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Understanding Of Australian Healthcare System

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Understanding Of Australian Healthcare System

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The World Health Organization describes a health system as ‘all the activities whose primary purpose is to promote, restore and/or maintain health’ (WHO, 2013). Further, a good health system ‘delivers quality services to all people, when and where they need them’. The success of the healthcare system of a country is judged by whether it provides quality service, access for all, is affordable and equitable for the population it serves. The large amount of spending on healthcare by the US ($8387 per person per year) cannot be used as a measure of excellence. But it scores well on preventative measures that focus on reducing disease burden through prevention and early detection (How to compare health systems between countries, 2014)In Australia, the healthcare system offers highly subsidized and even free services for all. Other than robust finances  healthcare system requires a highly trained workforce, and a policy framework based on needs and requirements of the people it provides services to (/which-country-has-worlds-best-healthcare-system-this-is-the-nhs, 2016).
The healthcare system provision in Australia consists of public and private service providers. It is accomplished by a network of providers that includes medical practitioners, nurses, pathology and testing services, clinics and hospitals. The publicly funded medical services are receive funds from the state and territory governments and function under the administration of the local, state and territory and the Australian governments. The private clinics and hospitals and pharmacies are funded and run by the private sector. A wide range of services are available to serve the medical needs of the Australian public, these include- preventive services, public health services, emergency healthcare, hospital-based treatment and care, palliative care and rehabilitation services. Primary healthcare services form the basis of the healthcare in Australia. Other programs that are provided by the government include- population health, community health and health infrastructure. Health services for the Aboriginals and Torres Strait Islanders are also provided.
Regulation of the health services is done through legislation that governs the public hospital system. Sale of tobacco and alcohol products is regulated by governments. Ensuring the safety and quality of goods and appliances and medicines is a function of the Australian government. Quarantine arrangements and medical insurance provided by the private sector when required and a safe supply of blood and blood products are the responsibilities of the local and state/territory governments. Private hospitals are licensed and registered in order to facilitate monitoring by the authorities.
The National Registration and Accreditation Scheme (NRAS) ensures that all practitioners are suitably qualified and if services are required, their mobility across the country is facilitated. The department of health ensures a responsive and flexible workforce for provision of healthcare services across all states and territories of Australia (Health Systems).
Many countries have opted for co-payments. The level of out-of-pocket payments in Australia is at $731 per capita, which is higher than the OECD average. This puts the vulnerable sections of the population at risk, because they either avoid treatment and this has long-term negative fall-outs on their health or they cannot afford the expensive range of healthcare treatments at all. Even though the healthcare system is largely government funded in Australia, 20% of the time, patients have to make out-of-pocket payments. High rate of hospital admissions in Australia for the treatment of chronic conditions points to the rather low rates of prevention programs delivered through the primary healthcare system. In particular, two health issues that can be treated by better self-management of patients and primary care are asthma and chronic obstructive pulmonary disease. Lesser hospitalisations can then lead to reduced healthcare expenditure due to fewer hospitalisations.  (/Health-at-a-Glance-2015-Key-Findings-AUSTRALIA.pdf, 2015).
Health expenditure in Australia in 2012 was 9.1% of the GDP. In 2010-11, public sector spending on healthcare was 68%, 20.4% payments were made out-of-pocket, and 8.3% of healthcare expenses were covered by private insurance providers. 47% Australians were insured for treatment in private hospitals. These include affluent Australians and women between 20 and 30 years of age. Out-of-pocket payment is $731 in Australia against an OECD average of $590. About 18% Australians had to wait for more than four months for elective surgeries, according to the health policy survey of  2010. 16% Australians experienced an access barrier to healthcare due to high cost (Jeyaratnam & Jackson-Webb, 2014).
The Medicare services under the public health system offer free treatment by doctors, dentists and optometrists, and prescription pharmaceuticals.
85% of the healthcare burden in Australia is due to the non-communicable diseases, 10% of the healthcare resources were utilized in 2010 for treatment of injuries. On the contrary, just 5% of the disease burden was due to communicable diseases, neo-natal, nutritional disorders and maternal problems. Among the non-communicable diseases, 16% disease burden in 2010 was due to cancer, 16% due to musculoskeletal disorders, 14% due to cardiovascular disease and 13% due to mental disorders.
The risk factors that contribute the most to disease burden in Australia are – dietary risks at 11%, obesity at 9% and smoking at 8%. The diseases that are on the rise due to these risk factors include- diabetes and cardiovascular diseases, cancer, uro-genital disorders and diseases of the endocrine system, examples are hypothyroidism and hyperthyroidism.
Hypertension, lipid disorders, diabetes, depression and arthritis are the most common reasons why patients in Australia consult their general practitioners. According to the WHO, the global burden of disease has shifted to non-communicable diseases. While the developed countries have registered high rates of cancer, diabetes and cardiovascular diseases, the developing countries are also part of the pandemic that sweeps the world, due to lower food prices, sedentary life styles and poor nutrition.
The expenditure incurred by healthcare systems is largely due to chronic diseases that can be prevented. 15% of the Australian population suffers from arthritis, 13% from lower back pain or slipped discs, 10% from hypertension and 10% each from asthma and depression. 360,000 Australians lived with cancer and 4.6% of the population is suffering from diabetes and its complications. 5% people living in Australia suffer from cardiovascular disease or have suffered a stroke. (/ill-health/). 
In Australia the per capita funding for the indigenous people was increased rather belatedly, by then the disease burden had grown to such an extent that it will take considerable time for the impact to be noticeable. In the U.S. the Indian Health Service provides the funding stream for the Indians, but it has shortcomings because funding is not hiked when there is inflation or salaries of healthcare staff increase. As the needs grow the funds appear to decline (financing/healthreport/IHNo33.pdf). Life expectancy for native Americans have increased by 39% from 51 years to 71 years from the year 1940 to 1995. But the disease burden due to chronic diseases has grown (Bramley, Hebert, Tuzzio, & Chassin, 2005).
Policy makers need to be inclusive while framing policy for improvement of health of the indigenous people and incorporate their values and beliefs for delivery of healthcare to be delivered with some success. The impact of colonisation and dispossession on the indigenous people’s mental health has been immense. It is important to recognise their collective rights and sense of self-determination when implementing healthcare strategy for them (/sowip-press-package-en.pdf).
Historically, the provision of health services for the indigenous populations has been rather poor. According to the Australian Department of Health the implementation plan for the Aboriginals and Torres Strait Islanders, a health plan has been under implementation from 2013-2023. It has several strategies for health improvement of the indigenous people that include- making an investment in health organisations controlled and run by the Aboriginal community. Reducing incidences of racism in the mainstream healthcare system so that the indigenous people can access health services without fear of being discriminated against. Increasing trained work force that is culturally sensitive to the requirements of the Aboriginals. Adoption of an inclusive approach to include the Aboriginal and Torres Islander peoples while planning, delivering healthcare services and the evaluation of services, so that the specific difficulties they face in accessing healthcare can be addressed. Adding numbers to the workforce that caters to their healthcare needs. (/national).
Strengths of the Australian health care system include an increased emphasis on preventive medicine than before. About 440,000 Australians died due to causes that were preventable between 1997 and 2012. The adoption of preventive medicine to treat causes like heart disease, cancer and suicides has improved the ability of people to reverse symptoms and lead healthier lives through timely intervention (Ting, 2015). Most Australians who cannot afford expensive healthcare have the option of subsidized or even free consultations and pharmacies.
But increased emphasis on chronic and preventable diseases in the Australian system of primary healthcare. The timely diagnosis and treatment of diabetes, obesity and lifestyle diseases is needed to reduce the disease burden. 
Another weakness of the Australian healthcare system is that it is becoming increasingly difficult for patients to understand and navigate. This is largely due to the fact that there is considerable control on funding by both- the federal and the state or territory governments. It will be easier for the various stakeholders if the federal governments steers and allows more spending to be done by the state or territory governments. Quality standards for healthcare should be extended to mental health and long term care services (https://www.oecd.org/australia/australia-s-health-system-is-too-complex-for-patients.htm).
In the US prevention of chronic diseases is much better and the rates of cancer survivals are highest in the world. 90% of the population is covered by medical insurance. But obesity and mental health treatment does not receive enough attention. Co-payments have to be paid by patients and often the staggering costs of intensive testing, at times unnecessary, has to be borne by the patient. The medical profession is also influenced by increasing law suits. There are gaps in insurance that leave the patients to pay rather hefty bills if some area of their treatment is not covered by insurance.
In its endeavour to improve the primary health care through preventing diseases so that the burden on healthcare services is reduced, Australia has started several programs that help to detect disease early. One such program is the Breastscreen Australia that sends invites to women between 50 and 74 years of age for a mammogram, every two years. The program aims to diagnose breast cancer in the early stages so that the disease burden can be reduced (/breast-screening-1).
The highest incidence of melanoma in the world occurs in Australia. The SunSmart program was launched for prevention of this form of cancer. In the state of Victoria, about 40,000 cases of melanoma are diagnosed annually and in 2013, 460 people succumbed to the disease. Treatment is expensive and the burden on the healthcare system is staggering. Prevention includes teaching people how to balance the exposure to sunlight, so that adequate Vitamin D formation occurs but one remains protected from the cancer causing UV rays of sunlight. Protection includes wearing full sleeved clothing, applying sunscreen to exposed parts of the skin and wearing a hat. Methods of prevention and awareness camps are held at schools, offices, sporting clubs, childhood centres and several other locations. Since skin cancer is also highly preventable, the staggering amount of $500 million spent on its treatment can be brought down (Welcome to SunSmart).
In conclusion, the delivery of healthcare is a complex process with several stakeholders. Each country has specific needs but there are several points to be learnt from one country to another. Australia has a healthcare system with robust finance and it largely dependent on federal and government funding. The US has a highly advanced healthcare system with a strong dependence on the insurance sector for funding. While Australia can learn from the US about how to implement preventive programs to reduce the disease burden; the US can think about ways to improve its healthcare delivery to the 10% of its population who are uninsured and cannot afford the high cost of treatment.
breast-screening-1. (n.d.). Retrieved from https://www.cancerscreening.gov.au: https://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/breast-screening-1
Health-at-a-Glance-2015-Key-Findings-AUSTRALIA.pdf. (2015). Retrieved from https://www.oecd.org: https://www.oecd.org/australia/Health-at-a-Glance-2015-Key-Findings-AUSTRALIA.pdf
ill-health/. (n.d.). Retrieved from https://www.aihw.gov.au: https://www.aihw.gov.au/australias-health/2014/ill-health/
index5.html. (n.d.). Retrieved from www.who.int: www.who.int/healthsystems/hss-glossary/en/index5.html
policies-strategies/general/national. (n.d.). Retrieved from https://www.healthinfonet.ecu.edu.au: https://www.healthinfonet.ecu.edu.au/health-infrastructure/policies/policies-strategies/general/national
sowip-press-package-en.pdf. (n.d.). Retrieved from https://www.un.org: https://www.un.org/esa/socdev/unpfii/documents/SOWIP/press%20package/sowip-press-package-en.pdf
which-country-has-worlds-best-healthcare-system-this-is-the-nhs. (2016, February 9). Retrieved from https://www.theguardian.com: https://www.theguardian.com/society/2016/feb/09/which-country-has-worlds-best-healthcare-system-this-is-the-nhs
Bramley, D., Hebert, P., Tuzzio, L., & Chassin, M. (2005). Disparities in Indigenous Health: A Cross-Country Comparison Between New Zealand and the United States. American Journal of Public Health, 95(5): 844–850.
financing/healthreport/IHNo33.pdf. (n.d.). Retrieved from https://www.who.int/: https://www.who.int/healthsystems/topics/financing/healthreport/IHNo33.pdf
health_systems/en/. (2013). Retrieved from https://www.who.int: https://www.who.int/gho/health_systems/en/
health-system/. (n.d.). Retrieved from https://www.aihw.gov.au: https://www.aihw.gov.au/australias-health/2014/health-system/
How to compare health-care systems (2014, June 29). /economist-explains-16. Retrieved from https://www.economist.com: https://www.economist.com/blogs/economist-explains/2014/06/economist-explains-16
https://www.oecd.org/australia/australia-s-health-system-is-too-complex-for-patients.htm. (n.d.). Retrieved from https://www.oecd.org/: https://www.oecd.org/australia/australia-s-health-system-is-too-complex-for-patients.htm
Jeyaratnam, E., & Jackson-Webb, F. (2014, September 1). /infographic-comparing-international-health-systems-30784. Retrieved from https://theconversation.com: https://theconversation.com/infographic-comparing-international-health-systems-30784
Ting, I. (2015, October 9). he-440000-australians-who-didnt-need-to-die-revealed-in-report-2015. Retrieved from https://www.smh.com.au: https://www.smh.com.au/national/health/the-440000-australians-who-didnt-need-to-die-revealed-in-report-2015
Welcome to SunSmart. (n.d.). Retrieved from https://www.sunsmart.com.au/: https://www.sunsmart.com.au/

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