Health systems part 3 Flashcards
Australia’s health system prioritises which of the following goals?
- attainment of highest quality of health for a country given available resources
- responsiveness to the expectations of tehe populations
- fairness of financial contribution
Are Out-of-pocket costs are an accepted feature of Australia’s health system?
Only if health expenses are under a limit
What erodes the underlying principle of universal health care?
Lack of bulk billing and high gap payments
Which term is used to describe the presence of two or more chronic conditions in a person at the same time?
Multimorbidity
What are the three broad goals of a health system?
The World Health Organisation (WHO) suggests that every health system strives to achieve three broad goals:
- Attainment of the _highest quality of health_ for a country given available resources
- Responsiveness to the expectations of the population
- Fairness of financial contribution
These goals imply that health systems can provide high-quality healthcare while maintaining financial fairness. This is inherently challenging as health expenses and quality often go hand in hand. Thus, maintaining a balance requires a trade-off between equity and efficiency.
Discuss the advantages and disadvantages of the Beveridge model
Advantages
- The Beveridge Model is underpinned by UHC as a core principle that seeks to improve population health outcomes.
- Enhances social justice by promoting solidarity and equity as a societal value.
- Universal access to state-funded medical treatment is provided.
Disadvantages
- Population demand for health services can be challenging to manage.
- Under-resourced health systems can create long waiting lists/queues. This not only affects patients’ health outcomes due to delayed care, but can force vulnerable people to purchase private healthcare in order to receive the care needed.
- Financial burden as a result of out-of-pocket or private healthcare costs.
- Constant high demand for health services can lead to health system inefficiencies, creating a negative spiral of healthcare worker illness, burnout and absenteeism.
What measures are in place to alleviate the pressures of universal healthcare?
- patient financial risk protection: We learned that every year, financial safety thresholds for consumers are set for Medicare and PBS - these in principle are meant to reduce the impact of healthcare-related out-of-pocket expenditure borne by patients and their families.
- gatekeeping in primary care:The AHS also reduces the downstream pressures on hospitals and specialist care through general practitioners (GPs) ‘gatekeeping’ function at the primary care level.
- GPs act as coordinators of ongoing and comprehensive healthcare through assessment and referral for individuals from one primary care service to another and from primary services into secondary and tertiary services (such as specialist, hospital and palliative care services) and back again.
- Moreover, we shared that bulk-billing by GPs and other health care workers enhances UHC and reduces out-of-pocket costs. However, recall that bulk-billing is optional for most health care workers and may still require co-payments or gap fees to be paid out-of-pocket by patients.
- public and private healthcare co-exist: While the AHS is mainly publicly funded, private health insurance (PHI) and private health care co-exist in the country. PHI is readily available and offers coverage for out-of-pocket fees and private providers, a greater choice of providers (particularly in hospitals), faster access to non-emergency services, and rebates for selected services. Government policies encourage enrolment in PHI through a tax rebate (8.5%-33.9%, depending on age and income) and an income-based penalty payment (1%-1.5%) for not having private insurance. However, there are societal inequalities in who can afford PHI and access the linked benefits.
What are the effects of the ageing population?
- Population ageing is a desirable side product of health and societal advancement. Moreover, all highly-developed countries share longer life expectancy and lower fertility rates - it’s a shared global story
- However, population growth and an ageing population will require labour market innovations, adequate infrastructure and linked healthcare funding to keep up with population demand.
- While Australia’s population is growing, it is not growing equally across all age groups.
- By 2053, based on the Australian Bureau of Statistics (ABS) medium-level growth assumptions, 21% of the population will be aged 65 and over (8.3 million people) and 4.2% aged 85 and over (1.6 million people).
- This means we will have more people who are over 65 years
Ageing demography impacts the health system broadly through healthcare costs and shifting resources required for aged healthcare. Ageing and health systems are linked directly and indirectly through health costs.
- increased healthcare costs: Healthcare costs are expected to directly increase with ageing with the belief that healthcare requirements increase with age.
- decrease in taxation and linked revenues: Indirectly, as the economic productive workforce reduces due to reduced labour workforce participation, the overall taxation and linked revenue into the health systems reduces.
- increased health expenditure: Older people have higher health expenditures than younger people. This often leads to the assumption that health expenditure growth will accelerate as older people make up an increasing share of the population, potentially challenging the sustainability of health systems
Discuss the trend towards multiculturalism
Australia’s health system caters to a diverse, multicultural population which also includes migrants and refugees.
More than 50% of Australian residents were either born overseas (first generation) or have a parent born overseas (second generation).
48.5% of residents were born in Australia and have both parents born in Australia (third + generation).
Contrast this with Japan where, in 2019, a mere 2% of the population were foreign residents.
The health system needs to provide for mainstream and multicultural Australia alike while recognising that there are social, health and economic differences that exist between and within groups.
Broadly, some people of CALD backgrounds are more likely to experience language, literacy and social barriers:
- English literacy is a challenge for some CALD members especially if they are born in an overseas country where English is not predominantly spoken.
- For CALD groups, social and economic integration in Australia also differs — sometimes quite starkly across different cultural and linguistic communities.
What are the five health system principles advocated for better refugee health?
- continuum of care
- patient focus
- geographic coverage
- information systems
- governance
Describe the barriers faced by members of the CALD community
Barriers faced by members from CALD communities in accessing health service:
- language and communication challenges
- higher risk of diseases
What are the factors that affect Indigenous health in rural and remote areas?
- risk factors: In 2017–18, based on self-reported data from the Australian Bureau of Statistics’ National Health Survey and after adjusting for age, people living in inner regional and outer regional and remote areas were more likely to engage in risky behaviours, such as smoking and consuming alcohol at levels that put them at risk of life-time harm, compared with people living in major cities.
- chronic diseases: People living outside major cities had higher rates of arthritis, asthma and diabetes, while mental and behavioural conditions were higher in inner regional areas compared with outer regional and remote areas and major cities.Rates of all other conditions were similar across remoteness areas. The prevalence of multimorbidity – the presence of two or more chronic conditions in a person at the same time – was similar across remoteness areas.
- mortality: People living in rural and remote areas are more likely to die at a younger age than their counterparts in major cities. They have higher mortality rates and higher rates of potentially avoidable deaths than those living in major cities.
Define multimorbidity and comorbidity
Multimorbidity is a rising concern.
Multimorbidity is the presence of two or more chronic conditions in a person at the same time.
Comorbidity refers to additional conditions (comorbidities) experienced by a person who has a specific condition of interest.
Multimorbidity, as a concept, considers all of the conditions experienced by a person and places a much greater focus on the person as a whole, rather than their individual conditions. Understanding multimorbidity can be particularly useful in the primary care setting (such as a general practice) where following disease-specific guidelines for the treatment and management of multiple conditions can lead to overprescribing and patient harm (Harrison & Siriwardena 2018).
Discuss the difficulties of bulk billing
Healthcare is expensive and will become even more so. The question is, who pays (more) for it - the clinicians, patients or the government?The Royal Australian College of General Practitioners (RACGP) and the Australian Medical Association (AMA) are both advocating for GP consultation Medicare rebates to increase to continue bulk billing.
The increased rebates support GP practices to be economically viable and offer consultation fees that are bulk billed or with reduced gap fees to patients.
However, attempting to increase bulk billing rates may in fact reduce access to health services for populations that are regionally and socially disadvantaged, which creates worse health outcomes – a spiral of its own.
In the absence of bulk billing and optimised Medicare rebates, patients end up covering costs!
List some policies designed to assist vulnerable populations
- rural health: ‘The Stronger Rural Health Strategy (SRHS)’ policy aims to build a sustainable, high-quality health workforce that is distributed across the country according to community needs.Additionally, the Australian Government has expanded the scope of MBS items for telehealth in rural and urban areas as well as for strengthening primary care.
- health ageing: The DHAC aim to provide additional support and services to promote greater independence, mobility and autonomy, reducing or delaying the need for more complex aged care support services.
- disability: The NDIS provides funding to eligible people with disability to gain more time with family and friends, greater independence, access to new skills, jobs, or volunteering in their community, and improved quality of life.
- CALD communities and refugees: National and State Governments have implemented policy to support people of culturally and linguistically diverse backgrounds to have equitable access to healthcare services that are culturally responsive, safe and high quality.
- technology and healthcare: AI and Health: The Australian Government is funding game-changing applied artificial intelligence (AI) technologies to improve the ways we prevent, diagnose and treat a wide range of health conditions.
