A.8 Health sector structures Flashcards
Describe how health sectors are managed, funded, serviced, organised and measured.
How does Australia’s health system rank internationally?
Australia ranked 3rd behind Norway and the Netherlands in a comparison of 11 high-income countries.
What are the five domains used to compare health system performance?
- Healthcare outcomes
- Equity
- Administrative efficiency
- Care processes
- Access to care
What is the primary health insurance scheme in Australia?
Medicare
What does the Pharmaceutical Benefits Scheme (PBS) do?
Helps cover the cost of a wide range of prescription medicines.
What percentage of Australians are covered by private health insurance?
Around 11.4 million Australians.
What characterizes National Health Insurance systems?
- State regulation structures
- Tax financing
- Public and private actors in service provision
What are the two defining features of the Australian health system?
- Medicare
- Pharmaceutical Benefits Scheme (PBS)
What types of services does Medicare cover?
- Treatment by doctors, specialists, optometrists
- Dental and allied health services
- Free treatment in public hospitals
What is the role of Services Australia?
Administers Medicare and the PBS.
Which government department is responsible for developing guiding policies for health services?
Department of Health (DoH)
What is the community rating basis in private health insurance?
Premiums do not vary based on a person’s previous medical history.
How many hospitals are there approximately in Australia?
Around 1,350 hospitals.
What is the funding contribution of state and territory governments for hospitals?
42% of funding.
What percentage of hospitalisations in Australia in 2018-19 were in public hospitals?
6.9 million hospitalisations.
What are the most common reasons for hospital admissions in Australia?
- Dialysis
- Cancers
- Digestive system issues
- Musculoskeletal issues
- Injury and poisoning
What is elective surgery?
Surgery that can be scheduled in advance and does not involve a medical emergency.
What is the median waiting time for public hospital elective surgery in 2018-19?
41 days
What is the Australasian Triage Scale used for?
To indicate the urgency of a patient’s need for medical care.
What percentage of patients were seen on time in emergency departments in 2018-19?
71%
What does access block refer to?
What age groups were over-represented in emergency department presentations in 2018-19?
- Under 5
- 65 and over
What is the role of the Australian Commission on Quality and Safety in Health Care?
Quality and safety oversight in healthcare.
What type of healthcare systems does Böhm et al. categorize?
- National Health Insurance systems
- National Health Services
- Social Health Insurance systems
- Etatist Social Health Insurance systems
- Private Healthcare systems
What is the main characteristic of Private Healthcare systems?
Dominance of private market actors in the coordination of the healthcare system.
What types of services do local governments provide?
- Primary health services
- Public health services
What is the Australian Health Practitioner Regulation Agency responsible for?
Workforce regulation and oversight.
What is the role of the National Health and Medical Research Council?
Research and development in health.
What percentage of patients were seen within 19 minutes in emergency departments?
50%
90% of patients were seen within 100 minutes.
What is access block in the context of emergency departments?
Access block occurs when emergency department patients cannot access an appropriate hospital bed within a clinically reasonable time (typically 8 hours) due to a lack of inpatient bed capacity.
What are the consequences of access block?
- Emergency Department overcrowding
- Ambulance ramping
- Adverse effects on patient health outcomes
By what percentage did the number of patients experiencing access block rise between 2017 and 2019?
46.1%
This rise indicates a growing issue within the hospital system.
What proportion of patients were experiencing access block in Australian emergency departments in September 2020?
67%
This statistic is based on an average across 93 Australian emergency departments.
What is the definition of outpatient services?
Outpatient services provide access to medical and other specialised services, including individual and group sessions for various health-related needs.
How many non-admitted patient care service events were provided for public patients in 2019-20?
38.2 million
This was a 2.2% decrease from 2018–19, likely due to Covid-19 restrictions.
What are Local Hospital Networks (LHNs)?
LHNs provide public hospital services in accordance with the National Health Reform Agreement and can contain one or more hospitals within a defined geographical area.
What are some local names for LHNs in different Australian states?
- Local Health Districts (New South Wales)
- Hospital and Health Services (Queensland)
- Local Health Networks (South Australia)
- Tasmanian Health Organisations (Tasmania)
What is primary care?
Primary care includes a wide range of professions such as GPs, community-based specialists, ambulances, community health workers, and allied health professions.
What percentage of Australians saw a GP in 2019-20?
83.2%
This includes those seeking urgent care and after-hours care.
What were the most common reasons for seeing a GP in 2015-16?
- Prescriptions (8.8%)
- Check-ups (8.1%)
- Test results (6.7%)
- Coughs (4.1%)
- Immunisations/vaccinations (3.3%)
What condition groups were most frequently managed by GPs?
- Respiratory (12.7 per 100 encounters)
- Musculoskeletal (11.7)
- Skin (11.3)
- Circulatory (9.8)
What percentage of GP referrals were made to medical specialists?
- Orthopaedic Surgeons: 9.1%
- Dermatologists: 8.3%
- Surgeons: 8.1%
- Cardiologists: 7.8%
- Ophthalmologists: 6.5%
What percentage of Australians received Medicare-subsidised referred specialist attendances in 2017–18?
Over 33 million attendances were recorded
75% of these were provided in non-hospital settings.
What are community health services?
Community health services usually comprise multi-disciplinary teams and offer treatment and health promotional services.
What was the annual cost of mental ill-health and suicide to the Australian economy in 2018-19?
Up to $70 billion
This includes costs from disability and premature death due to mental illness.
What is the leading preventable cause of ill health and death in Australia?
Tobacco smoking.
What percentage of the total burden of disease in Australia did alcohol use contribute to in 2015?
4.5%.
What is the estimated expenditure on complementary and alternative medicine in Australia?
$3.5 billion annually.
What are the two main objectives of Primary Health Networks (PHNs)?
- Increase the efficiency and effectiveness of medical services
- Improve care coordination
What percentage of people with mental illness report having a co-existing physical condition?
Almost 60%.
What are some examples of complementary therapies?
- Acupuncture
- Aromatherapy
- Herbal medicine
- Homeopathy
- Naturopathy
What percentage of drug-related hospital separations in Australia from 2014–15 to 2018–19 were associated with alcohol?
54%
Alcohol was associated with the highest number of drug-related hospital separations.
In 2019–20, what was the most common drug that led clients to seek treatment?
Alcohol (34%)
Followed by amphetamines (28%), cannabis (18%), and heroin (5.1%).
What was the most common treatment type provided to clients in 2019–20?
Counselling (37%)
Other types included assessment only (19%) and support and case management (16%).
What does the AN-SNAP classification define as sub-acute care?
Rehabilitation, geriatric evaluation and management services, psychogeriatric care, and palliative care.
Non-acute care focuses on maintenance.
What percentage of total separations were for sub-acute and non-acute admitted patient care in 2019–2020?
4.9%
Around 550,500 separations occurred during this period.
What percentage of older Australians needed assistance with health care?
22.5%
Other assistance needs included property maintenance (20%) and household chores (16%).
What proportion of Australians had a disability in 2018?
17.7%
4.4 million Australians were reported to have a disability.
What was the most common physical disorder reported by people with disabilities in 2018?
Musculoskeletal disorders (29.6%)
This includes arthritis and related disorders.
What percentage of people with disabilities living in households needed assistance with at least one activity of daily life?
Around 60%
Commonly needed assistance included health care (29.9%) and property maintenance (27.1%).
What percentage of primary carers in Australia resided in the same household as the person they cared for in 2018?
79.1%
This highlights the close living arrangements of carers and those they assist.
What percentage of Australians aged 5–14 had visited a dental professional in the 12 months prior to the National Child Oral Health Study?
81%
Most of these visits were to private dental services (57%).
What was the total expenditure on Medicare-subsidised pathology, imaging, and other diagnostic services in non-hospital settings in 2017–18?
$7.0 billion
This includes $6.5 billion in Medicare benefits and $491.9 million in out-of-pocket costs.
What is the primary focus of pathology as a medical specialty?
The study of the nature and causes of diseases.
It includes diagnostic testing and monitoring of chronic diseases.
What is the percentage of Indigenous Australians who reported needing to see a healthcare provider but did not do so in the past 12 months?
30%
Common reasons included cost and access to services.
What is the median age of the Indigenous population in Australia compared to the non-Indigenous population?
20.3 years vs. 37.8 years
This indicates a considerably younger median age for Indigenous Australians.
What are Aboriginal Community Controlled Health Organizations (ACCHOs)?
Primary health care services initiated and operated by the local Aboriginal community.
They deliver culturally relevant health care.
What percentage of Indigenous Australians in major cities would prefer to attend an Aboriginal medical service for their health problems?
35%
However, only 15% usually did so.
What are the main types of machinery used in diagnostic imaging?
Ultrasound, X-ray, computed tomography, magnetic resonance imaging, gamma cameras
These technologies require interpretation by a radiologist or medical specialist.
What percentage of diagnostic imaging services in Australia is provided by private imaging practices?
60% to 65%
The remaining services are provided by public hospitals.
How many diagnostic images were funded under Medicare in Australia in 2017-18?
More than 27 million
This reflects the significant demand for imaging services.
What is the role of pharmacists in Australia?
Dispense medicines primarily in community pharmacies and hospitals
What are the two Government subsidisation schemes for community prescriptions in Australia?
Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS)
What was the total PBS Government expense for the supply of medicines in 2019-2020?
$12.6 billion
This represents a 6.7% increase over the previous year.
What percentage of total expenditure on PBS and RPBS prescriptions did the Australian Government cover in 2017-18?
80%
Consumers covered the remaining 20%, amounting to $3.0 billion.
Which category of medicines accounted for the highest percentage of PBS and RPBS prescriptions?
Cardiovascular conditions (31%)
What is defined as virtual health according to Deloitte (2019)?
A healthcare delivery approach driving continuous, connected, coordinated care via digital and telecommunication technologies
What are the components of virtual health?
- Telehealth
- Virtual health education
- Virtual care planning
- Health-smart environments
- Self-care
True or False: Telehealth includes only real-time consultations.
False
Telehealth includes synchronous, asynchronous communications, and remote patient monitoring.
What is the predominant mode of telehealth consultations in Australia?
Telephone
It accounts for well over 90% of MBS-subsidised telehealth services.
What significant change occurred in telehealth services in Australia in March 2020?
Expansion of Medicare-funded telehealth services to all Australians
What is healthdirect Australia?
A public company responsible for developing and managing virtual health services across Australia
What is the primary purpose of remote patient monitoring?
To measure vital signs and clinical data monitored remotely by health professionals
What percentage of Australians saw a GP in 2019-20?
83.2%
What is the role of the Australian Digital Health Agency?
Accelerates innovative digital services and coordinates the national digital health strategy
What percentage of total health spending was allocated to health and medical research in 2017-18?
About 3%
What is the National Health and Medical Research Council (NHMRC)?
Australia’s leading health and medical research expert body
How much did the NHMRC spend on health research in 2018?
$862 million
What does the Medical Research Future Fund (MRFF) do?
Provides grants for health and medical research and innovation
What was CSIRO’s investment in health objectives in 2018–19?
$58 million
This represented 4.3% of its total research investment spending.
What was the total funding through MRFF grants in 2018-19?
$206 million
This funding was primarily directed toward treatments, clinical trials, and advanced healthcare technologies.
What percentage of CSIRO’s total research investment was spent on health objectives in 2018-19?
4.3%
This amounted to $58 million invested in health objectives.
Name two principal agencies involved in providing national data about the Australian health system.
- Australian Bureau of Statistics
- Australian Institute of Health and Welfare
What is the role of the Australian Commission on Safety and Quality in Health Care (ACSQHC)?
Leads and coordinates national healthcare safety and quality improvements
This includes developing standards and improving patient outcomes.
How much did Australia spend on health goods and services in 2017-18?
$185 billion
This equates to around $7,485 per person.
What was the ratio of health spending to GDP in Australia in 2017-18?
10%
This increased from 8.3% in 2000-01.
What percentage of health spending is funded by the government in Australia?
68%
This includes 42% from the Australian Government and 27% from state and territory governments.
What were the primary sources of non-government funding for health in Australia?
- Individuals (17%)
- Private health insurance providers (9%)
- Other non-government sources (6%)
Fill in the blank: In 2000-01, health spending on primary health care contributed about ______ of total health spending.
37%
In comparison, hospitals accounted for 36% at that time.
What percentage of total health spending was accounted for by hospitals in 2017-18?
40%
Primary health care accounted for 34% during the same period.
What is the National Cabinet?
The Australian intergovernmental decision-making forum
It comprises the prime minister and state and territory premiers and chief ministers.
What does the National Health Reform Agreement aim to improve?
Health outcomes for all Australians and sustainability of the health system
It outlines four strategic priorities from 2020 to 2025.
List one of the strategic priorities outlined in the National Health Reform Agreement.
- Improving efficiency and ensuring financial sustainability
True or False: The Health Council consists of state and territory health ministers.
True
What is one long-term reform mentioned in the National Health Reform Agreement related to prevention?
Empowering people through health literacy
This is part of prioritizing prevention and health management.
What is one focus area for driving best practices as outlined in the National Health Reform Agreement?
Enhanced health data
This includes using data and research to improve performance.
Recommended reading for more information on the Australian healthcare system includes the work of which authors?
Duckett, S. and Wilcox, S.
Their book is titled ‘The Australian Healthcare System’.
