard, inadequate mechanisms to elevate the levels of equity seems as a major weakness in the Australian healthcare system when compared with other international models, for instance, Mackenbach and Bakker (2002) revealed that majority of the European countries like the United Kingdom have adopted profound policies to minimize the magnitude of inequality in their health systems. Quality Jackson, Duckett and Buxter (2006) determined that the evidence from Australian studies aimed at assessing the level of quality in hospital care reveal that a detrimental occurrence which is embedded with grave corollaries occurs in approximately 15% of overnight stays. This is amplified by the disclosure by one-sixth of ‘sicker Australians’ who believed that treatment errors occurred in their treatment process for the last couple of years. Poor continuity of healthcare has also been perceived as a major weakness in the Australian healthcare system which is directly linked to the issues in system design. Duckett (2008) noted that a survey among the ‘sicker Australians’ revealed that about one-quarter of them were attended to by five or more doctors which was characterized by delayed or lost records and repeat of information. The continuation of this trend is definitely bound to further jeopardize the quality in healthcare. However, this weakness of poor coordination and continuity of care which threatens the quality in healthcare is not restricted Australia. Pritchard and Hughes (1995) determined that there is in-depth poor institutional coordination in the United Kingdom, especially in large organizations like teaching hospitals and also unitary healthcare systems. This is best exemplified by the United Kingdom National Health Service which is characterized by diverse coordination challenges. The widespread perception of presumed lack of quality in the Australian health system culminates in limited public acceptability as will be highlighted later in this analysis. Acceptability The level of acceptability of any given healthcare system is viewed relative to patient satisfaction. In Australia, consumer movements have continued to be strengthened since the early 1980s mostly as a response to the elevated dissatisfaction with the healthcare system in terms of the way in which the consumers are treated. This has been evident among populations from non-English speaking background, people with chronic illnesses and women health movements (Duckett, 2008). Against this background, the Australian healthcare system has been characterized by gaps in addressing the issues of language barriers and cultural insensitivity among the non-English speaking population. On the other hand, aboriginal and Torres Strait islander population is also encounter lack of cultural sensitivity in the course of their healthcare seeking efforts. The lack of acceptability in the healthcare system greatly undermines successful implementation of diverse reforms aimed at streamlining this imperative sector. The level of acceptability of the healthcare system in Australia is not so different from other international healthcare models, for instance in India, there is widespread dissatisfaction with the healthcare system in issues like insurance policies. However, in other countries like the United States, there is a general feeling that the healthcare system is doing relatively well in promoting the wellbeing of the population when compared to other parts of the world but may be threatened by the advent of healthcare reforms (Docteur &Berenson, 2009). Efficiency The weakness in efficiency in the Australian healthcare system can be perceived to be double fold; allocative efficiency and dynamic efficiency. In allocative efficiency, the Australian healthcare system has some inherent challenges in priority setting which infers to the decisions on the appropriate division of various resources to be allocated to among diseases (for instance orthopedic services versus cardiac services) and different methodological approaches to health (for instance, curative as opposed to preventive investments) (Duckett, 2008). Stamp et. al (1998) revealed that majority of the Aboriginal and Torres Strait islanders are often admitted into hospitals for conditions which do not call for admissions or in situations whereby the preference of that particular condition could otherwise have been minimized with formulation and implementation of quality primary care. In regard to dynamic efficiency, Australian healthcare system is deficient of an ample platform on which to base community-based healthcare. On the other hand, in contrast with the United States, the healthcare system in Australia is not endowed with a policy culture which underscores systematic experimentation in health policy innovation, with the Coordinated Care trials being the most apparent example (Duckett, 2008). Key issues confronting Australian healthcare system Most of the main issues that continue to face the healthcare system in Australia are founded on the weaknesses previously analyzed. However, there are other independent concerns which will be explored in this section. Fragmentation and non-development of the primary health care sector Dwyer and Eagar (2008) noted that this is a major impediment that primarily confronts those in need for continued healthcare, for instance the people with chronic conditions as well as those in the rural and remote areas. On a wider scale, this also infers that depending on the locality of a particular patient, there are varied probabilities of both accessing or not accessing guidance and sustenance for new mothers. In addition, the healthcare system has little provisions for preventive approach to health aimed at deterrence of illnesses which is a potentially fundamental function in primary healthcare system (Dwyer & Eagar, 2008). This provides a major challenge in the attainment of stable healthcare posing doubts on the sustainability of the healthcare system. Confusion in the funding programs The healthcare system in Australia is confronted by a wide range of funding programs each with distinct access hindrances, accountability prerequisites, timelines and eligibility criteria. This generates a maze even to the managers on whether their institutions will get the funding they are eligible for. This is coupled with the impediment of massive duplications as well as gaps in the service delivery systems (Dwyer & Eagar, 2008). Dwyer and Eagar (2008) cited that this complexity has adverse effects in generating both reporting regulatory complications which are epitomized by increased overhead costs of administering population health programs which are ‘vertical’ in nature. Contentious relationship between the government, NGOs and private service Despite the elevated involvement of the private sector and the non-governmental organizations in the provision of healthcare being cited as a paramount strength of the Australian healthcare system, the relationship between these stakeholders is often determined by personal relationship as opposed to communications which are transparent and efficient referral systems. In addition, there is evident inadequate linkage and coordination between these participants and other agencies. This limits the probability of coordinated planning, policy formulation and eventual execution of these policies aimed at improving the health care system (Dwyer & Eagar, 2008). Inequitable access to healthcare As previously mentioned, this is a major ‘Pandora’s box’ that continues to confront the Australian healthcare system. This is whereby the access to healthcare is predetermined by financial capacity, locality especially among the inhabitants of remote areas among other factors. Dwyer and Eagar (2008) forwarded and interesting argument by determining that whereas the healthcare that an individual ought to be founded on the level of need, there is an unfortunate trend in Australia whereby where one lives and the amount of money that one is endowed with are key determinants of the nature of healthcare that one receives and the speed that he/she will receive it. This is a vital issue that requires urgent redress or else it will continue to cause diabolical impacts both on the credibility of the Australian healthcare system and the overall acceptability of this system by the Australian population. All the above issues continue to confront the healthcare system in Australia and pose different levels of effects on the system when compared with other international models. However, it is imperative to note that there have been several reform proposals which have been aimed at rectifying some of these anomalies in the Australian healthcare system. Some of them are analyzed and evaluated in the subsequent section. Reform proposals In regard to equity of outcomes, Duckett (2008) suggested that due to the complexity of the strategic approach, albeit additional resources are required to address some of the issues like preventive healthcare, there should also be intensive engagement of the indigenous communities to enhance the process of priority setting. Moreover, the approach to enhance equity ought to be multi-sectoral which will improve the knowledge and skills capital among the healthcare providers. This proposal is integral since it addresses the core issue that detriments the Australian healthcare system. A holistic approach in minimizing the level of inequality in healthcare will be imperative since it will not only enhance coordination but will also create a sense of ownership for the various interventions by different groups. They will feel appreciated, consulted and their opinions valued which will be key in creating sustainability of the implemented policies. In terms of increasing quality of the healthcare system, there is a reform proposal that more intensive efforts should be underpinned in regard to technical reforms. This is whereby the current system does not fully utilize the talents that are in available which culminates in overburdening some practitioners with excessive tasks or generating ‘shortages’ and needs which are unmet (Duckett, 2008). Against this background, the experienced nurses who are based locally mostly in rural areas ought to have their skills upgraded and be empowered with the capacity of providing primary healthcare while partnering with the general practitioners. This will not only address the issues of minimizing the burden of the GPs but will also be integral in enhancing efficiency thorough improved coordination. In regard to the safety and quality challenges in the Australian healthcare, adverse events ought to be reported, analyzed, and viable recommendations proposed from therein. This will be key in deducing variable lessons from these events and prudent measures undertaken to curtail their recurrence in the future. The funding programs also ought to be streamlined in order to sole the maze surrounding them, which will ensure that the medical providers are endowed with clarity in regard to eligibility criteria and timelines that precondition the funding procedure. This will be principle in promoting accountability and transparency among the diverse healthcare providers. This should be coupled with formulation of ideal frameworks which will ensure clear demarcation of the roles to be undertaken by each stakeholder in the entire health provision realm. This will not only forge favorable working relationships but will also be fundamental in promoting coordinated efforts towards improving the healthcare system in Australia. Conclusion The healthcare system in Australia is endowed by diverse strong points when compared to other international models. However, despite these strengths, major weaknesses are apparent which continue to significantly mar the credibility and future sustainability of this imperative system. 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