Core 1 The role of health care in achieving better health

What roles do health care facilities
and services play in achieving better
health for all Australians?
HSC - Core 1
Chapter 3
Health Care in Australia
• Health care for a long time was seen as curative.
• Little thought was given to the population or the
social factors that contributed to ill health.
• Health care today is a partnership between public
health initiatives and medical care.
• The major causes of sickness and death relate to
lifestyle therefore the aim is to improve the quality of
life through health promotion.
• Health care is the responsibility of many
organisations working with the private
• Health care is no longer curative but rather
Range and types of health facilities
and services
• A mix of public and private provides health services
in Australia.
• These services are provided by
A range of doctors
Other health professionals
Government and Non-government agencies
Public Health Services
• Cancer Screening
• Immunisation
Primary care and community health
care services
Primary health care for ATSI
Community health
Ambulance and Royal Flying Doctor Service
Complementary and alternative health
• Admitted patient care
• Emergency department
• Outpatient care and other non admitted care
Specialized health services
Specialist medical practitioners
Specialized mental health services
Sexual and reproductive health
Alcohol and other drug treatment services
National diabetes services scheme
Hearing services
Palliative care services
Health services in the Australian Defense Force
Responsibility for health facilities and
• Public Sector - The Australian Government has primary
responsibility for funding services provided by GPs, medical
specialists and other health practitioners that are fully or
partly covered by Medicare. It also funds the Pharmaceutical
Benefits Scheme (PBS), health research and Aboriginal
community controlled health organisations.
• State/territory governments have primary responsibility for
public hospital services, community health services, patient
transport, and public health activities such as health
• Private Sector - Non-government sources of funding
include the payment of out-of-pocket expenses by
individuals, benefits paid by private health
insurance, third party motor vehicle insurance and
workers compensation insurance.
• Among the responsibilities of the non-government
sector are the provision of health aids and
appliances, dental services, private hospitals and
Equity of access to health facilities and
• Access in rural and remote areas
– The continued funding of the RFDS, and programs
encouraging health professionals to work in rural
and remote areas, are designed to support the
access needs of people in these areas and reduce
health inequities.
– However, despite these increases, people in rural
and remote areas still only have proportionally
half the supply of medical practitioners and
dentists as people in major cities
• Language support
– Language support strategies, such as th
translation services provided by the NSW
Multicultural Health Communication Service, are
designed to remove the language and cultural
barriers that prevent some people from accessing
medical care. These strategies have proven
particularly beneficial for overseas-born people.
• Bulk-billing through Medicare
– Bulk-billing is a feature of Medicare that helps to remove
cost as a barrier to receiving medical care.
– It allows certain health practitioners to directly bill
Medicare for the amount payable under the Medicare
Benefits Schedule for the service provided.
– There are no out-of-pocket expenses that need to be met
by the patient.
– Bulk-billing helps promote equity for people who
experience socioeconomic disadvantages.
– It also allows people living on limited fixed incomes and
who need to access health services more frequently, such
as older Australians, to access the services they need.
• Other access issues
– the prohibitive costs associated with expensive,
government-provided or privately funded facilities and
services that cater for only small numbers of people
– the extensive costs in time, distance and travel borne by
people living in rural and remote areas when they require
diagnosis or specialist treatment that is only available in
larger urban areas
– health funding limitations that do not allow for important
health services, such as dentistry, to be subsidised and
therefore as accessible as other services
– entrenched social and cultural issues that need to be overcome so that
people in disadvantaged population groups have the
knowledge, skills and confidence to adopt healthpromoting behaviours and seek early intervention when
Health Care Expenditure vs early
intervention and prevention expenditure
• In 2005–06, Australia spent $86.9 billion on
health. This represents 9 %of our gross
domestic product (GDP).
• After adjusting for inflation and population
growth, this figure represents a 45 %increase
in health spending per person compared to
• Preventative services
– less than 2 per cent of Australia’s spending on
health was for preventative services or health
promotion. (This is a very small proportion of the
overall health expenditure.)
– The health benefits include:
reduced morbidity and mortality rates
increased life expectancy
enhanced quality of life
reduced impact on carers, family and friends.
– This approach can also be a cost-effective one.
When people are prevented from getting ill or
injured, substantial savings are made—in
treatment costs, as well as in productivity at the
– Evidence also tells us that lifestyle-related
conditions are the most significant causes of
sickness, injury and death.
– The effects of risk behaviours are often cumulative
and develop over time, so there is merit in
allocating substantial resources to preventative
• Early intervention
– Over time, significant improvements have been
made in the rate of early intervention and the
survival rates for many causes of sickness and
– Research indicates that survival rates for
cardiovascular disease, cancers, respiratory
diseases and injury are improving. This is due to a
combination of factors, such as earlier
intervention, and improved treatment and
recovery programs.
Impact of emerging new treatments and
technologies on health care
• New treatments and technologies offer the potential for
significant improvements in health care and health status.
• Education programs that promote positive behaviours (such
as self-examinations, regular screening and check-ups for atrisk groups) have contributed to improvements, there is no
doubt that emerging technologies have also contributed
– For example, since the 1980s, advancements have been made in the
field of medical imaging that greatly enhance the capacity to detect
many health concerns, including the presence of cancer.
• A natural concern that often accompanies emerging
treatments or technologies is the associated costs.
– For example, in the 1990s, the cost of MRI machines was
exorbitant; to fund their purchase, larger budgets were
needed or cost savings needed to be made.
• When new treatments or surgical techniques are
developed, there are often significant costs
associated with accessing these, and issues in how
the knowledge and skills are shared among
– The development of drugs to treat the human
immunodeficiency virus (HIV) was a highly
expensive process. The extensive research had to
be completed quickly, so the drugs themselves are
also expensive, but they are critical to the longterm survival of people with HIV. In Australia the
government places them on the PBS schedule,
thus subsidising most of the substantial cost.
Health Insurance: Medicare and
• Health care is essentially provided in Australia in one
of three ways:
• through the public health care system
• through private health insurance
• through out-of-pocket expenses paid for by the
individual directly
• All Australians have access to health care through the
public health care system, -Medicare.
• Medicare is based on:
• universality・ equity・ simplicity.
• People can choose to have a greater range of
services and other privileges made available to them
by also opting to take out a private health insurance
premium with any of the private providers.
– Examples of private health insurers include HCF, NIB and
Medibank Private.
• People who choose to take out private health
insurance remain in the public health care system
and are still able to access service through Medicare.
• They are also able to purchase medications through
the Pharmaceutical Benefits Scheme (PBS).
• Medicare provides all Australians— regardless of
their personal circumstances—with access to
adequate health care at an affordable or no cost.
• Medicare is largely funded through general taxpayer
revenue that includes a 1.5 per cent Medicare levy
collected from all income earners who earn above a
minimum amount in Australia.
• An additional levy of 1 per cent is imposed on highincome earners who choose not to take out private
health insurance or who do not have an appropriate
level of private health insurance hospital cover.
• Private health insurance
– After 1984 the proportion of Australians choosing to have
private health insurance declined consistently from
approximately 50 per cent of the population, to a low of
about 30 per cent in the late 1990s.
– Reasons for this included:
• a high level of satisfaction with the range and quality of
health care available under Medicare at little or no cost
• perceptions that private health insurance did not offer
value for money
• views that private health insurance was mainly a
priority at certain stages of life when medical services
were accessed more frequently, such as when having a
baby or when approaching older age.
• To arrest this decline and to help reduce the increasing
pressure placed on Medicare, the Australian Government
introduced three measures to help encourage people to
continue with or adopt private health insurance.
• These measures included the following:
• A 30 per cent government rebate is offered on private health insurance
• A lifetime rating, which becomes applicable after the age of 30 years, was
introduced. The government imposes a 2 per cent surcharge for each year
a person does not take out private health insurance after the age of 30
years. So, if a person waits until the age of 60 years to take out private
health insurance, they can expect to pay a surcharge of 60 per cent on top
of their annual premium each year (i.e. 2% × 30 years = 60%).
• The standard 1.5 per cent Medicare levy that is payable by all income
earners was increased to 2.5 per cent for those people earning
comfortable incomes who do not take out private health insurance.
• As a consequence of these measures, in 2000
there was an immediate increase in the
proportion of Australians with private health
• By June 2006, the proportion of Australians
with private health insurance was 43.5 per
cent of the population.
• What does private health insurance cover?
– There are two types of private health insurance
cover available: hospital cover and ancillary (or
extras) cover.
– Hospital insurance covers all or some of the costs of hospital
treatment as a private patient, including doctors’ charges and
hospital accommodation.
– Ancillary cover helps with the cost of services such as
physiotherapy, dental treatment and optometry.
• Why do people take out private health
– People choose to take out private health insurance for many
reasons, including:
» Ancillary benefits
» Treatment as a private patient in either public hospitals or
private hospitals.
» Superior standard of comfort
» Peace of mind
» A response to chronic disease, injury or mental health
» To avoid having to pay a higher Medicare levy surcharge
• Out-of-pocket expenses
• Private health insurance may not always cover
the total cost of the doctors’ services provided
in hospital, which in turn may result in out-ofpocket expenses having to be met by the
• This difference between the scheduled fee,
which is the amount covered by private health
insurance, and the actual cost of the service is
called ‘the gap’. The gap is met by the
Complementary and alternative
health care approaches
• Reasons for growth of complementary and alternative health
care products and services
– Complementary and alternative health care refers to
health-related treatments and services that typically fall
outside the Western medical tradition.
– Common forms of complementary and alternative health
care include acupuncture; chiropractic and osteopathic
services; naturopathy; and various forms of massage such
as shiatsu and reiki.
– It is a $2 billion dollar industry in Australia per year.
• Being embraced by both Medicare and private
health insurance increases the legitimacy of
these products and services in the eyes of the
consumer, and also subsidises their cost,
making them more appealing and more
• Reasons for the growth of complementary and
alternative health care products and services
in Australia
• the inclusion of several of them in the public health
care system and private health insurance.
– These services include those provided by chiropractors,
osteopaths and acupuncturists. Private health insurance
packages sometime cover services provided by naturopaths
chiropractors, osteopaths and acupuncturists.
• Formal qualifications
• Greater authenticity
– relevant professional associations, such as the Chiropractors’
Association of Australia, often have codes of ethics or industry
standards that members are expected or encouraged to meet.
• Persuasive marketing campaigns
– they may emphasise the use of only natural or organic
products, promote non invasive techniques, or link health
improvements to enhanced connections between mind, body
and spirit.
• Changes in the demographic mix.
• Attitudinal changes within the medical
– complementary and alternative therapies are increasingly
being viewed as approaches that can work alongside
traditional medical approaches rather than instead of them.
• Attitudinal changes within the wider
– Behavioural choices and the use of products and services that
promote health are increasingly well known and generally
viewed as positive. Using complementary and alternative
therapies is often viewed in this way; for many people, it
reaffirms their commitment to their personal health and
Range of products and services
• Females were more likely than males to access
services provided by complementary and alternative
health professionals,
• Other less common complementary products and
services include:
traditional Chinese medicine
rehabilitation therapies
the use of herbal remedies.
How to make informed consumer
• The increasing use of complementary and alternative
health products and services in Australia, means that
it is critical that measures are put in place to ensure
appropriate standards are met when these products
and services are delivered.
• Making informed consumer choices about
complementary and alternative health products and
services involves similar skills and strategies as
making any consumer choice,
• What do you need to make informed
– Research
– Select
– Reassess
Sample Exam Questions
1. Outline the range and type of health care
facilities and services in Australia? (5 marks)
2. Discuss reasons why more people are
choosing to use complimentary and
alternative health care approaches. (7 marks)
3. Explain why some people choose to take out
private health insurance. (8 marks)