Health Care in australia
What you will learn
Analyse the different models of health and
health promotion
Biomedical model of health
Social model of health
The Ottawa Charter for Health Promotion
What you will learn
Describe the role, mission and priorities of
VicHealth
Identify the potential health outcomes of a
VicHealth funded project for promoting health
Identify the principles of the social model of
health evident in a project used by VicHealth
what you will learn
Identify and explain key
Australia’s health system
components
of
Local, state and federal governments ’
responsibility for health including funding
Medicare, Pharmaceutical Benefits Scheme
(PBS) and private health insurance
The values that underpin the Australian health
system
approaches to healthcare
There are a range of ways to address healthcare
BIOMEDICAL MODEL
OF HEALTH
SOCIAL MODEL OF
HEALTH
BIOMEDICAL MODEL
Diagnosing and treating illnesses and conditions
once symptoms are present
Doctors
Hospitals
Medications
Surgery
Limitations and disadvantages
Relies on professional health workers and
technology = costly
Does not always promote good health
Not every condition can be treated
Affordability
Advantages
Creates advances in technology and research e.g. Antibiotics
Many common problems can be effectively
treated
Extends life expectancy
Improves quality of life - medication, therapy,
surgery
The social model of health
Addresses the broader influences on health
ENVIRON
-MENTAL
SOCIAL
CULTURAL
ECONOMIC
The social model of health
Recognises the relationship between the social
determinants of health and health status
Prevention rather than cure
Socioeconomic status
Access to healthcare
Social connectedness
HEALTH
STATUS
KEY PRINCIPLES
1. Addresses the broader
determinants of health
Behaviours that affect health are often caused
by broader determinants
The social model of health addresses these
broader determinants
Gender
Socioeconomic
status
Culture
2. involves intersectorial
collaboration
•
The social model of health involves all
interested and concerned groups
Government
Non-government
• Employment
• Service providers
• Education
• Manufacturers
• Finance
3. Acts to reduce social
inequalities
•
The social model of health identifies and
targets inequalities in health
4. acts to enable access to
healthcare
The social model of health addresses
Cultural and language barriers
Economic and geographical factors
Education levels
5. empowers individuals and
communities
Helps people to make decisions about their
health
Individuals are more likely to participate in
healthy behaviours if they feel they have a sense
of control
quiz
•
What are the 5 principles of the social model of
health?
1.Address the broader determinants of health
2.Involves intersectorial collaboration
3.Acts to reduce social inequalities
4.Acts to enable access to healthcare
5.Empowers individuals and communities
Class activity
•
Work in small groups to design an acronym for
the principles of the social model of health
✓ Addresses the broader determinants of health
✓ Involves intersectorial collaboration
✓ Acts to reduce social inequities
✓ Acts to enable access to health care
✓ Empowers individuals and communities
Programs based on the social
model of health
Rural retention
program
Class activity
•
Using the health promotion strategy summary
provided, outline how your strategy address
key principles of the social model of health
biomedical and social models of
health summary
The biomedical model of health focuses on
diagnosing and treating illnesses and conditions
once symptoms are present. Includes doctors,
hospitals, medications, x-rays and surgery
The social model of health focuses on
addressing the broader influences on health,
such as social, cultural, environmental and
economic factors. It aims at prevention rather
than cure
the ottawa charter for health
promotion
Guidelines that help organisations and key
stakeholders incorporate health promotion ideas
into their strategies, policies and campaigns
Prerequisites or basic conditions and resources
that must be available if any gains in health care
are to occur
background
Ottawa
Charter
was
designed in 1986 at the
WHO ’ s first international
conference
on
health
promotion
Before then there was no
framework
to
guide
organisations on how to
develop health promotion
strategies
the ottawa charter - three areas
to remember
8
conditions
and
resources
needed
healthcare
3 basic strategies for health promotion
5 action priority areas
for
conditions and resources needed
for health
Peace
Income
Shelter
Stable ecosystem
Education
Sustainable resources
Food
Social justice and equity
basic strategies for health
promotion
ADVOCATE
ENABLE
MEDIATE
Advocate
Lobbying governments and organisations to
improve access to and provision of health care
services
Making political, economic, social, cultural,
environmental,
behavioural
and
biological
factors/conditions favourable to health through
advocacy for health
E.g. Groups/individuals working to influence public
policy in cancer services
•
ENABLE
Creating a supportive environment and providing
access to information and skills to enable people
to achieve their health potential
Making health equal for all
•
E.g. Enabling access to health promotion
•
E.g. Providing dietary guidelines to enable
people to choose a balanced diet
mediate
Ensuring the coordination of health services
across and within sectors
E.g. Working between clinicians and consumers to
reorient health services to bring about a greater
focus on health promotion rather than treatment
•
E.g. Ensuring that government and nongovernment organisations work together to improve
health outcomes for people
•
quiz
•
What are the three basic strategies for health
promotion as outlined by the Ottawa Charter?
Advocate
Enable
Mediate
ottawa charter priority areas
The Ottawa Charter also sets out 5 priority
areas that should be taken into account when
devising health promotion initiatives
An effective strategy does not necessarily need
to address all 5 priority areas
ottawa charter priority areas
1.Build healthy public policy
2.Create supportive environments
3.Strengthen community action
4.Develop personal skills
5.Reorient health services
1. Build healthy public
policy
Public policy - rules and laws that affect
individuals within a community
These decisions are made by government and
organisations
Removing
Increasing tax
Banning
GST on
on alcoholic
smoking in
unprocessed
drinks
certain places
foods
Compulsory
wearing of
seat belts
2.Create supportive
environments
Environment - can be physical or social
One that promotes health and assists people in
making healthy lifestyle choices
Recognises the impact broader environments
have on health
3. strengthen community
action
•
Building links between
Individuals
Community
Centres around the community
Giving the community a sense of ownership of a
health strategy increases its effectiveness
Government
immunisation
strategies
The Central
Australian
Aboriginal
Congress
(CAAC)
4. develop personal skills
Education is the focus - individuals need to be
taught how to look after their health
Involves schools, work settings, families,
government and non-government organisations
Attending classes to learn healthy cooking techniques
Learning to talk to people to resolve conflict rather than
use violence
5. reorient health services
Changing the health system so it promotes
health rather than just focusing on treatment
Involves doctors, hospitals, individuals in the
community,
community
groups,
health
professionals, health service institutions and
governments
Focus on health eating as opposed to surgery to treat
cardiovascular disease
Doctors recommending physical activity to prevent type 2
diabetes
quiz
•
What are the 5 action priority areas of the
Ottawa Charter?
1.Build healthy public policy
2.Create supportive environments
3.Strengthen community action
4.Develop personal skills
5.Reorient health services
Class activity
•
You will be allocated a health promotion
strategy
•
Restoring the Balance – Victoria’s Alcohol Action Plan
•
Sunsmart
•
Swap it, Don’t stop it
•
Healthy Spaces and Places
•
Quit
•
Identify which Ottawa Charter priority areas it
addresses
strategies that incorporate the
ottawa charter
“ Restoring the balance ” - Victoria ’ s Alcohol
Action Plan 2008 - 2013
Sunsmart
Quit
Swap it don’t stop it
Healthy spaces and places
Ottawa charter summary
The Ottawa Charter was designed so organisations
would have a framework to guide them when
designing health promotion policies
It outlines 8 basics conditions and resources that
must be available if any gains in health are to occur
There are 3 strategies for health promotion advocate, enable and mediate
It also sets out 5 action priority areas and should also
be taken into account when devising health promotion
initiatives
“The Victorian Health Promotion Foundation”
A Victorian Government body
Works with
Organisations
Communities
Individuals
Main focus
Health
Promotion
Illness
Prevention
To achieve goals, VicHealth works with a range of
community groups including sport, community,
urban planning, transport, local government,
education and the arts
vichealths mission
•
Promote good health in partnership with others
•
Recognise that the social and economic
conditions for all people influence their health
•
Pomote fairness and opportunity for better health
•
Support initiatives that assist individuals,
communities, workplaces and broader society to
improve wellbeing
•
Seek to prevent chronic conditions for all
Victorians.
Vichealths priorities
Promote healthy eating
Encourage regular physical activity
Prevent tobacco use
Prevent harm from alcohol
Improve mental wellbeing
Main contribution to health promotion is through
funding of programs
85% of its budget goes towards research and
programs that promote health and wellbeing
VicHealth and the social model
of health
VicHealth uses the social model of health as the
foundation of its work
Programs include
the Food for All program
the Walking School Bus program
funding the QUIT program
Food for all
VicHealth provides funds to local councils with
high numbers of disadvantaged people
Helps to reduce food insecurity
Improves access to healthy food by making it
accessible physically and economically
Works to education individuals on healthy
eating
The walking school bus
School children walk to school in groups lead by
volunteers
Encourages physical activity in children and
adults
Promotes road safety
Children have increased
•
opportunity to socialise
Anti smoking campaign
Support and education for those attempting to
quit and deter others from taking it up
Radio and TV ads
Phone counselling
Website
Vichealth summary
VicHealth is a government body that works with
individuals, communities and organisations
It’s main focus is health promotion and illness
prevention
VicHealth mainly contributes
promotion by providing funding
to
health
VicHealth uses the social model of health as the
foundation for all its work
Australian governments
responsibility for health
•
Australia’s health system is the responsibility of
all levels of government
FEDERAL
STATE
LOCAL
FEDERAL GOVERNMENT
RESPONSIBILITIES
1.The administration of Medicare
2.The administration of the Pharmaceutical
Benefits Scheme (PBS)
3.Quarantine
4.Funding (allocating funds - to states/territories)
5.Regulation (availability of pharmaceuticals,
private health insurance, food safety laws)
Medicare
Health insurance for Australians
Provides access to health care for
Australians subsidised by the government
all
what does medicare cover?
OUT OF HOSPITAL
EXPENSES
IN HOSPITAL
EXPENSES
All or some fees for
essential health care
services
Covers costs for public
patients in public
hospitals
Doctors, specialists,
tests (x-ray, pathology,
eye tests) and some
dental
Medicare pays 75%
schedule fee of private
patients
Not covered by medicare
Cosmetic or unnecessary procedures
Additional costs from treatment in a private
hospital
General dental
Ambulance
Alternative medicines
Glasses, hearing aids, artificial body parts
Medications (this is covered through the PBS)
Advantages of medicare
Choice of doctor for out of hospital services
Available to all Australian citizens
Reciprocal agreement between Australia and
other countries allows Australian citizen s to
access free health care in selected countries
Covers tests and examinations, doctors and
specialists fees (schedule fee only) and some
procedures such as x-rays and eye tests
Disadvantages of medicare
No choice of doctor for in-hospital treatments
Waiting lists for many treatments
Does not cover alternative therapies
Often does not cover the full amount of a
doctors visit
How is medicare funded?
Medicare levy
Medicare levy surcharge
General tax
•
•
•
•
•
From the 1 July 2012 the Australian government made changes to both the Medicare Levy Surcharge and the
Private Health Insurance Rebate. As a consequence, the VCAA provides the following information to be
incorporated into teaching of Unit 3 of VCE Health and Human Development for 2013.
• Medicare is the scheme that gives Australian residents access to health care. To help fund the Medicare
scheme, most taxpayers pay a Medicare levy of 1.5% of their taxable income.
• The Medicare Levy Surcharge (MLS) 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 Medicare
system. The Medicare Levy Surcharge is calculated at the rate of 1% to 1.5% of annual income. The Medicare
Levy Surcharge is in addition to the Medicare Levy of 1.5%.
• Lifetime Health Cover is a government initiative designed to encourage people to take out hospital insurance
earlier in life and to maintain their cover. People who are over 30 and do not have hospital cover but decide to
take out hospital cover later in life pay a 2% loading on top of the cost of the health insurance for every year
they are aged over 30. For example a person who takes out hospital cover at aged 40 will pay 20% more than
someone who first took out hospital cover at age 30.
• Most Australians with private health insurance receive a rebate from the Australian Government to help cover
the cost of their premiums. The Private Health Insurance Rebate is income tested. This means the Private
Health Insurance Rebate is reduced or no rebate is paid if people earn more than a certain amount.
The Pharmaceutical benefits
scheme (pbs)
The
government
medications
subsidises
Consumers make a co-payment
$34.20 per prescription
or
$5.60 per prescription for concession
card holders
essential
the pbs
If health costs to families and individuals exceed
$1317.20 in a year, the only pay $5.60 for PBS
medications for the rest of the year
Not all medications are covered by the PBS
The
Pharmaceutical
Benefits
Advisory
Committee decides which medications are
included in the PBS
Federal gov’t responsibility
summary
The federal government is responsible for the
administration of Medicare and the PBS,
quarantine, funding and regulation
Medicare provides access to health care for all
Australian citizens, subsidised by the government
It covers all or some fees for out of hospital
expenses for essential services and in-hospital
costs for public patients in public hospitals
Federal gov’t responsibility
summary continued
Medicare is funded by the medicare levy,
medicare levy surcharge and general tax
The Pharmaceutical Benefits Scheme (PBS)
subsidises essential medications. Consumers
make a co-payment and the government pays
the rest
state and territory governments
DELIVERY OF
HEALTH
SERVICES
REGULATING
STATE BASED
SERVICES
DELIVERY OF HEALTH
SERVICES
Public hospitals
Psychiatric hospitals
School health curriculum
Public dental health
Maternal and child health
regulatory responsibilities
Licensing GP’s
Licensing private hospitals
Industry regulations - sale of tobacco, alcohol,
food safety guidelines
Legislation - road rules, smoking bans
local governments (councils)
Health inspections
Removal of waste
Water quality testing
Maintaining parks/recreational facilities
state/territory and local gov’t
responsibilities for health
summary
The state and territory governments run public
hospitals and engage in service delivery
Local governments promote health by focusing
on the needs and challenges faced by the local
people, such as waste disposal
Private health insurance
Members pay a fee/premium
Insurance covers some costs towards health
related services not covered by Medicare
GIVES
AUSTRALIA
NS CHOICE
OF CARE
TAKES
PRESSURE
OFF
MEDICARE
COVERS
‘EXTRAS’
PRIVATE HEALTH INSURANCE
Cost of private health insurance depends on the
level of cover desired
Higher cover = higher cost
Greater choice of hospitals and doctors
Own room, no waiting period
private health insurance + costs
Most private hospitals and doctors charge more
than the schedule fee
Private health insurance companies will cover
the remaining cost (or most of it)
incentives to take up private
health insurance
When Medicare was introduced, lots of
Australians chose not to have private health
insurance as their medical needs were covered
This put a big strain on the public system
The government then introduced a number of
incentives to encourage Australians to take up
private health insurance
incentives to take up private
health insurance
1.30% rebate - government pays 30% of the cost
of your health insurance
2.‘ Lifetime cover ’ - if you don ’ t have private
health insurance after age 30, you pay 2% extra
for health insurance for each year of age over
30
3.Medicare surcharge - higher income earners
($77,000) pay 1% surcharge if they don’t have
private health insurance
Advantages of private health
insurance
Choice of doctor/hospital
Private room
Less waiting time
disadvantages of private health
insurance
Additional costs (premium)
Out of pocket expenses (gap)
Qualifying periods
private health insurance
summary
Private health insurance is a type of insurance
whereby members pay a premium (cost) in
return for payments towards health related costs
not covered by Medicare
It helps take the strain off the public healthcare
system
values of the australian health
system
•
Australia’s health system is based on a number
of values that have been established to ensure
we maintain a health system that adequately
services
the
Australian
maintaining high quality care
population
while
values
•
There are 9 values that provide direction for
future decision-making with regard to the
health system
Effective
Appropriate
Efficient
Responsive
Accessible
Safe
Continuous
Capable
Sustainable
1. Effective
•
Achieving desired outcomes in an appropriate
time frame
Looking at immunisation rates and incidence of
vaccine-preventable diseases in a two year
period
Improvements in health status in a set time
Results from surgery
2. appropriate
•
The health care provided is culturally relevant
and tailored to the individuals needs and wants
Allergies and reactions to treatment
The stage of disease
Patients preference to the type of care given
3. Efficient
•
Achieve desired outcomes with cost effective
use of resources
Using whatever funds you have to achieve
maximum benefits
Money can be wasted on management issues
4. Responsive
•
Treating people with respect
•
and
•
Ensuring the health system is client-oriented
Healthcare system should be based on users
needs
Rated by waiting lists, access to services and
public satisfaction of health system
5. accessible
•
The ability of people to obtain health care at
the right place and time irrespective of income,
cultural background or physical location
Encompasses equity
Access to healthcare regardless of location,
culture, religious beliefs and cost
6. safe
•
Reducing the risks associated with the delivery
of health care
Infection spreading in hospital
Compromised safety - slipper floors, no fire
action plan
Non-sterile environment for surgery
7. Continuous
•
The ability to provide uninterrupted,
coordinated care/intervention/action across
programs, practitioners, organisations and
levels over time
Aims to increase the level of communication
and care planning between different health
professionals
8. capable
•
Relates to the skills and knowledge of those
providing care
Health professionals educated in their field
Appropriate training and qualifications
Updated knowledge
9. sustainable
•
Provide infrastructure such as workforce,
facilities and equipment, be innovative and
respond to emerging needs (research,
monitoring)
Relates to funding