Introduction
Health care is a vital component of Australia’s economy just like it is in other countries of the world. The health sector employs around 7% of the total workforce and contributes approximately 8.5% of Gross Domestic Product (GDP). This means that yearly health care spending can be more than $2,500 for each person (Australian Bureau of Statistics,2003). Health care is not only measured in terms of improving health but It also involves provision of diagnosis and prognosis, reduction of pain and suffering and restoration of persons normal functioning.(Gulliford & Morgan 2003).
Government’s policies on the socio-economic develpment has a considerable impact on, inequalities, the health of the Citizens and wealth/resource distribution. These affectsaffect access to health care and its benefits.(Schrader,2003) In this paper am going to focus on access to medical services as my reference topic. I would define access to medical services in terms of whether those who need it get it or not. It incorporates two aspects,that is, having access which means the potential to utilize a service when needed and gaining access which means being initiated/being part of the process of utilizing a medical service. According to Courtney and David (2005), equity means fairness in providing health facilities to individuals or even a group.Australia has tried to enact eguality by provision of Medicare cards to every citizen. This entitles a person to get free medical attention in public hospitals. However; instances of inequality to access are there which are caused by various factors as we are going to see in the paper.
Issues of equity and inequity in relation to the public-private balance of health in Australia
Quality and safety
Research has shown that medical errors in Australia cost approximately over $1- $2 billion per year. Health Care Study shows that about half of the errors were preventable (Rutstein D et al.,1976). It is clear that the country has not come to terms with this medical error, and is not doing much to reduce it. However there is a new agency for safety and quality, although its effectiveness is yet to be seen. It is not clear whether ten years of quality and safety activity has born fruits
Public-private health care financing
It is clear that access to health services has become less equitable. Over the years Australia has had a health system that depends on public and private funding and service delivery though it has been presented only as a matter of choice.(Ducked 2010).Private health insurance is felt as unfair by those living in rural areas where there is limited access to private health facilities and services. Heavy reliance on private funding sources leads to regression ineluctability in financing health care. There is high regulation of private health insurance sector and premiums are the same for all people.(Lairson DR,Hindson P, Hauquitz A 1995). Those funds which have been set aside for the sake of catering for health funding played a very significant rol in this case. In addition there is limitation of payments to specific dialysis centers.(Organisation for Economic Co-operation and Development,2004) Today some surgery areas are now carried out in the private sector, and those without private health insurance have to wait, for months, for elective surgery in the public sector. In order to have access to healthcare, individuals need o have the ability to pay for such services. There is a very wide disparity between the healthcare services offered at the public sector compared to those in the private wing. Financial barrier will lead to untimely access to medical care. The need to reduce the cost of healthcare is being devised. For instance, cases where patients are admitted agan in hospitals units are being reduced alongsixde the time period when patients are expected to be confined in a healthcare unit as they receive medcal attention. Such plans are expected to secure millions of dollars within the nest five years or so.
Health inequality and equity
Health benefits have not been equally shared across Australian despite the improvements in life expectancy achieved in past years (Glover, Harris &Tennant ,1999) It is true that women do well healthwise than men; educated city dwellers living in condusive neighbourhoods do better than people who live in the remote or slum areas, the less educated/uneducated and the jobless.The poor and indigenous Australians would live 20 years less compared to the wealthy ones ( Hayes & Berry,2002).
Health workforce
In Australia,you find that doctors especially those in public hospitals and other health do not have the willingness to work in extra time/ extended hours.This has arose due to a number of factors like the increase in the number of women doctors/health workers,the ageing of the workforce and the the efforts by these workers to balance between their family life and the work itself. Most health professionals prefer to live in urban/metropolitant areas where their aspiration concerning family ,education and even work can be achieved.This has adversely affected the supply and also distribution of the health workers in the country.Shortages of doctors,nurses,dentists is significant in rural and remote areas.Some medical areas like disability and mental health lack specialists.-There has- been a reduction of d-oc-tors- who are trained oversees from 20% to 19%. In 2004,the Health Ministers’ Conference developed a National Health Workforce Strategic Framework-(N.H.W.S.F) to address these problems, but due to poor leadership and lack of integration of health with the government and sopporting private and public sectors.
What about new technology? The increase in the cost of health care can be attributed to improvement in medical technology. Advancement in diagnostic and therapeutic facilities such as radiology scanners, ,high tech surgical procedures and prostheses, biological therapeutics are expensive to offer.their subsidy through Medicare or PBS (Pharmaceutical Benefits Scheme) increases their availability and consequently their use.This cost goes to the community. Failure to subsidise them would create political pressure about why the medical advancements are not made available to all citizens. In Australia there is use of different criteria to determine access to any new technology in both public and private hospitals/health centres.There is a kept record of assessment of all new pharmaceutical products.The assessment is mainly based on cost-effectiveness principles but assessment surgical devices and that of other technologies has not been comprehensive.In addition they lack cost effectiveness rigour which has been applied to vaccines and pharmaceutical drugs and or products (Phelan & Link ,2005).
Causes of inequality in the access
The structure and function of the health care services affects health status in a number of ways.Different health structures will affect access.Secondly,the working of a health system on an individual or group affects the outcomes of treatment(Eckersley et al 2001).Just like in other parts of the world,Australia has been faced by various challenges that affects citizen’s access and provision of medical care.Changes in demography due to population growth and increased number of chronic illnesses.The larger the population the harder it is for one to get attention due to the congestion involved. Poverty is a major contributing factor to inequality.This in conjunction with poor infructure which hinders fast transportation lowers people’s accessibility to health facilities.According to research report, the greatest factor in the remote/very remote areas was that Aborigines(Rural the most oppressed groups in Australia who suffer from poverty and state isolation) comprised 49.3 percent of the country’s population (Finkelstein,2004) They have little or no access to health care and other basic services,for instance education. Another challenge is in health workers employment and distribution.A small number of health personnels may be recruited that is not enough to cater for.all medical cases.
The Increased costs of medical services and the need to make sure that they are, efficient, transparent and comprehensive innitiatives for assessing better health technologies.(Armstrong et al 2007).The governmemt focus much on this and service delivery to citizens is hindered. Due to the high cost of health services individuals are unable to access them as they cannot afford. After a long delay , the government finally released two reports about health inequalities. They confirm that death rates in 1998-2000 for the poor Australians remained higher than for the rich.The gap has increasing considerably over a period of 15-years. In 1998-2000, the wealthy males and females lived 2 years to 3.9 years longer than the poorest. This gap began at birth and remained in people’s lifetimes (Looper & Magnus.2005)..Economically disadvantaged areas experienced higher mortality rates and this occured at every stage of the life,that is from infancy and childhood through adolescence to adulthood.(Holland 2005). Another factor is the government recognition that children health should be invested on more.This means that little attention is given to adult health. Research has shown that the fundamental inequality is brought about by class or the socio-economic status of individuals (World Health Organization, 2005). The healthcare inequality levels depicted are as a result of the varying leves of economic well being which compels those within the low income bracket to seek cheaper and affordable services (Greig ,Lewins & White,2003).
The unemployed and low-paid are forced to live in substandard or poor housing.They have poor access to medical services and decent education.They are therefore inevitably more exposed to health problems both of physical and psychological nature.( Mackenbach, Stronks, Kunst,1989). The history of Aborigines,prove that youth suicide of males in remote areas is 280 percent greater than in urban areasThe rich live in urban areas where they have easier access to better health services (Holland 2005).
Key developments
There is a very complicated heathcare system in Australia. To begin with, the responsibility of handling the healthcare system is shared between both the central and regional governments. Moreover, the public healnthcare sector alongside the private one makes the provision of heathcare services to be a long and protracted process which requires proper coordination. Unless this is done, inequity will persist even in the near future. For as with most OECD countries, horizontal equity (equal care for equal need)—is a major objective of the health care sector and this principle underlies the country’s universal health care system,that is, Medicare.(Korda et al,2007)The key aspects of healthcare are underpinned by government programmes. Medicare which covers all citizens,is funded by tax revenue.It pays for hospital and all medical services.It caters for the whole cost of treatment in public hospitals.In addition there is no limit on the fee charged by doctors..(Armstrong et al. 2007). A government-set fee schedule has been implemented. Doctors are allowed to bill patients or send their bills directly to the Health Insurance Commission (HIC).
From the payment sent to the HIC 85% goes to the government-set fee for out-of-hospital expenses and 75% for in-hospital services.This money is paid directly to the doctor who t is not allowed to charge the patient any additional fee. All Public hospitals are owned by the government and major teaching hospitals are public hospitals and not private ones.Emergency services are given in public hospitals. The cost of medication is subsidized by Pharmaceutical Benefit Scheme (PBS) which covers most prescriptions but the government to first assess its cost.Pharmaceutical companies also play a very instrumental role as far as the cost on heathcare is concerned. Over ten percent in terms of cost is accrued as a result of the involvement of these medical companies in the provision of drugs and other medical kits. Nevertheless, obtaining medical services is quite costly with almost 20 percent inurred in form of direct costs (Ducket 2010). As much as the Australian government has often struggled to reduce the gap in healthcare inequity over the years, there are still key issues which are impeding these efforts. One such stumbling block is political will which does not seem to exist or operational. Any significant improvement on Australian health care cannot be realized if there will be no political support right from the grass root level. Alongside lack of political goodwill is long age complacency mentality on the current health care system which has created a misleading notion that since the system is being funded by the members of the public, then there is not need of improving the status. Moreover, the low level of research being undertaken healthcare system does not auger well as far as progress in this sector is concerned.
The private sector has been given more attention by the government in the provision of balanced healthcare. Once the private healthcare system will set in, it should be noted that it will be cumbersome for the cross section of the population to access equitable healthcare. Additionally, the assumption that a balanced healthcare is within reach of the entire population is misleading. Matters on the affordability and accessibility of Medicare are still assumed to be benefiting all and sundry in the same way, an assumption which is quite misleading. Although we all applauded the part played by Medicare, the situation is different when the same is to be considered in the provision of primary healthcare. There are several research studies which have been carried out to address the growing inequity in healthcare balance (Ducket 2010). Nevertheless, lack of political goodwill has impeded such recommendations because the government rarely acts on them. If the government would be acting positively on these report recommendations, the Australian healthcare balance would be a reality to be enjoyed by all.
Sticking to the publicly funded Medicare insurance plan as the main approach of balancing the growing inequity, it will be wrong because basic healthcare services require much more than just the insurance plan. The healthcare benefits derived from Medicare services is very limited and cannot be totally relied upon as a comprehensive healthcare plan ( Hayes & Berry,2002). In order to establish a reliable healthcare plan which is also affordable and easily accessed by all, good governance has to be put in place. Only the right political leadership can give room for political goodwill in advancing the need to draw sound equity in healthcare (Ducket 2010). Such a political leadership will equally give more emphasis to the public healthcare system much more to the private as it is the case. This is owing to the fact that the public healthcare plan is inclusive of all the needs of the population regardless of their social and economic status. The private healthcare plan might be quite discriminative only reaching a small section of the population which has the monetary ability to cater for the high costs which are often associated with private healthcare system.
Conclusion
As already discussed, healthcare is an issue of great concern in Australia.Inequity in terms of access is a challenge that can be rectified with the government initiative. There are those political parties which have sound policies regarding the need to spare some significant funds to cater for the growing level of health imbalance. If such political leaderships were given the chance to exercise their party manifestos, then, it is by no doubt that healthcare inequity in Australia would be a thing of the past.This means that health issues will be critically handled and due attention given to this sector.
Equitable distribution of hospital/health facilities is crucial.We find that most health facilities are concentrated in the urban area leaving rural or remote areas with inadequate services.This would even reduce mortality rates in this disadvantaged areas (Phelan JC et al,2004). Approaches to prevention,acute care and rehabilitation will be necessary in order to efficiently and effectively solve the health problems in Australia in this 21st century. The government should focus on the big picture and not narrowing to what is not basic for its citizens.Consultation and agreement even with the public about what the country should provide for health care of its citizens and thestructuring of health system to achieve that provision, should be a priorityThe eight challenges outlined above await Australia’s next government. Other ways of increasing access to health services is improvement of infrastructure even in rural areas.Increase and improvement of services such as ambulance and flight services would ensure that citizens access medical attention in time.
Though the government has tried to make health services cheaper and affordable,I can say it has not done its best yet.Regulation of cost and insurance and/or medical covers is crucial. Some factors that cause enequality in access may be difficult to handle and rectify,for instance the issue of class or social-economic status because it is hard to have a society without class and those in high class will always access health services faster and in time as compared to the lower classes. Therefore, resolving the issue of health inequaity will require close and commited cooperation among the key stakeholders in the healthcare sector. For instance, the federal government should work hand in hand with the state government in making sure that healthcare issues are addressed decisively. Moreover, the publicand private sectors should not work in isolation even though they are two separate entities. Apart from the already existing healthcare policies, these sectors should collaborate and offer high quality healthcare services. This initiative can be boosted by conducting research programs together so as to improve on standards.
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