Health Care In Australia Research Articles

Why it is time to review the role of private health insurance in Australia.

The role of private health insurance (PHI) within the Australian health-care system is urgently in need of comprehensive review. Two decades of universal health cover under Medicare have meant a change in the function of PHI, which is not reflected in policies to support PHI nor in the public debate around PHI. There is increasing evidence that the series of policy adjustments introduced to support PHI have served to undermine rather than promote the efficiency and equity of Australia's health care system. While support for PHI has been justified to 'take pressure off the public hospital system' and to facilitate choice of insurer and private provider', and the incentives have indeed increased PHI membership, this increase comes at a high cost relative to benefits achieved. The redirection of hospital admissions from the public to private hospitals is small, with a value considerably less than 25% of the cost of the policies. The Commonwealth share of the health care budget has increased and the relative contribution from private health insurance is lower in 2001-02, despite an increase in PHI membership to nearly 45% of the population, compared with the 30% coverage in 1998. The policies have largely directed subsidies to those on higher incomes who are more likely to take out PHI, and to private insurance companies, private hospitals and medical specialists. Ad hoc policy adjustments need to be replaced by a coherent policy towards PHI, one that recognises the fundamental change in its role and significance in the context of universal health coverage.

Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia

A common feature of health reforms in western nations has been the transformation or (re)construction of health and health care as both a commodity and product. In the hospital sector, this transformation has become increasingly evident in the growth of for-profit involvement in service delivery. Investor-owned hospitals are now prominent providers of hospital care in Australia. This paper examines the changing nature of health care space through the changing portrayal and meaning of hospitals as represented by and encoded in the built environment. Public hospitals once occupied ‘pride of place’. In contrast, up to the early 1980s, the private sector was seen as a cottage industry. However, increased levels of state subsidisation and government incentives and pro-market policies, combined with market-based opportunities for profit generation, have seen the emergence of large private hospital chains with a new corporate image to hospital care and the blurring of ‘public’ and ‘private’. A significant factor in the reconstruction of hospital space in Australia has been the co-location of private and public hospitals. Co-location is a popular strategy proffered by State governments and one that has been quickly acted on by corporate providers. Using Mayne Health Ltd, Australia's largest for-profit hospital chain, and four specific case studies, this paper explores four variants of co-location. Each of these examples represent a different public and private hospital space. The growth of for-profit hospital chains signifies a new phase in the delivery of health care in Australia but also importantly the creation of a new hybridised ‘health care’ space. This space is neither private nor public but a reflection of the economic, political and social processes underlying this transformation.

Pediatric ophthalmology in Australia

A ustralia is a modern and prosperous Western country of some 20 million people. Although Australian culture has traditionally been British, immigration during the last 50 years has changed the cultural and social milieu, and Australia is now a successful multicultural European and Asian society. The main cities are Sydney (population of 4 million) and Melbourne (population of 3 million), and three other cities each have a population of more than 1 million. To gain entry into one of Australia’s 10 medical schools, students must achieve extremely high marks in the final year of high school. The medical course lasts 6 years plus 1 year of compulsory internship, but some programs last 5 years with 2 years of internship. An increasing number of medical schools now accept graduate students who perform well on a nationally administered examination and who complete a 5-year course. After completing medical school and a compulsory year of internship, aspiring ophthalmologists typically spend 2 or 3 more years in hospitals on medical and surgical rotations before competing for admission to the 5-year ophthalmology training program. This process is supervised by the Royal Australian and New Zealand College of Ophthalmologists. Most primary eye care is provided by optometrists and family doctors who refer patients to an ophthalmologist if appropriate. General ophthalmologists are widely distributed and probably perform the majority of pediatric ophthalmology and strabismus care for their communities. Ophthalmologists with recognized training in pediatrics or strabismus are less accessible and in general are associated with the larger institutions in sizeable cities. Most optometrists treat children, and a small number practice as dedicated pediatric optometrists. Two orthoptic schools produce graduates who usually work in an ophthalmologist’s office in much the same capacity as an ophthalmic technician does in the United States (rather than in classical orthoptics). Complex financial and legislative arrangements involving federal and state governments exist for funding and administering health care in Australia. Medicine is practiced both in the private fee-paying sector and in government funded “free” facilities, and there is much overlap between the private and government sectors. Teaching hospitals are mostly in the state government sector, and it is here that undergraduate and postgraduate medical training takes place and professional prestige resides. The government sector is largely staffed at the senior level by part-time attending consultants who spend most of their time in private practice. Most of the population undergoes surgery performed at no cost in state government facilities, and all are eligible to use these facilities. Despite the universal availability of these free services, approximately 40% of the population has private insurance that pays for private hospital care. The federal government subsidizes 30% of such insurance to make it more affordable. Some 50% of consultation and surgical fees in private practice are subsidized by the federal Medicare scheme. Pharmaceuticals are subsidized by a different national federal government scheme with a small “top up” (partial recompense for out-of-pocket costs) available from private insurers. Doctors have the right to charge whatever fees they like; however, there is considerable pressure to adhere to recommended fees. If doctors charge only recommended fees, then insured patients have no copayments. However, remuneration for strabismus consultations and surgery is poor when compared with remuneration for, say, cataract treatment. Pediatric ophthalmology and strabismus developed in Australia as separate clinical and intellectual streams modeled more on the European rather than the American approach. Strabismus has developed in association with eye hospitals (Melbourne and Sydney each have a freestanding one) and pediatric ophthalmology in association with children’s hospitals. Each large city has an ophthalmology department as part of the children’s hospital. Before the 1970s, these departments were staffed by general (adult) ophthalmologists with an interest in pediatric ophthalmology. Prominent historical figures included Sir Norman Gregg, who in the 1960’s recognized the ophthalmic and nonophthalmic features of rubella embryopathy. He shared the Encyclopedia Britannica award for medicine with Dame Kate Campbell of Melbourne, a pediatrician who in 1951 showed that advanced retinopathy of prematurity (ROP) was linked to oxygen toxicity. In 1969, Frank Bilson headed the clinic at the Royal Children’s Hospital in Melbourne where he introduced the indirect ophthalmoscope and the operating microscope to Australian pediatric ophthalmology. Subsequently, he was appointed Professor in Sydney in the late From the Ocular Motility Clinic,a Royal Victorian Eye and Ear Hospital, East Melbourne, and the Department of Ophthalmology,b University of Melbourne, Victoria, Australia. Submitted April 29, 2003. Revision accepted May 21, 2003. Reprint requests: Lionel Kowal, FRANZCO, Private Eye Clinic, 19 Simpson St, E Melbourne, Victoria, Australia, 3002. Copyright © 2003 by the American Association for Pediatric Ophthalmology and Strabismus. 1091-8531/2003/$35.00 0 doi:10.1016/S1091-8531(03)00184-8

Managing health care in Australia: Steps on the health care roundabout?

This paper explores some of the lessons of the coordinated care trials in Australia in the context of managed care in America and asks how do we best manage our finite health care dollars for the most equitable and effective outcomes for whole populations? The COAG trial in Australia tested a more structured process for managing the care of patients with chronic illness and postulated that currently fragmented health system funding could be pooled around individual patient need, and managed for improved economic outcomes and patient wellbeing. There is little doubt, following this initiative and much work in other countries, that as health care costs rise, for a range of reasons, improvements are needed in the management of our resources if we are to control rising health care costs. We also know that chronic illness, much of which is preventable and avoidable, is the major component in the rising health care cost equation and a factor likely to consume around 75% of our health dollars in the future. Much chronic illness can be prevented through social and population health strategies and we know that even if chronic illness can?t be prevented, it can be managed better through community-based chronic illness management programs. These programs rely on information, education, patient lifestyle and behaviour change, and on patients developing improved self-management skills. But, what is the best way to manage population health in Australia and ensure equity and fairness in the health care market as we evolve new approaches, especially to the management of chronic illness?

Safety and quality in healthcare: what can England and Australia learn from each other?

Australia and England have similar healthcare systems. They are affordable and accessible to all; both are blessed with health professionals of great skill. Anybody who falls ill in either country can expect a high standard of care. And yet, all is not well. The care we give our patients is not as safe as it should be and the community is becoming well aware of this. Our public healthcare systems never seem to have enough resources; our public hospitals show varying degrees of dilapidation. Access to care, while universal, is too often delayed. The medical workforce is understaffed, maldistributed (or both) and the shortage of nurses is of great concern. In both professions, morale is fragile. What, then, can be done to improve the safety and quality of healthcare in Australia and England?

A New Model of Leadership: Getting Results in Australia

This paper provides an outline of the delivery of mental health care in Australia and the development of a National Mental Health Strategy, which set the agenda for mental health reform including a national transition to community-based care through an integrated health system. A key achievement in this reform process was the establishment of an independent national mental health body representative of the sector and community views, and which has direct access at national decision-making level. An overview of the development, structure, and significant activities of the Mental Health Council of Australia is provided, such as processes for influencing national policy, management of national projects, and representative activities. A core ingredient to the success of the Council has been through the establishment of committed partnerships between all key stakeholders in promoting the mental health of all Australians.

Primary Care-Led Mental Health Service Reform: An Outline of the Better Outcomes in Mental Health Care Initiative

Objective: To describe the key features of the ‘Better Outcomes in Mental Health Care’ initiative (2001-2005) and to detail some of the conceptual, community, professional and epidemiological forces that shaped its content. Conclusions: The ‘Better Outcomes in Mental Health Care’ initiative represents a major development in mental health care in Australia. It recognises the central role of primary care, promotes integrated medical and psychological care, rewards treatments that occur over an episode of illness, promotes active purchasing of non-pharmacological interventions earlier in the course of illness, and attempts to better link general practitioners, non-medical mental health specialists and psychiatrists to meet population-based mental health needs. Central to its development has been a commitment by general practitioners to develop progressively better mental health skills and measure both individual consumer and system-related outcomes.

Psychiatry and the need for mental health care in Australia: findings from the National Survey of Mental Health and Wellbeing.

This paper describes the pattern of consultations reported with psychiatrists and primary mental health care providers in the Australian adult population. It explores whether inequalities found in utilization of psychiatric services according to area are different in degree from inequalities in utilization of medical and surgical specialists,and describes the meeting of perceived needs for mental health care within those seen by psychiatrists. The National Survey of Mental Health and Wellbeing (NSMHW) was a community survey employing clustered probability sampling, with a computerized field questionnaire which included sections of the composite international diagnostic interview (CIDI), as well as self-reported service utilization and perceived needs for care. By survey estimates, 1.8% of the Australian population consulted a psychiatrist in the last year. Among people with an ICD 10-diagnosed mental disorder, 7.3% consulted a psychiatrist. Only about one in five people seen by a psychiatrist report the psychiatrist as the only mental health care provider. Disadvantaged areas of the cities and remote areas, when compared with the least deprived areas of the cities, showed lower rates of utilization. This effect is stronger in psychiatry than in other specialties. Patients seeing psychiatrists seem to be a more satisfied group than those seeing only other providers; nonetheless, some needs are not well met, and the role of the psychiatrist cannot be isolated as the cause of this satisfaction. Most care delivered by psychiatrists is de facto shared care. Psychiatrists as clinical professionals need to be continually mindful of the need to communicate with others providing care. Psychiatric services in Australia are not delivered in an equitable manner,and the inequalities are greater for psychiatric services than for other medical specialties.

Equity in health care from a communitarian standpoint.

Equity in health and health care is an important issue. It has been proposed that the pursuit of equity in health care is being hampered by the dominance of individualism in health care practices. This paper explores the way in which communitarian ideals and practices might lend themselves to the pursuit of equity. Communitarians acknowledge, respect and foster the bonds that unite and identify communities. The paper argues that, to achieve equity in health care, these bonds need to be recognised and harnessed rather than ignored. The notion of individual autonomy in the context of the community is examined. Alternative concepts of autonomy--social autonomy and community autonomy--are seen to be more respectful and nurturing of both the individual and the community. Moreover, these concepts appear desirable for the pursuit of health care equity goals. The paper concludes with some thoughts about how equity in Australia's health care system can reasonably progress within a communitarian vision. Disadvantaged communities are discussed throughout, in particular, Australian Aboriginal communities.

The third dimension: cultural awareness for non-English speaking background health professionals.

The complexity of the relationships between Aboriginal and Torres Strait Islander peoples and non-English speaking background (NESB) communities is difficult to capture in cultural awareness programs that are based on binary (Indigenous/non-Indigenous) models. This is illustrated by an examination of three major elements of cross-cultural programs, the historical/socio-political context of Indigenous people's positioning in Australia, cultural differences and racism. It is acknowledged that these are only a few ideas that may be useful in thinking about NESB-Indigenous relations in health care in Australia.

Aboriginal society and health: critical issues demand what from sociologists?

The author explores the position of Aboriginal people prior to and subsequent to the 1967 referendum. He notes the impact of organised medicine's resistance to nationalised health care in Australia and the impact this had on Indigenous people. He provides a social and historical analysis of the Constitution and other legal and quasi-legal regulations as factors in the provision or lack of health care for Aboriginal people. He raises questions about the impact of specific health professional groups and their professional structures on the kinds of health are provided. The ebb and flow of power between doctors, nurses and Aboriginal health workers illustrates the way Indigenous health and health beliefs and practices are constructed and understood. (non-author abstract)

Lesbian and Gay Parents: Their Experiences of Children's Health Care in Australia

This study investigates the experiences of lesbian and gay parents seeking health care for their children within the Australian medical system. Previously unavailable demographic data was collected on lesbian and gay families, and qualitative information was sought from parents about positive or problematic health care experiences related to sexual orientation and family constellation. Ninety-two lesbian or gay parents responded to a national postal and Web-based survey. Eighty-nine percent of respondents reported a high level of satisfaction with the health care received by their children. Despite overall satisfaction, however, 49 percent of parents identified fear of disclosure of sexual orientation, and 27 percent reported negative or problematic experiences with their children's health care related to sexual orientation or family constellation. This study indicates that fear of discrimination and homophobic attitudes towards lesbian and gay families remain a factor within the Australian health care system.

Half a century of healthcare in Australia.

One hundred years of European nationhood is no more than a blink in the long life of Indigenous Australia. Yet, even within half that short interval, there is plenty for reflection, pleasure and regret.

Recommendations for culturally sensitive nursing care.

Australia's health care clientele reflects the diversity of this multicultural society. Patients and health care professionals have expectations of health care which may not be met to their satisfaction or needs. The perceived inadequacies of and increased demands on the Australian health care system are reflected in the literature and by active political lobbying. Thus, there is an urgent need to investigate how the health care system can be improved and how recommendations from research can be put into place. One mechanism that may provide some of the changes required is to use the skills, experience and qualifications of culturally and linguistically diverse nurses. This paper, which is based on a descriptive ethnographic research project, will provide insight for utilizing this valuable and available resource, and how nursing education curricula can be modified to adequately incorporate transcultural nursing practices, so that nurses can meet the challenges of caring for Australia's multicultural population.

First Do No Harm: GST and Health Care Services

This article considers the impact of A New Tax System (Goods and Services) Tax Act 1999 (Cth) on health services, health practitioners and their patients. It discusses the basis for the concessionary treatment of healthcare in Australia and other jurisdictions. The difficulty of determining the tax status of a service not covered by Medicare is highlighted; so too the conflict between the medical and allied health provisions.

Trends in the global healthcare environment: The developed countries

The purpose of this paper is to examine trends in the global healthcare environment, especially the developed countries. The developed countries are examined in detail as they have influenced the changes that have occurred in the delivery of healthcare in Australia. The countries discussed include the United States, Canada, Europe and Australia. The most concerning trend is the increase in healthcare spending. There has been a marked rise in the cost of hospital and other institutionalised care and health insurance. The ageing population and the increased use of sophisticated and expensive equipment have also increased costs. Other issues identified are, the declining number of hospitals beds, the shift from care in the hospitals or institutions to care in the home or community, the increase in continuum of care programs, the establishment of health care networks, focus on service quality, the lack of security about gaining health insurance and the focus on treatment rather than prevention.

Future of medical training in Australia.

Clinical training for medical students and postgraduates needs redirection in the face of changes in Australia's healthcare system.

The AHA's ideas on health policies for Australia.

In late 1997 the Australian Healthcare Association (AHA) began a process ofreviewing and updating its ideas on health care in Australia. One importantactivity comprised a strategic planning workshop in February 1998, which wasattended by members of the National Council. Experts from government andother health associations also participated, and their support was greatlyappreciated.Preliminary ideas arising from the deliberations are summarised in a discussionpaper which has been widely distributed for comment (AHA 1998). Thefollowing is a condensed version, although the scope is hardly affected.

Cost and quality: The challenge for physiotherapists in a casemix funded environment

Inpatient health care in Australia is currently undergoing major change, moving from historically derived budgets to systems requiring much greater accountability to revenue providers. It is crucial for clinical staff, as well as administrators, to understand these changes as clinicians will be required to provide accurate and appropriate information regarding costs incurred and health benefits achieved to justify the services they provide. This article reviews three major initiatives in health care; casemix classification, outcomes evaluation and benchmarking, and analyses the role these processes play in achieving better and more efficient health care. The impact of these processes and the opportunities they provide for the physiotherapy profession are discussed.

Swapping Health Care Systems

By international comparisons, Australians enjoy good health and have health services with access and equity at reasonable cost.¹During the past 2 decades, longevity has increased significantly, deaths from cardiovascular disease have declined, and the human immunodeficiency virus (HIV) epidemic has been relatively contained in this country. Some proponents believe the Australian health system combines the best features of the systems in the United States and the United Kingdom. Critics harp that it has the worst of both systems. Unfortunately, health has become a political issue, not just an issue of well-being, and as a result there are constant changes and attempts by all levels of government to limit costs. See also p 1944. Australia's health care system is pluralistic, involving both the commonwealth (federal) and state governments, private and public medicine and hospitals, and medical insurance companies. The basic underlying principle is universal health coverage for the entire