2. The Role of Health Care
Aims of health care in
Australia
To provide public health services, including
hospitals and administration.
To provide quality health facilities and
services to meet the needs of all
Australians.
Organised, financed and delivered by both
public and private sources.
Emphasis placed on diagnosis and
treatment of illness by the medical
profession.
Health care in Australia mostly about
clinical diagnosis, treatment and
rehabilitation.
A shift has occurred in the role of health
care, from cure to prevention.
3. Range & Types of Health Facilities &
Services Available
Classified in 2 ways:
Institutional
Eg. Hospitals, nursing homes, psychiatric
hospitals
Non-Institutional
Admin and research, medical
services, pharmaceuticals,
health professionals - eg. physio, chiro
4. Responsibility for health facilities & services
Funding for health facilities and services comes primarily from the
Australian Government, state/territory and local governments, non-
government agencies and individuals
5. Responsibility for health facilities & services
Commonwealth GovernmentCommonwealth Government
• Funding to state/territories
• Medicare
• Pharmaceuticals Benefit Scheme
• Health promotion initiatives
• Worksafe
• Veterans
State and Territory GovernmentsState and Territory Governments
• Delivery of health services including
administering public acute-care
hospitals and psychiatric hospitals
• Legislation and regulations for
private hospitals, nursing homes
and health professionals
• Management of mental health
programs, dental health services,
home &community care, family
health services, rehabilitation
services
Local GovernmentLocal Government
• Personal preventative programs
(e.g. immunisations)
• Environmental &hygiene regulations
• Some home care operations and
community health centres
Private sectorPrivate sector
• Private hospitals
• General practioners
• Dentists, pharmacists, physios etc
• Private sector, NGOS, eg Cancer
Council, Diabetes Australia.
7. Equity of access to health facilities &
services
1. Access in rural and remote areas
2. Language support
3. Bulk-billing through Medicare
Bulk-billing occurs when a health
practitioner directly bills Medicare for
the amount payable for a service; the
patient does not have to pay.
9. Expenditure has increasedincreased due to:
· Increase in population
· Inflation especially in the 1980!s
· Australia’s wealth ’ has increased in recent times
· Medical research and technology
· Population is getting older - they require more medical services
In real terms, it has gone up:
· More expensive medical treatments
· Well informed population, who value screening & preventative
measures
· Increasing age of the population
10. Health expenditure comprises recurrent and capital expenditure on hospitals,
medical services, dental services, patient transport services, other health practitioner
services, community and public health services, medications, aids and appliances,
health research and the administrative systems that support these services.
(AIHW, 2007)
At the moment 90
% of the health
care dollar goes
not to "health“ but
to "illth“… ill people
in the hospital and
acute-care sector.
Health care expenditure vs expenditure
on early intervention & prevention
11. Health care expenditure vs expenditure
on early intervention & prevention
If we are to cope with the
challenges of a greying
Australia…. we must also
put more money into
prevention stopping people
needing medical treatment
in the first place.
If we are to cope with the
challenges of a greying
Australia…. we must also
put more money into
prevention stopping people
needing medical treatment
in the first place.
Much of the burden of disease
and associated costs are
preventable, making disease
prevention an important
approach for improving the
public’s health and to control
health care costs
Much of the burden of disease
and associated costs are
preventable, making disease
prevention an important
approach for improving the
public’s health and to control
health care costs
DiscussDiscuss: “An Ounce of Prevention is Worth a Pound of Cure”
12. Impact of emerging new treatments &
technologies on health care
There is no question that early detection
and subsequent early intervention
is proving to be a significant contributor to
improving health status
There is no question that early detection
and subsequent early intervention
is proving to be a significant contributor to
improving health status
A natural concern that often
accompanies emerging treatments or
technologies is the associated costs
A natural concern that often
accompanies emerging treatments or
technologies is the associated costs
since the 1980s, advancements have
been made in the field of medical imaging that
greatly enhance the capacity
to detect many health concerns, including the
presence of cancer.
since the 1980s, advancements have
been made in the field of medical imaging that
greatly enhance the capacity
to detect many health concerns, including the
presence of cancer.
13. Health Insurance: Medicare & Private
Health care is essentially providedprovided in Australia in one of three ways:
1.through the public health care system
2.through private health insurance
3.through out-of-pocket expenses paid for by the individual directly
Health fundingfunding is a complexcomplex issue.
Currently, the financing of health care in Australia comes
from 3 main sources:
1. the Medicare levy
2. general taxes paid to various levels of government
3. payments for private sector services.
14. What is health insurance?What is health insurance?
Health Insurance: Medicare & Private
Private Health InsurancePublic health insurance
Eg. Medicare Eg. HCF, MBF,
Medibank Private etc…
https://www.youtube.com/watch?v=7uRFFoTpVRw
16. Medicare, a government funded health system paid through
taxes and a Medicare levy on incomes (1.5% + a further 1% for
singles earning over approx $70 000 and couple earning over
approx $140 000 who don’t have private cover)
Advantages
· Affordable to all the pop’n
· Equity in health care
· Ease of access to the pop’n
· Universality of coverage
· Possibility of bulk billing
· Special benefits for family
Disadvantages
· Compulsory levy even if you don’t
use it
· No choice of doctor
· No choice of hospital
· Waiting time for selective surgery
· Shared accommodation
· The gap
17. Medicare & the PBS
The Pharmaceutical Benefits Scheme (PBS) was introduced by the
Commonwealth Government in 1986. This scheme subsidises most prescription
medicines bought at pharmacies in Australia. The major aim of the PBS is to allow
all individuals, regardless of socio-economic status, access to necessary
prescription medication.
Concession card holders (for example, holders of Pensioner Health Benefit cards)
can purchase PBS medicines for a lesser amount—known as the concessional
rate (approximately $5). General patients should pay no more than about $32
for each item. Once an individual, or family, has paid a set amount they are
issued with a Safety Net Card. This enables the holder access to prescribed
medicines free of charge, or at the concessional rate, for the remainder of the
calendar year.
http://www.pbs.gov.au/pbs/home
https://www.youtube.com/watch?v=KKIsg3rX3V4
18. Medicare & Bulk Billing
Bulk Billing – is when the practitioner bills Medicare
directly, accepting the Medicare benefits as full
payments for the service.
19. The Medicare Safety Net
The Medicare Safety Net provides families and
individuals with financial assistance for high out-of-
pocket costs for out-of-hospital Medicare Benefits
Schedule (MBS) services. Once you meet a Medicare
Safety Net threshold, you may be eligible for additional
Medicare benefits for out-of-hospital MBS services for the
rest of the calendar year.
20. Private Health Insurance
Advantages
· Payment of the gap
· Doctor of choice
· Hospital of choice
· Accommodation of choice
· Payment of ancillary services – chiro, physio etc…
· Coverage for travel insurance and other benefits
Disadvantages
· cost of services
· already paying for health cover (Medicare)
21. Private Health Insurance
There are two types of private
health insurance cover.
HospitalHospital
Cover covers your costs as
an in-patient in a hospital
Ancillary (or extras)Ancillary (or extras)
Cover is for the cost of
other health services such
as dental, optical,
physiotherapy and a
range of other therapies.
Private Health Insurance
23. Private Health Insurance
Ancillary cover helps with the cost of services such as
physiotherapy, dental treatment and optometry. Some funds
offer packaged products that cover both hospital and ancillary
services.
24. Private Health Insurance & ‘The Gap’
The Gap – Many people with private health insurance are
concerned about the gap. The gap is the difference
between what a health fund pays and what a particular
medical service costs, which you must pay out of your own
pocket.
26. The Federal Gov’t 30% Rebate
A 30 per cent government rebate
is offered on private health
insurance
premiums
27. The Medicare Levy Surcharge
A 1.5%Medicare levy is collected from all income earners who
earn above a minimum amount in Australia.
An additional levy of 1% is imposed on high-income earners
who :
a) choose not to take out private health insurance or,
b) do not have an appropriate level of private health
insurance hospital cover.
28. Lifetime Health Cover (Rating)
A lifetime rating, which becomes applicable after the age
of 30 years, was introduced. The government imposes a 2
per cent surcharge for each year a person does not take
out private health insurance after the age of 30 years.
So, if a person waits until the age of 60 years to take out
private health insurance, they can expect to pay a
surcharge of 60 per cent on top of their annual premium
each year (i.e. 2% °— 30 years = 60%).
Editor's Notes
PDHPE in Focus p55:
Read the first paragraph – what is the role of health care in Australia?
Notes:
Traditionally, Australia’s health care system has been predominantly based around diagnosis, treatment and rehabilitation with only a very small proportion of funding going to health prevention and promotion campaigns.
In recent times, there has been a shift from the “individual lifestyle” to the “new public health” approach, which recognised the social determinants of health
PDHPE in Focus pages 55 – 56
Identify the 2 classifications of health facilities and services in Australia
Activity:
Provide examples of both institutional and non-institutional health facilities and services, using letters of the alphabet
Notes:
Trends in Institutionalised Facilities and Services::
a) Acute Care Hospitals
Admission rates have risen
Stay rates have fallen due to: improved surgical techniques and medicines, elderly cared for in nursing homes, early discharge program with home
b) Psychiatric Hospitals
Have decreased as shift away from institutionalisation to integrated hospital and community care systems
Trends in Non-Institutionalied Facilities and Services:
a) Medical Services
Most commonly used doctor/patient service, which makes up 65% of payments made by Medicare
The use of medical services has increased due to a more informed population, larger numbers of general practitioners, the ease of access to medical services due to Medicare
More females than males visit general practitioners
The use of services increases with age
PDHPE in Focus pages 56 – 57:
Outline the 5 main groups responsible for health facilities and services in Australia
Notes;
In 2005–06, government funding of health expenditure reached almost $58.88 billion. This was provided by: the Australian Government—$37.23 billion state, territory and local governments—$21.65 billion. In addition, the non-government sector provided $28 billion of health funding
The non-government sector includes individuals, private health insurance and other non-government sources. The proportional contribution of each sector has been fairly consistent over the past decade
PDHPE in Focus pages 56 – 57:
Activity:
Students provide examples of the main responsibilities for each sector.
Notes:
Our system is characterised by:
• Australia’s federal structure of government, with all three tiers — Commonwealth, State and local — are involved in the health system;
• The dominant role of private practitioners in providing care, mostly on a fee-for service basis, but with governments increasingly influencing the structure of health services through their financing arrangements;
• Universal access to quality medical care via Commonwealth and State funding for Medicare; and
• Substantial private funding (particularly through private health insurance) supported and regulated by the Commonwealth — so that the system offers a degree of choice (particularly for hospital care).
Syllabus Question: HOW MUCH RESPONSIBILITY SHOULD THE COMMUNITY ASSUME FOR INDIVIDUAL HEALTH PROBLEMS?
PDHPE in Focus pages 56 – 57:
Notes:
The Australian Government has primary responsibility for funding services provided by GPs, medical specialists and other health practitioners that are
fully or partly covered by Medicare. It also funds the Pharmaceutical Benefits Scheme (PBS) (see Chapter 1), health research and Aboriginal communitycontrolled health organisations. Although the Australian Government does not manage public or private hospitals, it provides substantial funding to the states and territories to run public hospitals, and also partially subsidises private hospitals.
State/territory governments have primary responsibility for public hospital services, community health services, patient transport, and public health
activities such as health promotion. However, some concerns have been raised about the ability of state and territory governments to run their public hospital systems effectively. Extensive waiting lists, budget overruns and practices that are designed to save money but can potentially compromise the health of patients are all cited as reasons why the federal government might consider taking over the management of public hospitals from the states and territories in the future.
PDHPE in Focus page 57:
Outline the 2 key goals of equity in Australia’s health care system:
Horizontal (eg Medicare & PBS)
Vertical (eg priority population groups – Royal Flying Doctor service)
Notes:
Strategies to improve inequities include:
the Royal Flying Doctor Service (RFDS) programs encouraging health professionals to work in rural and remote areas
translation services made available through the NSW Multicultural Health Communication Service
the availability of bulk-billing through Medicare
Syllabus Question: HOW EQUITABLE IS THE ACCESS & SUPPORT FOR ALL SECTIONS OF THE COMMUNITY?
Consider:
How equitable is the access and support for all sections of the community?
How much responsibility should the individual consumer assume for individual health problems?
PDHPE in Focus pages 58 – 60:
Define health expenditure
Notes:
In 2005–06, Australia spent $86.9 billion on health. This represents 9% of our gross domestic product (GDP). After adjusting for inflation and population growth, this figure represents a 45 per cent increase in health spending per person compared to 1995–96
The need for early intervention is paramount in increasing survival rates and the likelihood of recovery, particularly from serious health conditions
such as cancer. Evidence tells us that early intervention brings significant improvements in health, so an increased allocation of resources to this area would seem justified.
PDHPE in Focus pages 58 – 60:
PDHPE in Focus pages 58 – 60:
Numeracy Activity: Who pays for health expenditure?
The majority of health expenditure in 2006–07 (69%) was funded by governments, with the Australian Government contributing $40 billion (42%), and state, territory and local governments contributing $25 billion (26%). The remaining $29 billion (31%) was funded by individuals, private health insurers, and other non-government sources (table 3.1)
PDHPE in Focus pages 58 – 60:
Activity:
Discuss: An once of prevention is worth a pound of cure
Get students to fill a table with 3 reasons why this statement is correct (pro’s) and 3 reasons why it is incorrect (con’s) in Australian society.
Notes:
More than 90% of government health expenditure is allocated to curative services, as the results are not seen in the short term from preventative strategies, therefore it may not be economically viable to a government currently in office.
The greatest challenge to federal and state budgets in coming years isn't the ageing of the population, it's the swelling demand for increased spending on health care
Preventive medicine is an investment: you spend up front in the hope of savings down the track NPHA s focuses on prevention.
PDHPE in Focus pages 60 – 61:
What can most of the costs be attributed to?
Provide 2 examples (cancer screening & childhood vaccinations)
Notes:
For example, health expenditure today is more than twice as great as in 1972–73. However, allowance has to be made for several factors. These include:
• Population increase—Australia must expect to pay more to look after more people.
• Inflation—One billion dollars spent in the last decade was worth much more than a billion dollars spent now.
• Australia’s wealth—Measured as gross domestic product, the country’s wealth has increased in the last 20 years, and health would seem to be a good area on which to spend the extra wealth.
• Medical research and technology—These have produced many wonderful new treatments, but they can be expensive. If we wish to use these newer treatments (and few people refuse them when they or their loved ones are ill), we should expect health expenditure to increase.
• Ageing population—The population is getting older, and older people require more medical care
PDHPE in Focus page 61:
Notes:
Through the Medicare system every Australian resident is guaranteed adequate health care at minimum cost
PDHPE in Focus page 61:
Video Clip Activity:
Watch Medicare video clip and answer questions
Notes:
Medicare is a system of health insurance which is accessible to all Australians. It reimburses a large amount of medical and hospital expenses that individuals incur. Every Australian is covered for 100% of public hospital services and 85% of an amount that is considered to be a scheduled fee.
PDHPE in Focus page 61:
PDHPE in Focus page 61:
Notes:
A universal system of health insurance, Medicare, was introduced in 1984. It is funded, in part, through a taxation levy of 1.5 per cent of income. Medicare's three main functions are to cover the cost of medical services, pharmaceuticals and public hospital care.
Medicare Australia also pays pharmaceutical benefits under the Pharmaceutical Benefits Scheme, which subsidises an agreed list of prescription drugs.
In both medical and pharmaceutical services, safety net arrangements ($1500 a family) exist to make sure that patients who need a high level of treatment do not incur significant out-of-pocket expenses.
PDHPE in Focus page 61:
(Pharmaceutical Benefits Scheme) – where certain prescription drugs are subsidised by the Federal government
PDHPE in Focus page 61:
PDHPE in Focus page 61:
Notes:
Also available is the PBS Safety Net if you and your family need a lot of medicines in any year.
Textbook page 62:
Notes:
Private hospitals provide about a third of all hospital beds in Australia. Private medical practitioners provide most out-of-hospital medical services and perform a large proportion of hospital services alongside salaried doctors. Private practitioners provide most dental services and allied health services such as physiotherapy.
About half of all Australians are covered by some form of private health insurance. The federal government is seeking a better balance between public and private sector involvement in the health sector by encouraging people to take out private health insurance, while preserving Medicare as the universal safety net.
SYLLABUS QUESTION: describe the advantages and health insurance: Medicare and private disadvantages of Medicare and private health insurance, eg costs, choice, ancillary benefits
PDHPE in Focus p62:
Activity:
Q: What hospital and ancillary costs does private health insurance cover?
(Students answer in workbooks)
Video Clip Activity: Watch video clips for HCF and Medibank Private. Identify the pros and cons
Presenter Notes:
Private health insurance is an extra insurance which allows people to cover private hospitals and ancillary expenses. People with private insurance have shorter waiting times for treatment, can stay in hospitals of their choice, having their own choice of doctor in hospital, private rooms in hospitals, ancillary benefits and insurance cover while overseas. The Government also introduced a 30% rebate system for those who have private health insurance
Pros:
Choice of doctor
Choice of hospital
Elective surgery
Other non-Medicare benefits Hospital expenses (theatre fees or accommodation) in a private hospital, dental treatment, ambulance, chiropractic treatment, home nursing, podiatry, physiotherapy, occupational, speech and eye therapy, glasses and contact lenses.
Cons:
already paying for public health insurance (Medicare 1.5%)
the Gap
waiting periods may apply
Video Clips:
Show video clips of private health insurance ads
PDHPE in Focus page 62 - 63:
Notes:
30% Rebate – For every dollar that you contribute to your private health insurance premium, the Government will give you back at least 30 cents as a Private Health Insurance Rebate.
After the introduction of Medicare in 1984 (then called Medibank), the proportion of Australians choosing to have private health insurance declined consistently from approximately 50 per cent of the population, to a low of about 30 per cent in the late 1990s. Reasons for this included:
a high level of satisfaction with the range and quality of health care available under Medicare at little or no cost
perceptions that private health insurance did not offer value for money
views that private health insurance was mainly a priority at certain stages of life when medical services were accessed more frequently, such as when having a baby or when approaching older age.
To arrest this decline and to help reduce the increasing pressure placed on Medicare, the Australian Government introduced three measures tohelp encourage people to continue with or adopt private health insurance.
PDHPE in Focus page 63:
Notes:
Medicare Levy Surcharge – The Medicare Levy Surcharge is levied on Australian taxpayers who do not have private hospital cover and who earn above a certain income. The surcharge aims to encourage individuals to take out private hospital cover, and where possible, to use the private system to reduce the demand on the public system.
Notes:
Lifetime Health Cover – Lifetime Health Cover is designed to encourage people to purchase hospital cover earlier in life and to maintain their cover. To avoid paying a LHC loading, you need to purchase hospital cover by 1 July following your 31st birthday.
