hsc core 1: health priorities in australia · 2018. 3. 10. · health care in australia (cont’d)...
TRANSCRIPT
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HSC Core 1: Health Priorities
in Australia
HSC Core 1: Health Priorities in
Australia
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Health Care in Australia
What role do health care facilities and Services
play in achieving better health for all
Australians?
“Health care in Australia now involves a strong
partnership between public health initiatives and medical
care. Because the major causes of sickness and death
relate to lifestyle, the aim is to improve quality of life
through health promotion initiatives that establish
environments that enhance positive health behaviour.
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Health Care in Australia (cont’d)
The role of health care is to achieve a delicate balance
between resources for prevention and resources for
treatment. This changing emphasis towards prevention
has been seen in numerous national campaigns, for
example Breast Cancer.”
“The role of health care is no longer simply curative.
Instead it is concerned with ensuring an improvement
in the health of the population as a whole through a
combination of preventative strategies and clinical
medical care”. 4
Health Care in Australia (cont’d)
“Traditionally the health care system has
provided:
Diagnosis
Treatment
Rehabilitation
Care for people with
long term illness or disability”
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Health Care in Australia (cont’d)
Range and types of health facilities and services
The health care system involves a complex interrelationship
between:
Commonwealth & State Governments
Health Insurance Funds
Public & Private providers of health ie doctors
Institutions, ie Hospitals
Other Organisations, ie Community Health Care 6
INSTITUTIONAL
FACILTIES &
SERVICES
Hospitals
Nursing Homes
Psychiatric
Hospitals
NON-
INSTITUTIONAL
FACILTIES &
SERVICES
Medical Services
Health related
services
Pharmaceuticals
Health Care in Australia (cont’d)
Health facilities and services provided in Australia
can be classified into two areas:
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Institutional Health Services
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Hospitals
“Hospitals provide general and specialised
healthcare. Patients in hospitals are
classified as public or private according to
their choice of service.
PUBLIC hospitals are operated and
financed by the government, and the
healthcare service is free of charge for
patients.
Institutional Health Services (cont’d)
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PRIVATE hospitals are owned and
operated by individuals and community
groups. Service must be paid for by the
patients, although Medicare and private
health insurance refund most of the
expense.
Institutional Health Services (cont’d)
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PUBLIC HOSPITALS PRIVATE HOSPITALS
“Public hospitals provide more
highly specialised and complex
services, such as heart and lung
transplants in the large teaching
hospitals. They also provide same
day surgery and take most of the
non-admited patients
(outpatients).”
“Private hospitals provide same
day surgery and perform more
short stay day surgery, elective
procedures and less complex
procedures requiring less
expensive equipment, such as
operations on the eye, ear, nose,
mouth, throat, musculoskeletal
and breast”
Institutional Health Services (cont’d)
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Public or Private – What is the difference?
“Patients in all hospitals are classified as being either private
or public, according to their choice of service. If they
choose to be in a public ward in a public hospital, then they
are allocated a doctor by the hospital and
provided with a bed – all free of charge.
Institutional Health Services (cont’d)
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If they choose private treatment, either in a public or a private
hospital, then they may choose their own doctor but must
pay for the service and accommodation provided by the
hospital and the doctor. Medicare and any private health
insurance of the patient will refund much of this expense.”
The issue of equity of access to public hospitals has been debated
in recent years. Some evidence suggests that private patients have
more rapid access to elective surgery than do public patients.
Urgency categories have therefore been applied to patients
conditions.
Institutional Health Services (cont’d)
13
Nursing Homes
“Nursing homes provide care and
long term nursing attention for
those who are unable to look after
themselves, such as the
chronically ill, the elderly and
people living with disabilities.
Institutional Health Services (cont’d)
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There are three types of nursing
homes in operation throughout
Australia:
Private charitable (such as
Anglicare)
Private for profit
State Government
The federal government funds the
running of all nursing homes through
taxes.
Institutional Health Services (cont’d)
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Psychiatric Hospitals
“Psychiatric hospitals provide treatment for people with
severe mental disorders. They use a system of care that
integrates hospital services and community settings
Non-Institutional Health Services
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Medical Services
“Medical services are services provided by doctors,
specialists and other health professionals.
General Practitioners (GP’s) are the most
commonly used service, however, consultation
rates have increased.
Non-Institutional Health Services
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Medicare refunds patients payments for these services.
Specialists such as obstetricians, dermatologists, orthopaedic
surgeons, who have expertise in a particular field of medicine
are also used.”
Non-Institutional Health Services
(cont’d)
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Health-Related Services
“Health related services include other
services such as dentistry, optometry,
nursing, ambulance services and
physiotherapy”
Non-Institutional Health Services
(cont’d)
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Pharmaceuticals
“Drugs are supplied through prescription
from doctors or hospitals (PBS) or over
the counter from shops or pharmacies.
Pharmaceutical Benefits Scheme (PBS)
drugs are subsidised by the federal
government for people with special needs”
Health Care in Australia
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Responsibility for health-care facilities and
services
Health-care facilities and services in Australia are
provided by government organisations and a range of
private and community groups. There are five levels
of responsibility:
Health Care in Australia (cont'd)
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Commonwealth
Government State & Territory
Governments
Local
Government
Private
Sector Community
Groups
Health Care in Australia (cont'd)
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Responsibility for health-care facilities and services: FEDERAL GOVERNMENT
“The formation of national health policies is the responsibility of
the federal government. They control funds obtained through
taxes and allocate these to state or local government health
sectors. The Australian Government operates assistance
programs such as Medicare and PBS; and coordinates approved
national health programs such as HIV/AIDS. They also support
special programs such as National Heart Foundation and Royal
Flying Doctor Service”.
Health Care in Australia (cont'd)
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Community
Groups
Health Care in Australia (cont'd)
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Responsibility for health-care facilities and
services: STATE OR TERRITORY GOVERNMENT
“The responsibility for providing funding for health and
community services, such as public hospitals, medical
practitioners, and family health services lies with the state of
territory. At this level, governments also regulate private
hospitals and provide immunisation programs”
Health Care in Australia (cont'd)
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Responsibility for health-care facilities and
services: LOCAL GOVERNMENT
“At a local level, governments are responsible for
implementing state health policies and controlling local
environmental issues such as maintenance of recreational
facilities. They are also responsible for providing a range of
personal, preventative and home care services such as waste
disposal and meals on wheels.”
Health Care in Australia (cont'd)
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Responsibility for health-care facilities and services: PRIVATE SECTOR
“The private sector is responsible for providing a wide range
of services, such as private hospitals and alternative health
services including dental, physiotherapy and chiropractic
services. These services are generally privately owned, funded
and operated through businesses, charity or religious groups,
such as Mayne Health. However, some private sector services
receive government funding such as NSW Cancer Council.”
Health Care in Australia (cont'd)
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Responsibility for health-care facilities
and services: COMMUNITY GROUPS
“On a community level, these groups are
responsible for promoting health within a more
concentrated or focused area of health, for
example, the Asthma Foundation and Diabetes
Australia.
Health Care in Australia (cont'd)
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Equity of Access to Health Facilities and Services
The pursuit of equity of access to healthcare is the central
objective of many healthcare systems.
There are two dimensions to equity of access to health
facilities and services:
Horizontal Equity
Vertical Equity
Health Care in Australia (cont'd)
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Horizontal Equity
Horizontal equity refers to equal treatment for
comparable needs. One example is Medicare, the national
health insurance system, which aims to provide the
majority of Australians with equal access to basic
healthcare.
Health Care in Australia (cont'd)
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“Another example is the Pharmaceutical Benefits Scheme
(PBS), where the service provided by the Australian
Government ensures a range of necessary prescription
medicines are made available at affordable prices to all
Australian residents.”
Health Care in Australia (cont'd)
31
Vertical Equity
“Vertical equity involves the priority treatment
of those groups with increased health needs and
reduced access to health facilities and services,
such as ATSI people, and people culturally and
linguistically diverse backgrounds.”
Health Care in Australia (cont'd)
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Vertical & Horizontal Equity
“Horizontal and vertical equity are both essential aspects
of a comprehensive health system, however governments
and service providers find it easier to work on a
horizontal level of equity as it is less complex and does
not involve the issues associated with needing to prioritise
population groups.
Health Care in Australia (cont'd)
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An example of a service addressing the vertically equitable
need of geographic disadvantage is the Royal Flying Doctors
Service of Australia.”
Health Care in Australia (cont'd)
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“For geographic, social and cultural reasons, mainstream
services are not always accessible to, or the most appropriate
form of service for ATSI people.
Australian governments recognise this and apply the
principles of vertical equity to provide specific healthcare
services to meet their needs.
Health Care in Australia (cont'd)
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Specific indigenous health services have funding provided at
federal, state and territory levels. In 2005-2006, OATSIH
(Office for ATSI Health) funded 151 services to provide or
facilitate access to primary healthcare for ATSI people.
Overall, 58 of these services (39%) were in remote or very
remote locations.”
Health Care in Australia (cont'd)
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Health care expenditure versus expenditure on
early intervention and prevention - Health-care
Expenditure:
Health-care expenditure is the allocation of funding and other
economic resources for the provision and consumption of
health services. Health-care expenditure includes expenditure
by Australian state and territory governments as well as
private health insurance, households and individuals.
Health Care in Australia (cont'd)
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Health expenditure is on the rise. In 2004-05, expenditure was
$87.3 billion, or $4319 for each person in the country. In the
2006-07 financial year, health expenditure was $94 billion,
which is 9% of the gross domestic product (GDP). For the
same period the average rate of expenditure per person was
$4507.
The Australian Government funded 41% of expenditure on
health in 2005-06 and the states and territories funded 50.6%,
thus together providing over 90% of the funding for health.
Health Care in Australia (cont'd)
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Why is Health-care Expenditure rising?
Australia’s aging population
More expensive medical services and treatment
Ongoing research and development of sophisticated medical
equipment
Health Care in Australia (cont'd)
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The high cost of pharmaceuticals
Increasing use of doctors and health care professionals
Litigation cases and insurance fees that need to be paid.
Health Care in Australia (cont'd)
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Prevention Vs Health-care Expenditure: Is
prevention better than a cure?
“Health-care expenditure has steadily been increasing and
will continue to do so while the focus is on ‘curative’
medicine, that is, the focus is on curing a disease or illness,
rather than preventing it.
For example, it costs more to ‘cure’ a disease such as
coronary heart disease once it has developed than it does to
fund measures to prevent the illness occurring.
Health Care in Australia (cont'd)
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In this example, early intervention might focus on the
following things:
Education
Healthy eating practices
Weight control
Active lifestyle
In contrast, curative measures such as treatment of heart
disease, stroke, clogged blood vessels, kidney failure are
more costly and contribute considerably more to health
expenditure.”
Health Care in Australia (cont'd)
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The new public health approach:
“The new public health model focuses on the
social factors that lead to ill health. This model
places the emphasis on health promotion as
the most cost-effective way in which to
address the social issues of health”.
Health Care in Australia (cont'd)
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Preventative approaches:
“With Australia’s leading causes of death and illness being
lifestyle related , the argument that prevention will be more
cost effective that cure has gained considerable support.
Prevention programs that have been implemented include:
School medical and dental services
Immunisation programs
Fluoridation of water supplies
Anti-smoking campaigns
Health Care in Australia (cont'd)
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The National Campaign Against Drug Abuse
National Mental Health Strategy
National HIV/AIDS program
“These programs often take time to show results.
However, preventative programs for CVD, Cancer and
traffic accidents have been visible over the past two
decades – for example, QUIT, SunSmart, National
Cervical Cancer and breast screening programs, stop
revive survive and drink driving campaigns,
Health Care in Australia (cont'd)
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“Organisations such as the Heart Foundation, the Cancer
Council and the Asthma Foundation also make significant
contributions to illness prevention”.
Health Care in Australia (cont'd)
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“Health-care expenditure in
Australia still far exceeds
expenditure on illness prevention
and health promotion. This is due to
an emphasis on medical treatments
to cure illness dominating the
allocation of public health
resources and spending”.
Health Care in Australia (cont'd)
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“The reasons for increasing funding and support
for preventative and promotional health include:
Cost effectiveness
Improvement in quality of life
Improved access and education
Maintenance of social equity
Use of existing structures
Reinforcement of individual responsibility for
health (empowerment)
Health Care in Australia (cont'd)
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Unfortunately, even though preventative health is
generally cheaper, the benefits often take years to translate
into a visible reduction in illness or death. Current
governments could spend money now on programs that
might be considered a risky political option.
Health Care in Australia (cont'd)
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Impact of emerging new
treatments and technologies on
health care, eg cost and access,
benefits of early detection
Emerging new treatments and
technologies invariably enable a better
quality of life, are less invasive and
promote a faster recovery and
rehabilitation period.
Health Care in Australia (cont'd)
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The range of emerging new
treatments and technologies has seen
a change in the way some procedures
are completed.
For example, while complex surgery
may require a team of surgeons and
staff, many treatments can now be
provided as day surgery in doctors
rooms.
Health Care in Australia (cont'd)
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Almost daily, we hear of new
treatments and technologies that will
improve healing and health care.
Much of this relates to health
technologies used in dianostic
procedures, such as ultrasound, keyhole
surgery and magnetic resonance
imaging (MRI).
The new emergence of technology has
seen a reduction in hospital stays and a
quicker recovery.
Health Care in Australia (cont'd)
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Some significant improvements through technology
can be seen in:
Minimal access techniques for interventions
including keyhole surgery, stent and grafts (e.g.
laproscopy and the use of nanotechnology to enable
cameras to see what is happening inside the body)
Gene technology and gene testing (e.g, for skin and
breast cancer)
Magnetic Resonance Imaging (MRI)
Health Care in Australia (cont'd)
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Enhanced capacity for vaccinations such as against the human
papillomomavirus (HPV)
Digital equipment and internet technologies for managing
information and possibly treatment of patients in remote
locations
Improved transporters for organs
Rapid diagnostic procedures
Health Care in Australia (cont'd)
54
Hip and knee replacements, heart valves and
stents, lens implants for eyes and lightweight
interactive prosthesis
“Emerging new treatments and technologies
should decrease the cost of health care and
provide an opportunity to reach a broad range
of people. We can only imagine what will
emerge in the next five to ten years, because the
current research and development around the
world is prolific.
Health Care in Australia (cont'd)
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Unfortunately, all new technologies come at a price. In the
context of a largely publicly funded health-care system,
balancing the cost of new technologies, limited resources and
the need to maintain health at an acceptable level is difficult.
Research, development, testing, medical and specialists fees and
highly sophisticated equipment amount to millions of dollars,
making some technologies unaffordable unless privately donated
or subsidised by government.
Health Care in Australia (cont'd)
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“Unfortunately, access may prevent some people from
participating in detection and treatment programs.
Socioeconomic circumstances and geographic location may
influence health care to the point where the diagnostic ,
treatment and/or rehabilitation process are not fully
utilised. For example, cardiac patients may have limited
access to exercise facilities in some areas”.
Health Care in Australia (cont'd)
57
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