1. Topic – Tax me for F’s sake
Private health insurance
Is private health insurance a “must have?”
2. Cultural Artefact https://www.youtube.com/watch?v=S-rTxG-uVPM
A health insurance company, HBA, came up with a comical TV ad about the unpredictability
of life and finishes with the question: “Are you with HBA?” This humorous advertisement by
the insurance company HBA begins with a small girl, sitting on a chair telling a story.
Girl: “This monster burst out and he ate my whole guts and he ate my whole body and then
he ate my cat.”
Boy: “This octopus came out the bath hole and he grabbed me and he squeezed the blood
out of me.”
2nd boy: “Crocodile came up, bit my guts out and bit me into parts, pieces and even my legs
went that way and even my head went that way.”
“Life’s unpredictable. Thank goodness for HBA.” But what if you cannot afford private health
insurance?
3. Public health issue
Private health insurance gives you more options and the literature supports that your
chances of a longer, healthier life are increased. Results of the NHS showed that 53% of the
population aged 15 years and over had private health insurance in 2007-08 (Australian
Bureau of Statistics, 2009). Not only are there penalties for not insuring if your income is
over $80,000/year (Australian Taxation Office for the Commonwealth of Australia, 2012),
but the ability to pay to have greater access to more services does offer an advantage in
health outcomes (Martins, 2009). However, the ability of purchasing the benefit to jump the
queue is contentious with regards to health. It is widely believed that for essential health
care one's means should not determine availability. No one enjoys waiting in a line and
witnessing others cutting the queue. It only slows everything down and if everyone was in
the same line it would no doubt be a more efficient and fair system. The following report
will discuss the role of private health care in shaping both health inequalities and population
health in general.
4. Literature review
Considerable controversy has surrounded continued commitment of both government and
the opposition to subsidy of private health insurance. The subsidy was initially introduced as
part of an incentive scheme to increase private health insurance rates following a major
decrease in the 1980’s and early 90’s. The rationale for public subsidy was that it would
result in subsequent greater use of private health care and reduce demands on public
sectors services in particular public hospitals. However, while to date there has been a
substantial increase in the use of private health care (largely for non-emergency surgery)
there is little evidence of any reduction in public sector demands. Moreover, as more people
have used their private insurance, the cost of premiums continues to rise and consequently
the cost of the public subsidy (Hindle & McAuley, 2004; Segal, 2004).
The cost to the community will increase, in terms of the average cost of health care per
episode of treatment. Competing private health insurers have to spend much more on
administration than government schemes; medical specialists' charging rates are generally
higher when they are treating private patients, and so on.
The literature overwhelmingly confirms this logic. For example, Duckett & Jackson (2000)
estimated that the 30% rebate cost $2.19 billion in 2000, to which had to be added a further
$1.2 billion of Medicare benefits expenditure in hospitals. They argued that the available
evidence shows that public hospitals are more efficient than private hospitals and suggested
that if the insurance subsidy and the Medicare Benefits Schedule rebate expenditure were
applied to purchasing public hospital treatment at full average cost, 58% of current private
sector demand could be accommodated. They concluded that the objective of taking
pressure off public hospitals could be more efficiently achieved by direct funding of public
hospitals rather than through subsidies for private health insurance (Duckett & Jackson,
2000).
There are always risks of reduced equity of health care and health status in any model that
permits some degree of choice. In most markets those with more means can afford more
goods and services, and economists and policymakers do not see this as problematic. For
health care, however, it is widely believed that for essential health care one's means should
not determine availability. The risks of poorer equity and efficiency outcomes may now be
greater as a consequence of the increase in private health insurance membership since
1997. Some of the most obvious adverse effects can be deduced from the simplest of
statistics. Take the case of the Aboriginal population, which is the most disadvantaged
segment of the Australian population in terms of health status. Few Aboriginal people have
private health insurance, and hardly any benefited from the $2.2 billion per year provided as
health insurance rebates (Martins, 2009).
Another aspect of increased inequity has been highlighted by the ability to buy the privilege
of queue jumping. Governments are implying we should buy private health insurance to free
the public system up for those who cannot afford it. Given the limited numbers of specialists
who serve both sectors, it seems that the more not-so-sick queue jumpers there are in the
private sector, the longer the queues will be in the public sphere (Coote et al., 1999).
Additionally, higher payments for professionals when treating private patients may affect
the elasticity of the supply of doctor time between the public and private sector. In public
hospitals, despite rules of access to care based on medical need, there may be incentives for
providers to offer preferential treatment to private patients because of the revenues and
higher payment they bring (Colombo & Tapay, 2003).
The literature consistently shows that people who happen to have private health insurance
have less need for health care on the average after control for other factors, as a
consequence of health status determinants like socioeconomic status. Recent Australian
clinical literature shows that people with private health insurance have less likelihood of
chronic pain (Blyth et al., 2001), better outcomes from laparoscopic fundoplication (O'Boyle,
Watson, DeBeaux, & Jamieson, 2002), lower levels of diabetes (McKay, McCarty, & Taylor,
2000), less visual impairment (Livingston, McCarty, & Taylor, 1997), fewer urinary symptoms
and incontinence (Muscatello, Rissel, & Szonyi, 2001), better smoking hygiene relating to
infant exposure (Bai, Wong, Gyaneshwar, & Stewart, 2000), better self-monitoring of blood
glucose in diabetes (Hoskins, Alford, Handelsman, Yue, & Turtle, 1998), lower rates of
disturbed mood during pregnancy and after birth (Kermode, Fisher, & Jolley, 2000), fewer
pregnancy complications including: hypertension, threatened preterm labour, antepartum
haemorrhage, and excessive vomiting that require hospitalisation (Adelson, Child, Giles, &
Henderson-Smart, 1999), and less risk for newborn encephalopathy (Badawi et al., 1998).
The Australian evidence shows that people with private health insurance have less need for
health care on the average and yet consume a disproportionately large share of services.
Social insurance schemes like Medicare have been directed at reducing the differences,
whereas private health insurance tends to increase them (Lokuge, Denniss, & Faunce, 2005).
This may be an example of policy losing its way: why not compel high-income earners to pay
the additional tax? The present policy allows those on high incomes to contribute less to
health care financing, and puts that reduced amount of funding through channels that may
be less efficient. There may be a greater concern for the health of the private health
insurance industry than for the wellbeing of the health care system.
5. Cultural and social analysis
Social exclusion is about more than income poverty. It is a short-hand term for what can
happen when people or areas face a combination of linked problems, such as
unemployment, discrimination, poor skills, low incomes, poor housing, high crime and
family breakdown. These problems are linked and mutually reinforcing (Social Exclusion
Unit, 2004).
Life expectancy is not uniform across populations within Australia. An issue of particular
public interest is that Aboriginal and Torres Strait Islander peoples have a much lower life
expectancy than the general Australian population. Indigenous Australians born in the
period 1996-2001 are estimated to have a life expectancy at birth of 59.4 years for males,
and 64.8 years for females. This is approximately 16-17 years less than the overall Australian
population born over the same period (Australian Bureau of Statistics, 2011). Various factors
explain this disparity, including higher levels of health risk factors, the higher proportion of
Indigenous Australians in rural areas, and less access to healthcare services. The Australian
Government has identified narrowing this differential in life expectancy as a priority in
health policy (Australian Institute of Health and Welfare, 2012b).
It is generally accepted that Australians living in rural and remote areas have lower health
status than their counterparts in urban areas. For the period 2002-04: Death rates in
inner/outer regional areas were about 10% higher than those in major cities. Death rates in
remote and very remote areas were between 20-70% higher than those in major cities. A
major contributor to elevated death rates in remote/very remote areas is Indigenous
Australian mortality, primarily because Indigenous Australians constitute a larger proportion
of the population in these areas, and have higher death rates than non-Indigenous
Australians. The specific causes of elevated death rates outside major cities are coronary
heart disease, other diseases of the circulatory system, motor vehicle accidents and chronic
obstructive pulmonary disease (Australian Institute of Health and Welfare, 2012a).
Conflict theory
Conflict theory emphasizes the role of coercion and power in producing social order. This
perspective is derived from the works of Karl Marx, who saw society as fragmented into
groups that compete for social and economic resources. Social order is maintained by
domination, with power in the hands of those with the greatest political, economic, and
social resources. When consensus exists, it is attributable to people being united around
common interests, often in opposition to other groups (Kriesberg, 2001).
According to conflict theory, inequality exists because those in control of a disproportionate
share of society’s resources actively defend their advantages. The masses are not bound to
society by their shared values, but by coercion at the hands of those in power. This
perspective emphasizes social control, not consensus and conformity. Groups and
individuals advance their own interests, struggling over control of societal resources. Those
with the most resources exercise power over others with inequality and power struggles
resulting. There is great attention paid to class, race, and gender in this perspective because
they are seen as the grounds of the most pertinent and enduring struggles in society
(Morris, 1998).
What is Social Inequality?
Sociologists see society as a stratification system that is based on a hierarchy of power (the
ability to direct someone else’s behaviour), privilege (honour and respect), and prestige
(income, wealth, and property), which leads to patterns of social inequality. Inequality is
about who gets what, how they get it, and why they get it. Social inequality is typically tied
to race, gender, and class, with whites, males, those with higher education levels, and those
with higher income levels sitting at the top of the hierarchy (Wrong, 2008).
Social inequality is characterized by the existence of unequal opportunities and rewards for
different social positions or statuses within a group or society. It contains structured and
recurrent patterns of unequal distributions of goods, wealth, opportunities, rewards, and
punishments (Borrell, 2009).
Inequality of opportunities refers to the unequal distribution of life chances across
individuals. This is reflected in measures such as level of education, health status, and
treatment by the criminal justice system. For example, why do upper-class white males
typically have more opportunities for wealth and success compared to lower-class black
males, who have a higher chance of landing in the criminal justice system?
6. Analysis of the Artefact and your own learning reflections
The ad from HBA involving the 3 children’s stories of unpredictable scenarios is definitely
memorable. I am positive most will remember this ad on TV.
The theme is concerned with capturing the attention of parents by showing children
speaking in a humorous manner to highlight to parents that whatever happens, private
health insurance can be a valuable protection. The visuals are concerned with showing
adorable and engaging children in a humorous way to capture the attention of parents. The
Advertisement attempts to strike a chord with parents who at some stage during their own
children’s younger years have had their children telling humorous and exaggerated stories.
The visual attempts to be reminiscent to parents of their experiences with their own
children and the language in the voice over are directed to parents as it encourages them to
purchase private health insurance. In addition, the services are private health insurance,
which is targeted towards, and has principal appeal to, parents, rather than children.
Private health insurance is an extremely valued commodity as it provides more health
options and if you have it your quality of life and life chances are automatically enhanced.
Personally, I have utilized my private health cover many times since birth. This list includes
but is not limited to: breaking both arms concurrently including a compound fracture,
breaking both arms again at a later stage (not at the same time), a broken nose, a head
fracture, food poisoning, nose surgery, internal bleeding in a tooth and wisdom teeth
removal. Luckily my folks chose to purchase private health insurance to give me the ability
to jump the queue and receive treatment from the doctor they chose and at the hospital
most convenient. Most reading this will have private health insurance and I am sure you
would agree that you’re glad you’re not in the 47% of Australians (Australian Bureau of
Statistics, 2009) who are uninsured.
Maybe if we focused a bit more on the public health system we might actually help those
who cannot help themselves and reduce the need to have private health insurance. This
would also level the playing field in terms of waiting times and available doctors and
hospitals. Obviously, it’s not as easy as this and if I knew the answer I would be doing great
things, but until I studied the role of tax and the role that private health insurance plays I did
not even consider what life might be like for those without.
https://www.youtube.com/watch?v=7uRFFoTpVRw Your health care choices
Australian public and private health care system: nib health insurance explained
https://www.youtube.com/watch?v=5cA2hihzmYA&feature=relmfu
http://www.google.com.au/imgres?um=1&hl=en&sa=N&biw=1920&bih=1075&tbm=isch&tbnid=q3
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M2oIdHqmAXoyYHgCA&zoom=1&iact=hc&vpx=1414&vpy=306&dur=7255&hovh=185&hovw=273&t
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d=1t:429,r:27,s:20,i:218
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