Australian Health Care System (part 1)

Australian Health Care System
Betterbodyz
1

What is Health ?
-Health is an important part of wellbeing, of how people feel and function
-Health contributes to social and economic wellbeing
-Health is not simply the absence of disease or injury, and there are degrees of goog
health
-Managing health includes being able to promote good health, identify and manage risk
and
prevent disease
-Disease processes can develop over many years before they show themselves through
symptoms
2

What is Health ?
The overall concept is that a person’s health and wellbeing result from complex
interplays among biological, lifestyle, socioeconomic, societal and environmental factor,
many of which can be modified to some extent by health care and other interventions.
3

What factors contribute to health?
Genetics e.g. you may be more susceptible to diabetes by having parents who have
diabetes.
Social e.g. consuming foods and adopting diets that are in trend such as fad meal
replacement shakes that you may see celebrities on social media taking. This can distort
your view of what healthy diets should look like.
Environmental e.g. not having as great access to parks and walking tracks or living in a
highly polluted area.
Emotional e.g. you could be going through a loss of a close person and forget to take time
out for yourself to exercise and eat well.
Spiritual e.g. if you don’t believe in yourself, it becomes hard to motivate yourself to
achieve the fitness and diet goals that you have set.
Economic e.g. having minimal money can place stress on a person, especially if they are
responsible for investing money in the health of others. This is likely to be the case of a
single mother with children.
5

World Health Organization definition of Health
A state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity. (this definition includes mental and social dimensions and move the
focus beyond individual physical abilities or dysfunction)
Aspects of health Huber and colleagues (2011) believe should be included in a definition
of health?
Huber and colleagues (2011) feel that the ‘ability to adapt and self manage’ is important
Physical – a human’s ability to adapt to new surroundings and exert a positive response.
Mental – a positive interaction between mind and body, there is a need for coherence to
understand, manage and find meaning out of a difficult situation.
Social – moving through life without having to be limited too much by social and
environmental
challenges. getting a better understanding of health.
8

The definition of health that WHO published in 1948, should be updated.
A ‘complete’ state of health is unrealistic to achieve, especially since people are living
longer with more chronic illness and disease. It’s like the inclusion of complete makes
health seem like something that cannot be achieved, and this may be problematic as
individuals should be encouraged to take control of their own health. There needs to be a
balance between physical, mental and social well-being and emphasis should be placed
on all aspects of health.
9

The positive aspects of this definition?
The WHO definition of health in 1948 seems to be moving towards health promotion and
prevention over simply curing an individual from disease. The importance of preventing
illness and disease is illustrated in Social Model of Health, where there is a decreased
reliance on specialist medical care and further responsibility of community based
services.
The limitations of this definition?
As the population is aging, chronic disease is becoming more of an issue compared to
infectious disease in the past with a younger and poorer population. As a result, many
people are living with chronic conditions and thus according to the WHO definition, many
people are considered unhealthy, which is not fair.
10

What is disease and illness?
A disease is a physical or mental disturbance involving symptoms, dysfunction or tissue
damage, while illness (or sickness) is a more subjective concept related to personal
experience of a disease (AIHW 2010).
There are many diseases that can afflict the human body, ranging from common colds to
cancers. The 2 main categories of disease that may lead to ill health are infectious and
chronic diseases.
Infectious diseases are caused by pathogens and can be spread from person to person
by air, food, water, inanimate objects, insects or by direct or indirect contact with an
infected person. Examples of infectious diseases include influenza, malaria and human
immunodeficiency virus (HIV).
Chronic diseases are caused by multiple factors, including a person’s genetic make-up
lifestyle and environment. They are long-term conditions and cannot be directly spread
from one person to another. Examples of chronic diseases include diabetes, asthma and
heart disease.
11

Health is heavily influenced by the circumstances in which people are born, grow, live,
work and age including political, social and economic factors that go beyond the
immediate causes of disease (Commission on Social Determinants of Health 2007).
The 10 social determinants of health (SDH) described in Marmot (2005) ?
1. The social gradient
2. Stress
3. Early childhood
4. Social exclusion
5. Work
6. Unemployment
7. Social support
8. Addiction
9. Food
10. Transport
14

Socioeconomic position
In general, people from poorer social or economic circumstances are at greater risk of
poor health, have higher rates of illness, disability and death, and live shorter lives than
those who are more advantaged.
Generally, every step up the socioeconomic ladder is accompanied by an increase in
health.
Historically, individual indicators such as education, occupation and income have been
used to define socioeconomic position.
16

Educational attainment is associated with better health throughout life.
Education equips people to achieve stable employment, have a secure income, live in
adequate
housing, provide for families and cope with ill health by assisting them to make informed
health
care choices.
An individual’s education level affects not only their own health, but that of their family,
particularly dependent children.
17

Occupation has a strong link to position in society, and is often associated with
higher education and income levels—a higher educational attainment increases
the likelihood of higher-status occupations and these occupations often come with
higher incomes.
18

Income and wealth play important roles in socioeconomic position, and therefore
in health. Besides improving socioeconomic position, a higher income allows for greater
access to goods and services that provide health benefits, such as better food and housing,
additional health care options, and greater choice in healthy pursuits.
Loss of income through illness, disability or injury can adversely affect individual
socioeconomic position and health
19

Early life
The foundations of adult health are laid in-utero and during the perinatal and early
childhood periods . The different domains of early childhood development—physical,
social/emotional and
language/cognitive—strongly influence learning, school success,
economic participation, social citizenry and health.
Healthy physical development and emotional support during the first years of life provide
building
blocks for future social, emotional, cognitive and physical wellbeing.
Children from disadvantaged backgrounds are more likely to do poorly at school, affecting
adult
opportunities for employment, income, health literacy and care, and contributing
to intergenerational transmission of disadvantage.
Investment in early childhood development has great potential to reduce health
inequalities, with the benefits especially pronounced among the most vulnerable children.
20

Social exclusion
Social exclusion is a broad concept used to describe social disadvantage and lack of
resources, opportunity, participation and skills (Hayes et al.
Social exclusion may result from unemployment, discrimination, stigmatization and other
factors.
Poverty; culture and language; and prejudices based on race, religion, gender, sexual
orientation, disability, refugee status or other forms of discrimination limit opportunity and
participation, cause psychological damage and harm health through long-term stress and
anxiety. Social exclusion can damage relationships, and increase the risk of disability,
illness and social isolation. Additionally,
disease and ill health can be both products of, and contribute to, social exclusion
21

Social capital
Social capital describes the benefits obtained from the links that bind and connect people
within and between groups . The extent of social connectedness and the degree to which
individuals form close bonds with relations, friends and acquaintances has been in some
cases
associated with lower morbidity and increased life expectancy, although not consistently.
It can provide sources of resilience against poor health through social support which is
critical to physical and mental wellbeing, and through networks that help people find work,
or cope with economic and material hardship.
Social infrastructure—in the form of networks, mediating groups and organizations—is
also a prerequisite for ‘healthy’ communities.
The degree of income inequality within societies (the disparity between high and low
incomes) has also been linked to poorer social capital and to health outcomes for some,
although there is little evidence of consistent associations
22

Employment and work
Unemployed people have a higher risk of death and have more illness and disability than
those of similar age who are employed. The psychosocial stress caused by unemployment
has
a strong impact on physical and mental health and wellbeing.
For some, unemployment is caused by illness, but for many it is unemployment itself that
causes health problems through its psychological consequences and the financial
problems it brings.
Rates of unemployment are generally higher among people with no or few qualifications or
skills, those with disabilities or poor mental health, people who have caring
responsibilities, those in ethnic minority groups or those who are socially excluded for
other reasons .
Once employed, work is a key arena where many of the influences on health are played
out. Dimensions of work—working hours, job control, demands and conditions—have
an impact on physical and mental health. Participation in quality work
is health-protective, instilling self-esteem and a positive sense of identity, while also
providing the opportunity for social interaction and personal development
23

Housing
Safe, affordable and secure housing is associated with better health, which in turn impacts
on people’s participation in work, education and the community. It also affects parenting
and social and familial relationships .
There is a gradient in the relationship between health and quality of housing: as the
likelihood of living in ‘precarious’ (unaffordable, unsuitable or insecure) housing increases
health worsens. The relationship is also two-way, in that poor health can lead to precarious
housing. Single parents and single people generally, young women and their children and
older private renters are
particularly vulnerable to precarious housing.
24

Residential environment
The residential environment has an impact on health equity through its influence on local
resources, behavior and safety. Communities and neighborhoods that ensure access to
basic goods and services; are socially cohesive; which promote physical and psychological
wellbeing; and protect the natural environment, are essential for health equity.
To that end, health-promoting modern urban environments are those with appropriate
housing and transport infrastructure and a mix of land use encouraging recreation and
social interaction.
25

"The poor health of the poor, the social gradient in health within countries, and the marked
health inequities between countries are caused by the unequal distribution of power,
income, goods, and
services, globally and nationally, the consequent unfairness in the immediate, visible
circumstances of peoples lives – their access to health care, schools, and education, their
conditions of work and leisure, their homes, communities, towns, or cities – and their
chances of leading a flourishing life.
This unequal distribution of health-damaging experiences is not in any sense a ‘natural’
phenomenon….Together, the structural determinants and
conditions of daily life constitute the social determinants of health.“ (WHO )
Social determinants of health have a direct impact on health
Social determinants predict the greatest proportion of health status variance (health
inequity)
Social determinants of health structure health behaviors
Social determinants of health interact with each other to produce health
27

Stress harms health
The evidence Social and psychological circumstances can cause long-term stress.
Continuing anxiety, insecurity, low self-esteem, social isolation and lack of control over
work and home life have powerful effects on health. Such psychosocial risks accumulate
during life and increase the chances of poor mental health and premature death.
Long periods of anxiety and insecurity and the lack of supportive friendships are damaging
in whatever area of life they arise.
How do these psychosocial factors affect physical health? In emergencies, the stress
response activates a cascade of stress hormones that affect the cardiovascular and
immune systems. Our hormones and nervous system prepare us to deal with an immediate
physical threat by raising the heart rate, diverting blood to muscles and increasing anxiety
and alertness. Nevertheless, turning on the biological stress response too often and for too
long is likely to carry multiple costs to health. These include depression, increased
susceptibility to infection, diabetes, and a harmful pattern of cholesterol and fats in the
blood, high blood pressure and the attendant risks of heart attack and stroke.
30

Social Support
Friendship, good social relations and strong supportive networks improve health at home,
at work and in the community. The evidence Social support and good social relations make
an important contribution to health. Social support helps give people the emotional and
practical resources they need. Belonging to a social network of communication and mutual
obligation makes people feel cared for, loved, esteemed and valued. This has a powerful
protective effect on health.
Support operates on the levels of both the individual and the society. Social isolation and
exclusion are associated with increased rates of premature death and poorer chances of
survival after a heart attack. People who get less emotional social support from others are
more likely to experience less wellbeing, more depression, a greater risk of pregnancy
complications and higher levels of disability from chronic diseases. In addition, the bad
aspects of close relationships can lead to poor mental and physical health
31

Addiction
Individuals turn to alcohol, drugs and tobacco and suffer from their use, but use is
influenced by the wider social setting. The evidence Drug use is both a response to social
breakdown and an important factor in worsening the resulting inequalities in health. It
offers users a mirage of escape from adversity and stress, but only makes their problems
worse. Alcohol dependence, illicit drug use and cigarette smoking are all closely
associated with markers of social and economic disadvantage. In the Russian Federation,
for example, the past decade has been a time of great social upheaval. Deaths linked to
alcohol use – from accidents, violence, poisoning, injury and suicide – have risen sharply.
Alcohol dependence and violent death are associated in other countries too. The causal
pathway probably runs both ways. People turn to alcohol to numb the pain of harsh
economic and social conditions, and alcohol dependence leads to downward social
mobility. The irony is that, apart from a temporary release from reality, alcohol intensifies
the factors that led to its use in the first place. The same is true of tobacco. Social
deprivation – as measured by any indicator: poor housing, low income, lone parenthood,
unemployment or homelessness – is associated with high rates of smoking and very low
rates of quitting. Smoking is a major drain on poor people’s incomes and a huge cause of ill
health and premature death. But nicotine offers no real relief from stress or improvement in
mood
32

Food
Healthy food is a political issue. The evidence A good diet and adequate food supply are
central for promoting health and wellbeing. The shortage of food and lack of variety cause
malnutrition and deficiency diseases. Excess intake (also a form of malnutrition)
contributes to cardiovascular diseases, diabetes, cancer, degenerative eye diseases,
obesity and dental caries.
Food poverty exists side by side with food plenty. The important public health issue is the
availability and cost of healthy, nutritious food. Access to good, affordable food makes more
difference to what people eat than health education.
Industrialization brought with it the epidemiological transition from infectious to chronic
diseases – particularly heart disease, stroke and cancer. This was associated with a
nutritional transition, when diets changed to overconsumption of energy-dense fats and
sugars, producing more obesity. At the same time, obesity became more common among
the poor than the rich.
33

Food
Healthy food is a political issue. The evidence A good diet and adequate food supply are
central for promoting health and wellbeing. The shortage of food and lack of variety cause
malnutrition and deficiency diseases. Excess intake (also a form of malnutrition)
contributes to cardiovascular diseases, diabetes, cancer, degenerative eye diseases,
obesity and dental caries.
Food poverty exists side by side with food plenty. The important public health issue is the
availability and cost of healthy, nutritious food. Access to good, affordable food makes more
difference to what people eat than health education.
Industrialization brought with it the epidemiological transition from infectious to chronic
diseases – particularly heart disease, stroke and cancer. This was associated with a
nutritional transition, when diets changed to overconsumption of energy-dense fats and
sugars, producing more obesity. At the same time, obesity became more common among
the poor than the rich.
34

Transport
Healthy transport means reducing driving and encouraging more walking and cycling,
backed up by better public transport. The evidence Cycling, walking and the use of public
transport promote health in four ways. They provide exercise, reduce fatal accidents,
increase social contact and reduce air pollution. Because mechanization has reduced the
exercise involved in jobs and house work, people need to find new ways of building exercise
into their lives. This can be done by reducing the reliance on cars, increasing walking and
cycling and expanding public transport. Regular exercise protects against heart disease
and, by limiting obesity, reduces the onset of diabetes. It promotes a sense of wellbeing and
protects older people from depression.
Reducing road traffic would reduce the toll of road deaths and serious accidents. Although
accidents involving cars injure cyclists and pedestrians, those involving cyclists injure
relatively few people. Well planned urban environments, which separate cyclists and
pedestrians from car traffic, increase the safety of cycling and walking.
35

Transport
More cycling and walking, plus greater use of public transport, would stimulate social
interaction on the streets, where cars have insulated people from each other. Road traffic
separates communities and divides one side of the street from the other. Fewer pedestrians
mean that streets cease to be social spaces, so that isolated pedestrians often fear attack.
Further, suburbs that depend on cars for access isolate people without cars, particularly the
young and old.
Social isolation and lack of community interaction are strongly associated with poorer
health. Reduced road traffic means decreasing harmful pollution from exhaust. Walking
and cycling make minimal use of non-renewable fuels and do not lead to global warming.
They do not create disease from air pollution, make little noise and are preferable for the
ecologically compact cities of the future. Bicycles, which can be manufactured locally, have
a good “ecological footprint” – in contrast to cars.
36

How well does Australia addresses the social determinants and other factors that influence
health?
Australia definitely has some great policies in place to promote equity within the health
care system, for example Medicare allows for access to medical care when required for all
Australians. We can see a GP for free or of little cost, I think this is pretty amazing.
Furthermore, the Closing the Gap initiative allows for Indigenous people with chronic
conditions to have great access to specialist care and medications for a very low cost,
which is great.
On the contrary, I believe preventative measures and social determinants of health can be
neglected. I feel as if healthy and active lifestyles need to be further promoted. For example,
walking into the service station and seeing chocolates and chips at the front counter that
are just far too accessible for the public. I don’t think it is fair to have as big a market as we
do for calorie dense foods, processed foods, fast foods – it is contributing greatly to
Australia’s current obesity epidemic – I think this is so wrong and it needs to change.
38

Key characteristics of the Australian health care system?
The Australian Health Care system is pluralistic and complex.
It involves three levels of government - Commonwealth, State and Local - with public and
private providers who may be individuals or institutions.
The health system can be broadly divided into institutional and non-institutional services.
The system is based around the National Health Care Act of 1953 which regulates how
medical, dental and pharmaceutical services are provided
39

A well functioning health system responds in a balanced way to a population’s needs and
expectations by:
• improving the health status of individuals, families and communities
• defending the population against what threatens its health
• protecting people against the financial consequences of ill-health
• providing equitable access to people-centered care
• making it possible for people to participate in decisions affecting their health and
health
system.
40

What is the role of Medicare to the Health system ?
Medicare gives Australian residents access to health care. It is partly funded by taxpayers
who pay a Medicare levy of 2% of their taxable income. The Medicare levy is reduced if
taxable income is below a certain threshold. The Medicare levy changed in 2014 when the
National Disability Insurance Scheme (NDIS) was introduced by the Gillard Government. The
Medicare Levy was 1.5% however the introduction of NDIS added an extra 0.5% to the levy -
now a total of 2%.
What is the role of the public and private health care systems?
The role of the public health care system is to provide universal access to subsidized
medical and pharmaceutical services and free hospital treatment as a public patient, to all
Australian citizens and permanent residents, this health scheme is called Medicare.
Medicare's objectives are to make health care accessible and affordable to all Australians,
and to provide high quality care.
This public system is supported by optional private health insurance (and injury
compensation insurance) for hospital treatment as a private patient and for ancillary
health services (such as physiotherapy and dental services) provided outside a hospital.
Private health insurance provides cover for private hospital services not covered by
Medicare (such as denistry). Consumers with private cover avoid potentially long waiting
lists in public system and choose their own health care providers/specialists. Private
42

Primary Care Prevention of Health
• Disease prevention
– Screening
– Brief health education
– Brief intervention
• Usually provided by
– GPs
– Community nurses
– Allied health clinicians
Secondary Prevention
• Timely treatment
– Prevention of exacerbation of disease/injury/illness
• Treatment by specialist medical, nursing and allied health professionals.
43

Tertiary Prevention
• Intervention or rehabilitation
– Restoring health (to the level of that person)
– Often happens in the hospitals
– Usually under the medical model of health
Services
• Informal care
– Care provided not by the system:
• Family members
• Friends
• Volunteers (non paid)
• Formal services
– Provided by paid people:
• Must be licensed professionals
• Licensed organizations
• Paid privately or public
45

Medicare
• Federally funded
• Provides a minimum level of health to all Australian citizens (plus a few others eg
refugees)
• Can either fully pay a health service eg bulk bill at GP or public hospital stay; or can
subsidise a
health service eg private hospital or private GP.
• Also covers some pharmaceuticals, imaging, optical, etc.
Public Health
• Health promotion
• Preventative health
Medicare
• free or subsidized treatment by health professionals
• free treatment and accommodation as a public patient in a public hospital
• 75% of the Medicare Schedule fee for services and procedures if you are a private
patient in a
public or private hospital.
• some health care services in certain countries
46

Focus • Individual focus: acute treatment of ill individuals
• Clinical services, health education, immunisation
Assumptions • Health and illness are objective biological states
• Individual responsibility for health
Key indicators of illness • Individual pathology
• Hereditary factors, sex, age
• Risk-taking factors
Causes of illness • Gene defects and micro-organisms (viruses, bacteria)
• Trauma (accidents)
• Behaviour/lifestyle
Intervention • Cure individuals via surgery and pharmaceuticals
• B ehaviour modifi cation (non-smoking, exercise, diet)
• Health education and immunisation
Goals • Cure disease, limit disability, and reduce risk factors to prevent disease in individuals
Benefi ts • Addresses disease and disability of individuals
Criticisms • Disease focus leads to lack of preventive eff orts
• Reductionist: ignores the complexity of health and illness
• Fails to take into account social origins of health and illness
• Medical opinions can reinforce victim-blaming
Biomedical Model
48

Focus
Assumptions
Key indicators of illness
Causes of illness
Intervention
Goals
Benefi ts
Criticisms
Biomedical Model
• Societal focus: living and working conditions that aff ect health
• Public health infrastructure and legislation, social services, community action, equity/access issues
• Health and illness are social constructions
• Social responsibility for health
• Social inequality
• Social groups: class, gender, ‘race’, ethnicity, age, occupation, unemployment
• Risk-imposing factors
• Political/economic factors: distribution of wealth/income/power, poverty, level of social services
• Employment factors: employment and educational opportunities, stressful and dangerous work
• Cultural and structural factors
• Public policy
• State intervention to alleviate health and social inequalities
• Community participation, advocacy, and political lobbying
• Prevent illness and reduce health inequalities to aim for an equality of health outcomes
• Addresses the social determinants of health and illness
• Utopian goal of equality leads to unfeasible prescriptions for social change
• Overemphasis on the harmful side eff ects of biomedicine
• Proposed solutions can be complex and diffi cult to implement in the short-term
• Sociological opinions can underestimate individualresponsibility and psychological factors
49

Medical Model of Health
Medical model is the term coined by psychiatrist R. D. Laing in his The Politics of the Family
and Other Essays (1971), for the "set of procedures in which all doctors are trained."[1] It
includes complaint, history, physical examination, ancillary tests if needed, diagnosis,
treatment, and prognosis with and without treatment.
The medical model has proven highly successful and even indispensable in many contexts;
it is difficult to name a plausible alternative to medical diagnosis and treatment for a
depressed skull fracture.
The medical model embodies basic assumptions about medicine that drive research and
theorizing about physical or psychological difficulties on a basis of causation and
remediation.
It can be contrasted with other models that make different basic assumptions. Examples
include holistic model of the alternative health movement and the social model of the
disability rights movement, as well as to biopsychosocial and recovery models of mental
disorders.
50

The concepts of "disease" and "injury" are central to the medical model. In general,
"disease" or "injury" refer to some deviation from normal body functioning that has
undesirable consequences for the affected individual. An important aspect of the medical
model is that it regards signs (objective indicators such as an elevated temperature) and
symptoms (subjective feelings of distress expressed by the patient) as indicative of an
underlying physical abnormality (pathology) within the individual.
According to the medical model, medical treatment, wherever possible, should be directed
at the underlying pathology in an attempt to correct the abnormality and cure the disease.
In regard to many mental illnesses, for example, the assumption is that the cause of the
disorder lies in abnormalities within the affected individual’s brain (specially their brain
neurochemistry). That carries the implicit conclusion that disordered behaviors are not
learned but are spontaneously generated by the disordered brain.
According to the medical model, for treatment (such as drugs), to be effective, it should be
directed as closely as possible at correcting the theorized chemical imbalance in the
mentally ill person’s brain.
51

Proper diagnosis (that is, the categorization of illness signs and symptoms into meaning
disease groupings) is essential to the medical model.
Placing the patient's signs and symptoms into the correct diagnostic category can:
Provide the physician with clinically useful information about the course of the illness over
time (its prognosis); Point to (or at least suggest) a specific underlying cause or causes for
the disorder; and
Direct the physician to specific treatment or treatments for the condition
52

Adherence to the medical model has a number of other consequences for the patient and
society as a whole, both positive and negative:
In the medical model, the physician was traditionally seen as the expert, and patients were
expected to comply with the advice. The physician assumes an authoritarian position in
relation to the patient. Because of the specific expertise of the physician, according to the
medical model, it is necessary and to be expected. However, in recent years, the move
towards patient-centered care has resulted in greater patient involvement in many cases.
In the medical model, the physician may be viewed as the dominant health care
professional, who is the professional trained in diagnosis and treatment.
An ill patient should not be held responsible for the condition. The patient should not be
blamed or stigmatized for the illness.
Under the medical model, the disease condition of the patient is of major importance.
Social, psychological, and other "external" factors, which may influence patient behavior,
may be given less attention
53

• Absence of disease
• Defect is within the person
Positives
– Cause & effect relationship
– Infectious diseases (historical)
Negatives
– It is a negative model
– Inequality of power
– Inadequate for chronic illnesses
54

Advantages of biomedical healthcare:
· Effective at treating common/known health issues
· Can lead to advancements in the medical industry
· Can improve quality of life for chronic sufferers
Disadvantages of biomedical healthcare:
· Can be costly to the government
· Doesn’t address factors that lead to the development of health conditions
· Not all conditions are curable, however they can be managed via behavioral changes
· Medications and treatment can be costly for patients
55

The Social Model of Health
The social model of health offers a distinctive and holistic definition and understanding of
health that moves beyond the limitations and reductionism associated with the medical
model of health. Health, according to the social model, is not a state of being solely under
the domain of the medical profession, nor is health and disease only made intelligible by
findings of medical science. Rather, a perspective of health is realized that embraces all
aspects of human experience and places health fully in the dynamic interplay of social
structures and embodied human agency.
The social model logically implies that any attempts to improve the overall health of the
community need to address overall living and working conditions such as poverty,
employment opportunities, workplace health and safety, and cultural differences.
The social model gives equal priority to the prevention of illness along with the treatment
of illness, and aims to alleviate health inequalities. Such issues necessitate community
participation and state interventions—including social services and public policies (such
as workplace safety and The social model arose as a critique of the limitations and
misapplications of the biomedical model.
57

The Social Model of Health
• Health is a fundamental human right
• Requires actions of other social and economic sectors as well as health
• Existing gross inequalities in health status of people is politically, socially and
economically
unacceptable.
• Individuals have a right and a duty to participate
• Shift the health resources from hospitals to community based
• Increased participation of community health clinicians and workers
• Decreased reliance on specialized medical (specialists, nurses)
• Strong and communicated link between health and social and environmental
determinants of
health
58

The SOCIAL model of health acknowledges that health is a human right. The social model is
based on an interaction between the social, physical and economical environment and how
they each affect each other.
The social model involves individuals to participate in their health care. It involves
community resources and less reliance from specialists and the hospital setting. An
advantage of the social model of health is that it has a holistic approach; considering the
needs of the whole person. A disadvantage is that it is a very complex model requiring time,
attention and often a variety of health practitioners to reach all the required needs.
59

Australia’s health care system is very focused around the medical model of health.
The majority of funding is in alignment with treating the illness, injury or disease rather
than treating the individual or addressing the social determinants that underlie a
condition. We can see this when looking at health care expenditure.
Of the 70%of total Government health care expenditure in Australia 40% of that is directed
toward the hospitals which is a tertiary health care sector. Meaning, the individual is
already sick or injured. A following 38% of expenditure is toward Primary Health Care. Again,
this sector is primarily focused on diagnosis of illness, injury or disease. Especially with the
large cost of pharmaceuticals that is designed to treat the already ill.
The remainder of funding which is about 17% is on other recurrent medical services such as
administration, health products and health technology. Australia only contributes a
relatively small amount to health education and community based programs that address
social determinants of health. Therefore, it appears Australia has a ‘sick care system’ that
focuses primarily on the condition rather than the individual.
60

Difference between ‘inequity’ and ‘inequality ?
Inequity is the uneven distribution and access to resources, this is something that can be
altered and help to improve the population health.
Inequality refers to something that may be biological, such as race, gender etc and cannot
be changed. Medicare’s core function is to be accessible to everyone, regardless of who or
what you are.
66

The Australian Government of a federal level has a large impact on population health.
Firstly, depending on which preferred political party is in power will reflect on the amount of
expenditure to certain sectors of the health care system. For example, the Liberal party has
more conservative ideals and tend to support the private health systems, whereby the
Labour party has more liberal ideals and has shown to focus expenditure on the public
system. Once a preferred party is in power, funding is then allocated accordingly.
The Australian Government is responsible for funding Medicare.
This is Australia’s universal insurance scheme. It provides Australians access to the
minimum level of health care either paid in full through the public hospital or bulk billed by
practitioners or highly subsidized through medicare safety nets, which further reduces the
out of pocked expense for the consumer. Medicare allows individuals to access health care
and supports the ideal that health is a universal right, not only reserved for those who can
afford it. This affects population health because it maintains equality.
68

The Australian Government also largely contributes to population heath by providing and
funding the PBS (pharmaceutical benefits scheme).
This scheme gives individuals access to necessary medicine, as long as they are listed on
the schedule, at a highly subsided cost. The consumer will only pay a small maximum
amount, whilst the Federal government pays for the remainder of the cost to
pharmaceutical companies. Population health is affected because individuals have
affordable access to the necessary medications and therefore live longer or can treat
health conditions effectively.
Whilst the large contributions from the Australian Government are toward Medicare, PBS,
Hospitals (although, not as much as state), they also contribute to Primary Health Care
services such as community and public health. There is also a large element of funding
from Federal government that contributes to health research and technologies. All these
things contribute to population health because it encourages equality amongst the
population so all have access. The funding encourages better education amongst
populations so individuals can make healthier choices and in effect increase wellbeing. A
healthy individual makes for a healthy population.
69

Acute Care
Acute care is initial care when acuity needs are high. Secondary care is when a referral is
required eg seeing a specialist. Residential aged care provides a range of care options
and accommodation for the elderly who are unable to continue living independently in their
own home.
The World Health Organization defined Acute Care as being services such as preventive,
promotive, curative and rehabilitative that are targeted towards individuals and
populations through systems which rely heavily on rapid intervention and time-sensitivity.
The term Acute Care encompasses fields such as emergency and trauma medicine, critical
care and time sensitive patient stabilization.
70

Acute Care
Acute care is care in which the primary clinical purpose or treatment goal is to:
• manage labor (obstetric)
• cure illness or provide definitive treatment of injury
• perform surgery
• relieve symptoms of illness or injury (excluding palliative care)
• reduce severity of an illness or injury
• protect against exacerbation and/or complication of an illness and/or injury which
could
threaten life or normal function
• perform diagnostic or therapeutic procedures
71

Why does Australia need different types of health care provision?
So that the correct care is received at the correct time from the correct health care
provider. To limit the strain on any one system. Acute
care is for patients that are already ill and require immediate, short term attention. Primary
care enables the patient to be treated by a GP and investigate if a referral is required.
Residential aged care is to ensure the elderly are cared for in a safe environment.
Australia requires different types of health care as there is no one model that fits the needs
of all individuals. Individuals in residential aged care require more of a community based
approach when compared to those requiring acute care in hospitals. These health care
provision types can be interchangeable depending on circumstances, eg. if an individual
improves in acute care and leaves the hospital they can then go in to Secondary Care model
of health care.
Australia requires different types of health care to cater for the diversity of our
Sociodemographic, environmental and geographic characteristics. These characteristics
influence the types of health care provided and the ways in which Health care is
implemented. For example, a rural/remote town with a high suicide rate may require more
mental health services and facilities than a metropolitan area who's social demographic
may have a very low rate of suicide. Because it is made up of a web of
72

Sub-acute care ?
The pre-acute care delivery systems focus on health maintenance and prevention (primary
and secondary) of illness or unnecessary progression/deterioration in a client's health
condition. They usually require the least complex and least costly services.
Subacute care is defined as specialized multidisciplinary care in which the primary need
for care is optimization of the patient’s functioning and quality of life. A person’s functioning
may relate to their whole body or a body part, the whole person, or the whole person in a
social context, and to impairment of a body function or structure, activity limitation and/or
participation restriction.
Subacute care comprises the following care types:
Rehabilitation care
Palliative care
Geriatric evaluation and management (GEM) care
Psychogeriatric care
73

Non-admitted care
Non-admitted care encompasses services provided to patients who do not undergo a
formal admission process and do not occupy a hospital bed.
For example, services provided by hospitals:
in hospital outpatient clinics
in community based clinics
in patients’ homes
Non-admitted patient care includes emergency occasions of service for non-admitted
patients, outpatient care (including specialist clinics) and other non-admitted patient care
(such as the dispensing of medication, provision of diagnostic procedures, district nursing
and community health services)
74

Post-acute care?
The Post Acute Care (PAC) program aims to facilitate a safe and timely discharge from
hospital. The person returns home with an appropriate package of community-based
supports. They are also linked with ongoing long-term support in the community if required.
The most common services provided are
• community nursing
• personal care
• home help
• accompanied or unaccompanied shopping
The Post Acute Care (PAC) Program provides short-term services and support for those who
need extra help at home after a public hospital stay. The services and support offered are
designed for individual needs. This program aims to help people recover and return to a
normal lifestyle as soon as possible, and to avoid any unplanned return to hospital. Referral
to the program is arranged by your hospital when you are being discharged.
75

Mental health phase of care
There are five possible phases of care: assessment only, acute, functional gain, intensive
extended and consolidating gain. The classification also provides for ‘unknown phase’.
Mental health phase of care is defined as the “primary goal of care that is reflected in the
consumer’s mental health treatment plan at the time of collection, for the next stage in the
patient’s care”. It reflects the prospective assessment of the primary goal of care, rather
than a retrospective assessment.
Mental health phase of care is a clinical decision. It is independent of both the treatment
setting and the designation of the treating service, and does not reflect service unit type.
Mental health phase of care is assessed at the commencement of an episode of care and
reviewed where there is a significant change to the consumer’s symptoms and/or
psychosocial functioning requiring a clinical review and a change to the mental health
treatment plan.
77

Emergency care
Emergency Departments (EDs) are dedicated hospital-based facilities specifically designed
and staffed to provide 24 hour emergency care. The role of the ED is to diagnose and treat
acute and urgent illnesses and injuries. Patients are seen in order of medical urgency with
non-urgent patients being seen after more acute patients.
On arrival in the ED, patients are assessed by a clinician and given a triage score. A triage
score is a ranking from one to five (one being the most urgent and five being non-urgent)
used to prioritize or classify patients on the basis of illness or injury severity and need for
medical and nursing care. During the treatment phase of their time in ED patients are
assessed by a clinician, a diagnosis is made and treatment is given, if required.
79

Activity Based Funding
Activity Based Funding (ABF) is a way of funding hospitals whereby they get paid for the
number and mix of patients they treat. If a hospital treats more patients, it receives more
funding. Because some patients are more complicated to treat than others, ABF also takes
this in to account. ]
ABF funding should support timely access to quality health services, improve the value of
the public investment in hospital care and ensure a sustainable and efficient network of
public hospital services. ABF payments should be fair and equitable, including being based
on the same price for the same service across public, private or not for profit providers of
public hospital services.
The National Health Reform Agreement, signed by the Commonwealth Government and all
states and territories in August 2011, commits to funding public hospitals using ABF where
practicable.
80

Data Collection
In order for Activity Based Funding to be effective, each patient episode needs to be
counted. This includes inpatient admissions, emergency department presentations and
outpatient appointments as well as a range of mental health and rehabilitation services.
The Data Acquisition team at IHPA works with states and territories to develop appropriate
data specifications, and to acquire, validate and maintain data in the IHPA information
technology environment.
ABF six-monthly activity data submission
The purpose of the ABF six-monthly activity data submission is to collect information about
various kinds of patient services provided by Australian hospitals. To input into the in the
Activity Based Funding process. Currently, IHPA collects activity data for seven data
streams, including:
• Admitted acute
• Non-admitted services (aggregated data)
• Non-admitted services (patient-level data)
• Emergency (aggregated data)
• Emergency (patient-level data)
• Admitted subacute & non-acute
• Teaching, training and research
81

Pricing Framework
The Pricing Framework for Australian Public Hospital Services is updated annually. It
outlines the principles, scope and methodology adopted by IHPA to determine the National
Efficient Price (NEP) and the National Efficient Cost (NEC) Determinations for Australian
public hospital services for the specific financial year.
IHPA consults with all stakeholders including the general public prior to finalising the
Pricing Framework for each year. The Pricing Framework emphasizes IHPA’s commitment to
transparency and accountability in how IHPA undertakes its work.
83

Costing
Hospital costing focuses on the cost and mix of resources used to deliver patient care.
Costing plays a vital role in Activity Based Funding (ABF). Costing informs the development
of classification systems and provides valuable information for pricing purposes. Hospital
patient costing is essential for understanding the total costs involved in treating a patient
including the services or products used.
A key output of IHPA is the collection, validation, analysis and reporting of the National
Hospital Cost Data Collection (NHCDC). This process is performed in conjunction with states
and territories and private hospitals, who submit cost data to the NHCDC on an annual basis,
known as a round.
84

How Much does Australia spent
How much Australia spent on Health
85

Primary (Community) Care
The Australian Institute of Health and Welfare (AIHW) outlines Primary Health Care as being
the front-line health services that individuals have 'first contact" with, these services are
provided to the community in the form of GP's, dentists, optometrists etc.
Residential Aged Care
Community based health care designed to encourage the elderly to be cared for in their
own homes. Services include nursing care, domestic assistance, home maintenance and
provision of meals, respite care etc.
Medicare Safety Net
Financial assistance for high costs for out of hospital medical services that attract a
Medicare benefit. If you see a doctor often, or have tests regularly, your medical costs could
be high. Visiting a doctor or having tests may cost you less once you reach a Medicare
Safety Net threshold.
Once you reach the relevant threshold, the Medicare Safety Net may provide a higher
Medicare benefit for all eligible services for the rest of the calendar year. This may mean
that visits to your doctor or having tests could cost you less. For example, once you reach
the relevant threshold, you still pay the same amount upfront to your doctor, however you
may receive a higher Medicare benefit, making your out of pocket expenses much less
86

The Medicare Safety Net covers a range of out of hospital doctor visits and tests covered by
the Medicare Benefits Schedule.
These include:
Healthcare professional consultations, blood tests, CT scans, pap smears, psychiatry,
radiotherapy, tissue biopsies, ultrasounds ,x-rays
The Pharmaceutical Benefits Scheme (PBS) provides affordable and reliable access to
necessary medicines for Australians. The PBS provides medicines at a lower cost to
Australian residents. The PBS also provides for visitors from other countries where there is
a Reciprocal Healthcare Agreement with Australia.
The Repatriation Pharmaceutical Benefits Scheme (RPBS) provides access to
pharmaceuticals and wound dressings, including items available under the PBS, to the
following people:
• eligible veterans
• war widows and widowers, and
• any dependents
87

The Medicare Levy Surcharge (MLS) is levied on payers of Australian tax 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 surcharge covers you and your dependents. Your dependents include your spouse, any
of your children who are under 21 years of age, or any of your student children who are
under 25 years of age. For more information about who is considered a dependant for MLS
purposes, you can refer to the ATO's Medicare Levy Surcharge page
The surcharge is calculated at the rate of 1% to 1.5% of your income for Medicare Levy
Surcharge purposes. It is in addition to the Medicare Levy of 2%, which is paid by most
Australian taxpayers. To work out your annual income for MLS and Rebate purposes, you can
refer to the Australian Taxation Office's Private Health Insurance Rebate Calculator or
contact the ATO directly.
88

You must meet one of the following requirements to avoid the Medicare Levy Surcharge:
Your taxable income for MLS purposes is below the income threshold ,
Your taxable income for MLS purposes is over the income threshold and you have hospital
insurance (see below) for you and all of your dependents with a registered health fund, with
a total yearly front-end deductible or excess no greater than $500 for singles or $1,000 for
families/couples,
You are normally exempt from the Medicare levy because you are a prescribed person and
you do not have any dependents. Your income level is not considered in this case,
You are a high-income earner who had already purchased a hospital insurance product
with a total yearly front-end deductible or excess greater than $500 for singles or $1,000 for
families/couples, on or before 24 May 2000. In this case you will continue to be exempt from
the surcharge as long as you maintain continuous membership under the same hospital
treatment policy.
To be exempt from the surcharge, your hospital cover must be held with a registered health
fund and cover some or all of the fees and charges for a stay in hospital, with a maximum
payable excess per year that is no greater than $500 for singles or $1,000 for
89

The World Health Report says the main failings of many health systems are:
• Many health ministries focus on the public sector and often disregard the frequently
much
larger private sector health care.
• In many countries, some if not most physicians work simultaneously for the public
sector and
in private practice. This means the public sector ends up subsidizing unofficial private
practice.
• Many governments fail to prevent a "black market" in health, where widespread
corruption,
bribery, "moonlighting" and other illegal practices flourish. The black markets, which
themselves are caused by malfunctioning health systems, and low income of health
workers,
further undermine those systems.
• Many health ministries fail to enforce regulations that they themselves have created or
are
supposed to implement in the public interest.
91

What is the Health System ?
• Public health (in hospitals and in the community)
• Preventative services
• Primary health care services
• Emergency health care services
• Hospital based treatment
• Community based treatment
• Rehabilitation
• Palliative care
92

Hospital Funding; A state of change
• 2011 – National Health Reform Act
– Established Independent Hospital Pricing
Authority (IHPA)
• National Activity Based Funding (ABF) for public hospitals
• Calculates and delivers National Efficient Price (NEP
93

Public hospital
– Funding by
• State/territory governments and
• Australian Commonwealth Government
– Managed by
• state/territory governments or
• Local Hospital Networks (LHNs)
• Public community services
– Funding by
• Local government
• State/territory governments and
• Australian Commonwealth Government
94

Activity Based Funding
• How a hospital is paid by the Government (National Health Reform Agreement)
– Classification = groups patients into clinical
categories
– Counting = Episodes of care
– Costing = sample of patient episodes care costed to develop the price
– Price = Model of price per patient (includes index for remote areas & children)
95

Local Hospital Network
• LHNs receive National Health Reform funding (public)
– All admitted and non admitted
– All emergency department services
– Outpatient, mental health, sub-acute and other sources
• LHNs also receive funding from other sources
– Commonwealth, states and territories, and third parties
– functions and services outside the scope of the Agreement
• dental services,
• primary care,
• home and community care,
• residential aged care and
• pharmaceuticals.
96

State/Territories
• A total of $2.0 billion will be provided to the
States in 2013-14 under the following health categories:
– National Partnerships supporting National Health
Reform arrangements;
– health infrastructure
– health services
– Indigenous health
– mental health
– preventive health
– other health payments (Adult public dental; breast screen expansion)
97

Community: Aged Care/Older persons
• Home and Community Care (HACC)
– Basic community help to stay at home
• Centre-based, home-based, social or transport
• Funding by Commonwealth and state government
– Provided by range of service providers
• Local public, Charitable, Non Government organization (NGO)
• Often co-payment for services
– Eligibility:
• Over 65 years (50 years if ATSI)
• Living at home
98

Community services: Disability
• In the middle of changes
• Currently services
– Most services and packages funded by state /territory governments
• Mixture of government managed or private management
– Limited services in some states (HACC)
– Trial of National Disability Insurance Scheme (NDIS) Packages
• Future:
– Commonwealth funding through NDIS
• NGO & private management
• Self management
99

Veterans- Service men & women
• Department of Veteran Affairs
– Funded by Commonwealth government
– Health services through
• Private hospitals (day and overnight)
• Public hospitals
• General practices
• Private practices (allied health)
100

Rural/Regional Health Issues Australia
Obesity
Lifestyle – alcohol, drugs, diet
Less physically active
Disability issues
Rate of Cardio-vascular, cancer
Trauma/injury
Lower income – socio-economic factors
101

Public Health Care System
• Medicare
• Pharmaceutical Benefit Scheme
• Funding Medicare and safety Nets
• Public Hospitals
• Community and primary health care
“Medicare is a compulsory, universal health insurance scheme based on the principle of
equal access for all Australians”
The 35-year-old universal health care system is a hybrid of public and private plans. Every
permanent resident or citizen in Australia -- that's everyone, regardless of age -- is covered
by the government's Medicare program and is entitled to highly-subsidized, or even free,
treatment by doctors in their offices, and fully-covered treatment and care in public
hospitals.
The system isn't perfect; what health care system is? Yes, occasionally there are published
reports of people waiting long periods for admittance to public hospitals, or put on gurneys
for hours in an emergency ward of an overcrowded public hospital.
102

What does Medicare cover?
• Free or subsidized treatment by health professionals
• Free treatment and accommodation as a public patient in a public hospital
• 75% of Medicare Schedule free for services and procedures as a private patient in a
public
hospital
Medicare Benefits Schedule
• Lists services subsidized by the Australian Government under Medicare
Pharmaceutical Benefits Scheme
• Subsidizes the cost of medications
103

Funding Medicare
Progressive taxation (Medicare Levy)
• 2% of taxable income
Medicare Levy Surcharge
• For people who earn above a certain amount but do not have private hospital health
insurance
purposes, you can refer to the ATO's Medicare Levy Surcharge page.
104

purposes, you can refer to the ATO's Medicare Levy Surcharge page.
refer to the Australian Taxation Office's Private Health Insurance Rebate Calculator or
contact the ATO directly.
105

Singles
Families
≤$90,000
≤$180,000
$90,001-
105,000
$180,001-
210,000
$105,001-
140,000
$210,001-
280,000
≥$140,001
≥$280,001
Rebate
Base Tier Tier 1 Tier 2 Tier 3
< age 65 25.934% 17.289% 8.644% 0%
Age 65-69 30.256% 21.612% 12.966% 0%
Age 70+ 34.579% 25.934% 17.289% 0%
All ages 0.0% 1.0% 1.25% 1.5%
The Medicare Levy Surcharge (MLS) is levied on payers of Australian tax 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.
106

Currently, you have to pay the surcharge if you are:
A single person with an annual taxable income for MLS purposes greater than $88,000 in
the 2013-14 financial year or $90,000 in the 2014-15, 2015-16 or 2016-17 financial years
A family or couple with a combined taxable income for MLS purposes greater than
$176,000 in the 2013-14 financial year or $180,000 in the 2014-15, 2015-16 or 2016-17
financial years. The family income threshold increases by $1,500 for each dependent
child after the first
And do not have an approved hospital cover with a registered health fund.
You must also pay the surcharge if you are a prescribed person with a taxable income over
the threshold, and have any dependents who are not prescribed persons and who are not
covered by an approved health cover policy as described above.
This means if you are a family, have a combined income of more than $180,000 in 2016-17,
and don't have hospital cover for you, your partner, and your children, you will pay the MLS.
107

You must meet one of the following requirements to avoid the Medicare Levy Surcharge:
Your taxable income for MLS purposes is below the income threshold
Your taxable income for MLS purposes is over the income threshold and you have hospital
insurance for you and all of your dependents with a registered health fund, with a total
yearly front-end deductible or excess no greater than $500 for singles or $1,000 for
families/couples
You are normally exempt from the Medicare levy because you are a prescribed person and
you do not have any dependents. Your income level is not considered in this case
You are a high-income earner who had already purchased a hospital insurance product
with a total yearly front-end deductible or excess greater than $500 for singles or $1,000
for families/couples, on or before 24 May 2000. In this case you will continue to be exempt
from the surcharge as long as you maintain continuous membership under the same
hospital treatment policy.
108

The Australian Government Private Health Insurance Rebate
If it’s the price of the premiums that’s making you a tad hesitant to invest in private health
insurance, you’ll be happy to hear that the government may be able to give you a helping
hand. The private health insurance rebate is income-tested and it applies to hospital,
extras, and ambulance
policies.
Most Australians are eligible for the rebate, based on the following three conditions:
You must be eligible for Medicare
You must have complying health insurance product (CHIP) that provides hospital cover,
extras cover, or both
You must have an income for Medicare levy surcharge purposes below Tier 3, as shown in
the table below
109

You can claim your private health insurance in one of two ways:
As a premium reduction through your health fund, or as a tax offset when you lodge your
annual tax return. If you want to use the former method, contact your insurer to discuss the
matter, and if you prefer to do the latter, your insurer can provide you with the right
paperwork for your tax return. More information can be found at the Australian Taxation
Office website.
Singles
Families
≤$90,000
≤$180,000
$90,001-
105,000
$180,001-
210,000
$105,001-
140,000
$210,001-
280,000
≥$140,001
≥$280,001
Rebate
Base Tier Tier 1 Tier 2 Tier 3
< age 65 25.934% 17.289% 8.644% 0%
Age 65-69 30.256% 21.612% 12.966% 0%
Age 70+ 34.579% 25.934% 17.289% 0%
All ages 0.0% 1.0% 1.25% 1.5%
110

Claiming the Rebate
If you are eligible for the rebate, there are two ways you can claim:
Through a reduced premium
Through your tax return with ATO.
If you choose to receive your rebate through your insurer, you will be asked to nominate the
tier you expect to fall into in order to avoid a tax liability. You can nominate your tier by
contacting your insurer or by filling out the Medicare rebate claim form.
111

Public hospitals are the single largest component of the health care system, with about 30
per cent of total health care expenditure directed to Australia’s 753 public hospitals. The
cost of public hospital care for the Commonwealth and States exceeds $40 billion a year
and is growing well above the inflation rate.
Public health care in Australia is also underpinned by Medicare (refer Attachment 9.3.1)
with Commonwealth expenditure on the Medicare Benefits Schedule at around $19 billion
in 2013-14. In 2013-14, an estimated 353 million medical and associated services will be
funded through Medicare, approximately 15 services per year for each person in Australia
(Australian Government, 2013).
112

Public Hospital Funding Australia
113

Private Hospital Funding Australia
114

Projected commonwealth health spending
115

Australian Health Care System (part 1)

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