NRSG138 Lecture Notes - Lecture 2: Health Promotion, Emergency Department, Primary Healthcare
The Australian Healthcare System and Governance
What is a healthcare system?
● An extremely large, and complex web of services ranging from community situated
providers, to large tertiary hospitals, research institutes and online providers
● The World Health Organisation (WHO) states that a healthcare system should;
○ “...deliver quality services to people, when and where they need them...and in
all cases require a robust financing mechanism, a well trained and adequately
paid workforce; reliable information on which to base decisions and policies;
well maintained facilities and logistics to deliver quality medicines and
technologies
Historical context
● Australia has been heavily influenced by the United Kingdom
● Post War Britain (1948) saw the establishment of the NHS (National Health Service)
● This was a social welfare model - free care for all citizens, all of the time
● Australia has shifted to a mix of socialised healthcare and free market (private)
healthcare
● Some costs to patients in the public system, but these are minimised or removed
where possible
Social context
● Healthcare is informed by the social attitudes of its governers, users and workers
● Decision making is political, because it is used and populated by humans!
● Healthcare can lead social change or respond to change, such as:
○ Marriage equality - healthcare organisations actively leading social change
○ Safe injecting rooms - healthcare organisations responding according to
changing political and social attitudes
○ Climate change - organisations are responding slowly but actively discussing
ways to improve sustainability
Medicare
● Introduced by the Hawke government in 1984
● Principal objective is to remove or reduce financial barriers to healthcare access for
all Australian residents
● Funding model - federal government provides money, state governments budget,
spend and deliver healthcare
● States (and therefore healthcare) are vulnerable to changes in government
● Reciprocal agreements with many countries
(some) Language of Medicare
● Bulk billing
● PBS
● Activity-based funding
● Bed blocking
● MBS
● Gap payment
● NDIS
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● Inpatient
● COAG
● Health concession card
Libertarianism and the free market
● No commitment to universal healthcare
● User pays through health insurance
● Health insurers are private and for profit
● Care costs and insurance premiums are adjusted to meet market shifts
● No safety net
● People may be refused care on ability to pay, OR given care but face millions of
dollars of bills afterwards
● Costs exist similarly in Australia but the government covers them
● USA - hybrid system. Medicaid (government) for poorest citizens but extremely
underfunded. Very basic care only
Current global trends
● Push to shifting funding out of acute care and into public health
● Improving patient navigation of complex multi-service provider systems
● Supporting developing nations to build sustainable healthcare systems
● Removing silo-based behaviour - integrated, openly collaborative approaches to our
patients
● Identifying and addressing social determinants of health
Challenges in Funding
● Vulnerable to political ideology
● Vulnerable to public opinion and social attitudes
● Vulnerable to shifting population needs and change continuously
Issues in 2017 that had NEW fiscal implications included:
● Increased violence against healthcare workers
● Extraordinarily virulent influenza season
● Meningococcal outbreak requiring ad-hoc vaccination program
● Rise of STIs following prominence of social media dating apps
● Introduction of free mental health checks for pregnant women
Private healthcare
● Private healthcare is often complementary to public (Medicare) and incentives exist
to use it:
○ 30% government rebate on premiums
○ Private patient in public system: ability to choose consultant
○ Over 40% of population has private cover
Role of private healthcare in public system
● Several types: acute care, psychiatric and community/allied health
● Now include emergency and intensive care units
● Subject to same NSQHS standards of care as public system
● Combination of profit and non for profit
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
An extremely large, and complex web of services ranging from community situated providers, to large tertiary hospitals, research institutes and online providers. The world health organisation (who) states that a healthcare system should; Australia has been heavily influenced by the united kingdom. Post war britain (1948) saw the establishment of the nhs (national health service) This was a social welfare model - free care for all citizens, all of the time. Australia has shifted to a mix of socialised healthcare and free market (private) healthcare. Some costs to patients in the public system, but these are minimised or removed where possible. Healthcare is informed by the social attitudes of its governers, users and workers. Decision making is political, because it is used and populated by humans! Healthcare can lead social change or respond to change, such as: Marriage equality - healthcare organisations actively leading social change. Safe injecting rooms - healthcare organisations responding according to changing political and social attitudes.
