Resource Allocation and the Nursing Profession - Essay Example

Running Head: Resource Allocation and the Nursing Profession Resource Allocation and the Nursing Profession and Section] [Date] Abstract The health care industry in any country is managed by both the government and the private sectors. The government because health care is a public good and as much as possible, should be enjoyed by all sectors of the society. The private sector, too, because health care is also an industry where they can get revenues. This paper looks into the management of both the government and the private sector in Australia, with emphasis on the resource allocation on the acute sector and health promotion sectors. This paper also explores the dynamics of the governance of the health care sector, as well as the policy-making and the decision-making processes. Introduction The health care industry in any given country is as much a system and an industry. In the case of Australia, the health care system is not managed hierarchically. It is not also designed centrally by the government. The participants in the health care in Australia, namely the consumers and the providers, do enjoy a great degree of autonomy and independence. Nonetheless, the health care system occupies an important portion in the Gross Domestic Product (GDP) of Australia—the health care sector currently accounts for 9.7% of this GDP (Podger, 2005, p. 1). In spite of the degree of freedom enjoyed by health care practitioners and recipients, the government still plays a large part in the industry. According to Podger (2005, p. 1-2), the objectives of the health care system are (1) good health for the citizens; (2) health care is equitable, meaning it is available and accessible to all citizens, taking into account their capacity to pay; (3) costs reasonably low; and (4) the satisfaction of consumers and of health care professionals. To meet these objectives, the government, inevitably intervenes. In the interest of promoting equity, the government reallocates its resources to meet the needs of the population. Secondly, health has several features that involve public goods; as such, the government is also involved in the prevention of diseases and the safety of foods and drugs. The role of the government becomes especially important because of market failures as well as the provision of asymmetric or incomplete information. Especially in the case of the health insurance industry, the government steps in to regulate the industry so that the consumers are protected and are given the health care they need at the right cost (Podger, 2005, p. 3). Yet, in order for the health care system to be efficient and for it to become accessible to all sectors, both the public and the private sector should work together in achieving efficiency in the market. It is true that government intervention is needed in resource allocation, however, such interventions do not always work and there are costs involved. On the other hand, competition in the private sector may enhance efficiency and at the same time, provide flexibility to the particular needs and requirements and preferences of individuals within the country (Podger, 2005, p. 3). Resource Allocation in the Acute Care and Health Promotion Sectors In Australia, the purchasing and funding responsibilities are separated according to the health care sector concerned such as acute care, adult care, primary care and health care promotions. However, such a system is increasingly becoming inefficient. Although general practitioners can easily navigate through and use such a framework well, the need for efficiency of allocation is in much greater need at this time and the boundaries in funding does not help achieve such level of efficiency; it also has negative impact on the effectiveness of the health care availed of by the patients (Podger, 2005, p. 6). Given this scenario, it is worth looking at the resource allocation between the acute care sector and the health promotion sector. In addition, how such allocation causes inefficiency is another important concern. Inevitably, this resource allocation and inefficiency affects the nursing profession in Australia. In this regard, this paper reviews literature about this topic and provide a summary of the main concerns, findings and debates in this field of study. More specifically, this paper will also create a matrix presenting these strands of thought and noting the arguments of various authors who spent their time and efforts analyzing this issue. Public Governance of Health in Australia Johnston and Duffield (2002, p. 125) provides a picture of the complex situation of the public governance of health in Australia. The authors noted the multi-level sharing of power and governance by the government and how it is shared with the private and not-for-profit sectors. In addition to this, within the government, there are also various levels of government—from the State to the federal levels. As such the allocation of resources is complex and subject to the interests of various stakeholders and players in the health care system of Australia. The duo also noted that in Australia, the public governance system in most sectors already follow neo-classical economic principles that empowers the private sector and relies on free market forces for regulation. In the health care sector, however, this is not the case. The government is socially-oriented in governing the health sector; hence, it has greater involvement in this sector compared with other industries. But this is slowly changing as the government leans towards a giving the private sector wider latitude in the health care sector. Such move, however, might create negative impacts on the total outcome on the health care sector (Johnston & Duffield, 2002, p. 130). Because of these trends, the two researchers expressed doubts regarding the effectiveness of strategic governance in the health care sector. They also compared the health care system of Australia with that of other Anglo-American States and provided an assessment of the capacity of Australia for the strategic governance of health. They concluded that strategic governance of health in Australia is being undermined because of the government’s efforts to relegate its former role to the private sector. Although the article does not deal directly with the issue of resource allocation on the acute care and health care promotion, it provides an overview of the current situation of public governance of the health care sector. In effect, the article helps a researcher get the prevailing picture of the government’s intervention efforts in the health sector. If the government decides to let market forces dictate the way that funding responsibilities and access to the entire health care system, then it would have important effects on both the acute care and health promotion sectors of Australia. Consequently, the profession of nursing would be affected as this would impact the opportunities available for nurses. According to Alford (2005, p. 27), twenty five (25) percent of spending on the health care sector in Australia is on public hospitals. In addition to that, these spending are usually directed to the acute care sector rather than on primary health care. The author also noted that among indigenous population in Australia, there is a lower rate of government spending for their primary health care. Alford’s article dwelt on the level of health care provided to indigenous populations in Australia. Nonetheless, she provides a good overview of the level of resources allocated to the acute services sector. Her findings also suggested that early detection of illness and the overall promotion of health would help improve the health care situation of both indigenous and non-indigenous populations in Australia (Alford, 2005, p. 27, 39). She also noted the difficulties being faced by Canada, Australia, and New Zealand in the allocation and distribution of resources for health care. There is a problem in funding for health care services in these three countries. The allocation of funding according to the particular health needs in the grassroots level is ideal, but there are several problems that need to be faced in order to do this effectively (Alford, 2005, p. 39). Perhaps the primary contribution of Alford’s analysis to this study would be the analysis of the impact of allocation and funding problems to a specific segment of the Australian society. The indigenous sector is not the only one affected, though. Surely other sectors in the society are affected by the difficulties in resource allocation and funding problems between and among the various sectors of the health care system of the country. Health Promotion and Public Policy The role of evidence, facts and data is crucial in advocating for health promotion, especially its impact on public policy. This is because policy makers can be more readily influenced by facts and data instead of rhetoric and grand pronouncement. In this regard, Armstrong, Doyle, Lamb and Waters (2006, p. 169) examined an approach of collaboration in the process of gathering evidence and how such evidence would be implemented for a multi-sector health promotion campaign and public health intervention. They looked at the way in which the formulation of decisions may be impacted by several issues and personalities that are outside the health care sector (Armstrong, et. al, 2006, p. 170). The authors argued for a better level of collaboration and cooperation among various sectors in the interest of gathering evidence and advocating for health care promotion as well as in the formulation of policy related to this matter. In addition, the evidences gathered for this purpose will greatly help in devising better means of interventions, which would positively affect the public health in Australia. Likewise, if such an advocacy were effective, it would lead to a better allocation of resources toward health care promotion, which effectively helps in curbing the incidence of major illnesses in the Australian society (Armstrong, et. al, 2006, p. 171). This study provides a strategy for the advocacy of health promotion in Australia. What the authors did not provide, however, is the current state of the health promotion sector in Australia. Such data would have been helpful in comparing the level of spending in this sector as compared with the acute care and other sectors in the health care system in Australia. Such comparison would also be helpful in assessing the problematic areas in the allocation of resources in the health care sector of Australia and the call for reform would then be sounded for an improved allocation of resources and consequently for a more efficient and effective Australian health care system. The work of Demarteau (2002, p. 454) supplements that of Armstrong, et. al (2006, p. 168). Demarteau proposed a framework that seeks to unify the models pertaining to program evaluation in the health care sector. More specifically, he analyzed the health promotion sector using the practices and framework of program-evaluation. In the evaluation process, there are three crucial components. The first one would the collection of information, which is referred to as evidence by Armstrong, et. al. (2006, p. 168). The second would be the value-judgment product based on the information and data gathered. The last component is the value of such value-judgment product in making important decisions. In the health promotion sector, these components are effective in assessing its effectiveness, as well as the problems and issues that arise in the sector. In addition to the three components proposed by Demarteau, he also identified three dimensions for differentiation in the process of program-evaluation. These are the social enunciation, which pertains to the prevailing social conditions and cultural contexts in the society; the external or internal position of actors, which refers to the backgrounds and biases of individuals and groups involved in the process; and the formal and informal qualities of the evaluation criteria (Demarteau, 2002, p. 460). The components identified by the author are helpful in helping public health practitioners look at the current state of health promotion in Australia. Such evaluation would naturally point to several issues on funding and access to health promotion programs. Both the works of Armstrong, et. al. (2006, p. 168) and Demarteau (2002, p. 454) highlight the need for greater advocacy in the area of health promotion. They also did not delve on the level of funding and resource allocation on the said sector. Hence, it is implied that not enough resources are being channeled to the sector as is the case for the acute care sector. This corroborates the observation of Alford (2005, p. 27) that acute care is one of the most heavily funded sector in the Australian health care system. All of them, however, concur that that reform is needed in the way that resource is being allocated in the health care system. Acute Care and Australian Health Care Spending Around 3 billion dollars have been channeled into acute or chronic disease care in Australia in the year 2000-2001. This is roughly a third of the total government spending on health care. In November 2005, the Australian Health Ministers’ Conference adopted a strategy to address these diseases. The first is the establishment of a national chronic disease strategy; the development of frameworks that seek to improve the delivery of service and a plan for detecting and monitoring these kinds of diseases. The major diseases identified were asthma, cancer, diabetes, cardiovascular diseases and bone diseases (Dowrick, 2006, p. 61). The reason behind the said strategy is the growing rate of incidence of these diseases. Treatment of these diseases is only a part of the solution, however, the early detection and surveillance would also help greatly in addressing these problems. Not only would private citizens be involved in this process. Likewise, health practitioners and medical professionals such as doctors and nurses would be involved in this program. Logically, the government would allocate funds in order to see through the completion of this project. Dowrick (2006,p. 6) called for several reforms in the way that government is handling the acute care sector in order for a more effective program of preventing and treating these kinds of diseases. In particular, he called for a better way of handling information in the sector, advocacies directed towards influencing the policy makers. In addition to this, he also argued that the general practice of medicine in Australia should be configured to deliver optimum service for the whole population. This could be done through the use of effective information technology, as well as the generation of funding models for this purpose. Through the strategies outlined by the author, it is not wonder why the Australian government needs to spend billions of dollars over the acute care sector of the health care system. Through his paper, it can also be seen how the decision-makers are affected by the evidence on the diseases mentioned above and their impact on the whole population of Australia. Health Care Resource Allocation and Decision-making It cannot be denied that the resources in fulfilling the health care needs of citizens are limited and scarce. As such, there is a need for government and for other sectors of society to allocate these resources effectively and efficiently. Because of the realization of this scarcity, policymakers in the health care sector have drawn upon economic analysis to arrive at decisions for resource allocation. According to Mitton (2002, p 241), decision-makers and policy-makers do not usually possess the right tools and knowledge in making their decisions. The researcher noted the weaknesses of prevailing tools, such as needs assessment, cost-of-illness studies, economic evaluation and program budgeting and marginal analysis among others, in setting the priorities for spending and allocating the meager resources available. What they fail to consider, according to the author is the principle of opportunity cost and margin. Because of this, the policy-makers tend to rely on historical factors and what has been done before in making their decisions. Hence, Mitton’s argument runs contrary to Armstrong, et. al. (2006, p. 168), who claimed that evidence in the form of facts and data are important in setting the priority for spending in the health promotion sector. But as Dowrick (2006, p. 61) showed in his article, the setting of the priority in addressing acute or chronic diseases is in recognition of the growing number of incidences of these diseases. Hence, based on more recent findings, evidence has a role in setting the agenda for the health care system in Australia. Nonetheless, Mitton (2002, p. 241) identified program budgeting and marginal analysis (PBMA) as one of the more important tools of analyzing health care needs of the Australian society. Through this tool, decision-makers and policy-makers alike will be able to make more informed choices as to the priorities and program agenda that they will arrive at. Drummond (2004, p. 3) added to the impetus on the analysis of the usage of health economics principles in the process of setting priorities and agenda in the health care system of a country. He analyzed the use of economic principles in the health care sector, particularly because there have doubts regarding the practical utility and value of these principles in the decision-making process for the health care sector. He also noted two particular settings in which the decision-making is implemented. One is in the central level, where a single agency, such as the government or one of its instrumentalities, determines the priorities of the health care system in the society. “The other one, is at the local level, where various stakeholders and actors make the important decisions for the health care sector”. Drummond (2004, p. 3) The author concurred with Mitton (2002, p. 241) that some of the economic tools that seeks to aid policymakers fall short in providing a complete picture of the health care situation. However, he digresses and presents a counter-argument, saying that economic evaluation is not being used properly and that it still has much to offer, provided it is used properly and optimally (Drummond, 2004, p. 8). Acute Care, Health Promotion, Resource Allocation and the Nursing Profession Based on the foregoing, it can be seen that in the case of Australia, resource allocation is more heavily leaning towards the acute sector, both because of historical decisions as well as because of evidences generated pointing to the increasing incidence of the diseases that are considered acute. In addition to this, the decision-making is also rife with political issues that further provide additional dynamics in the process (Mitton & Donaldson, 2004, n.p.). The allocation of resources in the health care system necessarily affects the way that medical professionals do their work. Particularly, nurses, who are providing assistance in hospitals in both urban and rural areas are affected, depending on the priorities of the government and the system of relationships fostered by the priorities set. Brookes, Davidson, Daly and Hancock (2004, p. 195) conducted a qualitative survey about the role of nurses, more specifically community nurses, and the impact to them of the priorities in the health care system of Australia. They found out that there is an unclear definition of the role of nurses in the Australian health care sector. Moreover, the nurses no longer have significant power in policy and decision-making. Because of the priorities set by the government, there is also a conflicting expectation as to the role of the nurses in the health care system. If greater resource were allocated to the acute care sector, then nurses would be expected to deliver services in that sector. This will also be the case, if the priority were health promotion. Such a state of affairs also leads to the underutilization of the potentials of nurses and their possible contributions to the health care system. The authors, then, called for a more active participation on the part of the nurses to vocalize their sentiments and make their voices heard through advocacy and the gathering of evidence regarding the impact of the resource allocation on their profession. Conclusion This paper examined the situation of the health care system in Australia. It began with an overview of the situation of the health care sector and how the sector works. Mention has been made as to the complexity of the funding boundaries in country. Because there are boundaries in the spending among various health sectors in the country and a myriad of actors and sectors are involved in the system, a level of complexity leads to the inefficient allocation of health care services. The level of spending and dynamics for allocating a huge part of the whole spending on the health care sector was also explored in this literature. Moreover, based on the foregoing review, it can be seen that health promotion spending is considerably less than the spending on acute care. The decision-making and policy-formulation in regards to resource allocation is complex and make use of available tools, particularly those from health economics. The process of resource allocation impacts the role of nurses in the communities as well as in the whole health care system. Unclear expectations and definition of the roles of nurses result from unclear and shifting priorities in the health .care system. Reference Alford, K. (2005). Comparing Australian with Canadian and New Zealand Primary Care Health Systems in Relation to Indigenous Populations: Literature Review and Analysis. VicHealth Koori Health Unit Discussion Paper No. 13 July 2005. Retrieved 14 September 2007 from http://www.onemda.unimelb.edu.au/docs/dp13.pdf. Armstrong, R., Doyle, J., Lamb, C. & Waters, E. (2006). Multi-Sectoral Health Promotion and Public Health: the Role of Evidence. Journal of Public Health, 28 (2), 168-172. Retrieved 14 September 2007 from http://jpubhealth.oxfordjournals.org/cgi/reprint/28/2/168.pdf. Brookes, K., Davidson, P., Daly, J. & Hancock, K. (2004) Community Health Nursing in Australia: A Critical Literature Review and Implications for Professional Development. Contemporary Nurse, 16 (3), 195-207. Demarteau, M. (2002). A Theoretical Framework and Grid for Analysis of Programme-evaluation Practices. Evaluation, 8 (4), 454-473. Dowrick, C. (2006). The Chronic Disease Strategy for Australia. Medical Journal of Australia, 185 (2), 61-62. Retrieved 14 September 2007 from https://www.mja.com.au/public/issues/185_02_170706/dow10471_fm.pdf. Drummond, M. (2004). Economic Evaluation in Health Care: Is It Really Useful or Are We Just Kidding Ourselves?. The Australian Economic Review, 37 (1), 3–11 Johnston, J. & Duffield, C.(2002). Strategic Public Governance in Australian Health: The “Unsmart”, Incapacitated State?. Administrative Theory & Praxis, 24 (1), 125-144. Mitton, C. R. (2002). Priority Setting for Decision Makers: Using Health Economics in Practice. European Journal of Health Economics, 3 (4), 240-243. Mitton, C. R. & Donaldson, C. (2004). Health Care Priority Setting: Principles, Practice and Challenges. Cost Effectiveness and Resource Allocation, 2 (3). Retrieved 14 September 2007 from http://resource-allocation.com/content/2/1/3. Podger, A. (2005). Directions for Health Reform in Australia. Paper Presented to the Productivity Commission Roundtable on “Productive Reform in a Federal System”. Retrieved 14 September 2007 from http://www.newmatilda.com/admin/imagelibrary/images/txo0Rfe65LsO.doc. Read More