Australia's health system - St Leonard's College

Australia's health system - St Leonard's College

AUSTRALIAS HEALTH SYSTEM CHAPTER 10 KEY KNOWLEDGE On completion of this unit the student should be able to describe how to access Australias health system, explain how it promotes health and wellbeing in their local community, and analyse a range of issues associated with the use of new and emerging health procedures and technologies. To achieve this outcome the student will draw on key knowledge and key skills outlined in Area of Study 2. Key knowledge key aspects of Australias health system such as Medicare, the Pharmaceutical Benefits Scheme and private health insurance the range of services available in the local community to support physical, social, emotional, mental and spiritual dimensions of health and wellbeing

factors affecting access to health services and information rights and responsibilities associated with accessing health services, including privacy and confidentiality relating to the storage, use and sharing of personal health information and data opportunities and challenges presented by digital media in the provision of health and wellbeing information, for example websites, online practitioners and digital health apps issues such as ethics, equity of access, privacy, invasiveness and freedom of choice relating to the use of new and emerging health procedures and technologies options for consumer complaint and redress within the health system. WHAT DO YOU ALREADY KNOW ABOUT THE AUSTRALIAN HEALTH CARE SYSTEM? It is important to know which level of government provides which responsibilities in regards

to the health care system ?v=swSwRd86Xb0 MEDICARE AND THE PHARMACEUTICAL BENEFITS SCHEME (PBS) Australias health system is a complex network of public and private services and providers. The health system is the responsibility of all levels of Government federal, state and local as well as the private sector. The three key aspects of Australias health care system which aim to increase access to healthcare for all Australians are; 1. Medicare 2. The PBS 3. Private health insurance

On an average day in Australia, there are: 616 000 subsidised prescriptions dispensed 381 000 visits to a general practitioner (GP) 246 000 pathology tests 79 000 visits to a specialist 27 000 hospitalisations 59 per cent in the public sector 27 000 allied health services provided 24 000 contacts made at community mental healthcare services 20 000 presentations to public hospital emergency departments 30 per cent end up being admitted to hospital 1900 people admitted for elective surgery in public hospitals 9 per cent for cataract surgery. Due to our ageing population and an increase in the number of people suffering from chronic disease, our healthcare system is getting busier each

year. AUSTRALIA'S HEALTH CARE SYSTEM WORKS TO PROMOTE HEALTH AND WELLBEING IN RELATION TO THE FOLLOWING 4 AREAS S - Sustainability A - Access F - Funding E Equity FUNDING THE HEALTH CARE SYSTEM Funding the health system is essential to provide high-quality levels of care for all Australian, not just those who can afford it. Funding

promotes health by: Providing infrastructure such as hospitals and medical technology such as scanning machines Provide ongoing training for health professionals so the quality of care remains high Subsidising health services through Medicare Subsidising essential medicines through the PBS Subsidising the cost of private health insurance for eligible policy holders Providing support through the NDIS Paying salaries of support and administrative staff Allowing the implementation of public health programs such as Quit FUNDING THE HEALTH CARE SYSTEM

The health expenditure in Australia was estimated to be 155 billion over 2013-14 Almost 68% of this funding was by governments Health expenditure on Public Health activities has been declining since 07-08, in 2013-14 spending was 1.4 per cent, or 2.2 billion of the total which included both public health and health promotion services.

Of the 155 billion spent on healthcare in 2013-14, most was spent on hospitals, followed by primary healthcare (GPs, nurses, allied health professionals, midwives, FEDERAL/COMMONWEALTH GOVERNMENT Responsible for healthcare that impacts on all Australians including the following: Management and funding of Medicare Pharmaceutical Benefits Scheme (PBS) Allocating funds to state and territory governments for the running of public hospitals Providing financial incentives for those taking out private health insurance

Funds the bulk of the nations health services e.g. Hospitals Develops and funds health policies e.g. NHPA, National Mental Health Strategy, Immunization etc. Quarantine services protecting Australian borders Provides health funds for aged and war veterans Monitor food safety and regulations State/ Territory Governments They are responsible for the following: Public hospitals Psychiatric hospitals The school health curriculum Delivery Health services e.g. Public dental health, maternal and child welfare clinics

Ensures that the environment is healthy e.g. Regulates water cleanliness, sanitation and air quality Provision of information and education programs promoting health through government agencies such as VicHealth Ambulance services Provision of preventative and early detection programs such as breast cancer detection using mammograms. Legislation including road rules and smoking bans Local Government Contribute to the health and wellbeing of their citizens by focusing on the needs and challenges faced by the local people. Commonly referred to as councils Responsibilities include:

Health inspections of restaurants and other commercial kitchens Maintains clean public areas Collects garbage Recycles waste Provides emergency care shelters Organizes meals on wheels Maintain parks and sporting facilities and gardens to ensure they are safe and available for use. Local laws such as consumption of alcohol in public places Ensure public safety on roads and in public areas such as street lighting Delivering immunisation programs AUSTRALIAS UNIVERSAL HEALTH

CARE SYSTEM H T T P : / / W W W. A B C . N E T. A U / B T N / S T O RY / S 2 2 5 2 3 9 4 . H T M MEDICARE What is it? Introduced in 1984 to provide eligible Australian and New Zealand residents with affordable, accessible and high-quality health care. Aims to improve access to adequate health care for all Australians in need of treatment regardless of age or income. Who can use this service? Everyone who lives in Australia and is an Australian or New Zealand citizen or has a permanent visa. Anyone over the age of 15 years may be enrolled to have their own Medicare card. do you have your own card?

MEDICARE How is it funded? It is funded by the Federal Government, partly through contributions made via the 2% Medicare Levy. Refers to the amount of money paid by taxpayers based on taxable income that contributes to the funding of the health care system. Those with low income or specific circumstances may be exempt. People earning over a certain amount ($84,001 for individuals; $168,000 for families) WITHOUT private health insurance have to pay an extra 1% Medicare surcharge. MEDICARE

WHAT IS COVERED BY MEDICARE? Doctors consultation fees Treatment and accommodation as a public patient in a public hospital Tests and examinations needed to treat illness including x rays and blood tests. Eye tests Most procedures performed by doctor.

W H A T IS N O T C O V E R E D B Y M E D IC A RE ? Dental examinations Dental treatment Ambulance services Home nursing Physiotherapy Cosmetic or unnecessary treatments Hearing aids, contact lenses and glasses Medicines (Except those on PBS) Private hospital costs Alternative medicines such as acupuncture Medical examinations for employment purposes.

SCHEDULE FEE The amount that Medicare contributes towards certain consultations and treatments. The government decides what each item is worth and that's what Medicare pays. Doctors and private hospitals may choose to charge more than the schedule fee. For example, the schedule fee for a GPs visit in January 2011 was $34.90. Based on this contribution, every time an individual goes to the doctor for a standard consultation,

Medicare will contribute $34.90. OUT-OF-HOSPITAL EXPENSES Medicare will pay all or some of the fees relating to many essential health care services: Consultation fees for doctors and specialists Tests and examinations needed to treat illnesses, including x-rays and pathology tests and eye tests Some surgical and therapeutic procedures performed by GPs In-hospital expenses

As a public patient in a public hospital, treatment by doctors and specialists is covered by Medicare, including: Initial treatment and aftercare If individuals chooses to be admitted to a private hospital or as a private patient in a public hospital, Medicare will pay 75 per cent of the schedule fee for treatment by doctors and specialists MEDICARE SAFETY NET The Medicare Safety Net gives families and individuals financial assistance for out-of hospital Medicare services. Once you reach the threshold, having tests may

cost you less for the rest of the calendar year. Covers a range of tests received out of hospital, xrays and minor procedures NOT doctor visits because you get back 100% of schedule fee so no gap amount. PHARMACEUTICAL BENEFIT SCHEME (PBS) Through the Pharmaceutical Benefit Scheme (PBS), the Australian Government makes a range of essential prescription medicines available at affordable prices to all Australian residents. From 1 January 2018, you pay up to $39.50 for most PBS medicines or $6.40 if you have a concession card. The Australian Government pays the remaining cost. PBS Safety Net - Once the individual (or family) has

spent a certain amount within a calendar year on PBS listed medications, the patient then pays only a concessional payment Currently there are 2600 prescription medication on the list. Subsidy to help battlers quit smoking By Mark Kenny THE price of a month's supply of nicotine patches will be slashed from $120 to $5.40 when they are finally listed on the Pharmaceutical Benefits Scheme next February. The Government says the subsidy will push down the cost of transdermal patches from $120 a month at the pharmacy, down to just $5.40 for concession card holders. The listing, which has been long campaigned for by public health and anti-smoking groups, will apply to 70,000 low income concession card

holders, giving them access to affordable treatment for nicotine addiction. QUIT executive director Fiona Sharkie said it was a major step forward. Research suggests that subsidised Nicotine Replacement Therapy can increase the number of smokers using the products to help them quit, and the amount who have a successful quit attempt, she told The Advertiser. This is great news for helping bring down smoking rates. The anti-smoking drug varenicline has also had its PBS listing extended and a drug for the treatment of benign non-cancerous prostate enlargement, will be included for the first time. Cabinet signed off on the PBS expansion this week at a cost of $320 million over four years, all of which is said to be offset by other savings. Health Minister Nicola Roxon will formally announce the changes today. Supporting over 70 000 Australians to kick the habit next year is another part of the Gillard Government's innovative anti-smoking approach, including world-leading action to mandate plain packaging on tobacco products, she said. Cancer scars the lives of too many Australians and we know that reducing the smoking rate is one of the most effective ways to reduce the rate of death from this terrible disease. Australia records about 15 000 smoking-related deaths per year. Transdermal, or skin patches work by administering nicotine, the prime addictive agent of tobacco, through the skin, and when effective, can help wean people off the cancer-causing and inherently anti-social habit of smoking.

The decision to include nicotine patches such as Nicorette, Nicabate P and Nicotinell, has been a long time coming, given the deadly health implications of tobacco smoking and the huge public costs associated with its myriad diseases. Australian Council for Action on Smoking and Health president Mike Daube described the subsidy of patches as the last big piece of the puzzle to get people to quit. A steep $2.26 per packet tax rise on a packet of cigarettes ordered in this year's Budget, was sold as a health measure but slated to also deliver up to $5 billion in revenue. 8 December 2010 Case study review 1) Discuss why Nicotine Replacement Therapy has been included in the PBS. 2) Which population group is being targeted by the inclusion of Nicotine Replacement Therapy in the PBS? Explain why this group may have been targeted. 3) Briefly explain how the PBS can improve the health and wellbeing of Australians Medicare Advantages of Medicare

Disadvantages of Medicare Medicare Advantages of Medicare Disadvantages of Medicare Available to all Australian and New Zealand residents No choice of doctor for in-hospitals services/treatments

Free accessible to everyone Waiting lists for many treatments Choice of doctor for out-of-hospital services Does not cover alternatives therapies/cosmetic services Covers tests and examinations, doctors and specialists fees (Schedule fee only) and some procedures such as x-rays and eye

tests Often does not cover the full amount of the doctors visit (unless its bulkbilled) MEDICARE 1. Explain what Medicare is. 2. Outline what is covered by Medicare. 3. Explain what is not covered by Medicare. 4. Outline the objectives of Medicare. 5. Outline the advantages and disadvantages of Medicare. 6. Explain what the Medicare safety net is. 7. Explain how Medicare promotes health through ensuring sustainability, access and equity. 8. Outline how Medicare is funded.

9. Describe what a schedule fee is. 10. Explain the difference between a gap payment and an out-of-pocket payment. 11. Describe bulk-billing Understanding the PBS Visit the Medicare website, then copy and complete the following table with the updated information for the current year. The aim is to provide essential medicines to people who needed them, regardless of their ability to pay. Read case study on page 293 of the textbook. Table 5.1 Cost of PBS medications and the PBS safety net threshold General patients

Cost of medication on PBS PBS safety net threshold Cost of medication once threshold is met Concession PRIVATE HEALTH INSURANCE Private health insurance is a type of insurance under which members pay a premium (or fee) in return for payment towards health-related costs not covered by Medicare. It is additional insurance purchased on top of Medicare. Private health insurance cover is generally divided into hospital cover, extra cover and ambulance cover. If a patient pays for private health insurance cover, this enables patients to have access to public and private hospitals with the choice of their own

doctor or specialist; choice about timing of treatment and shorter waiting times. PRIVATE HEALTH INSURANCE Whats so good about it? Individuals can choose the type of cover to suit their needs by opting for extras cover which can cover services such as dentists, physiotherapists, and chiropractors. Pay a premium which can vary depending on how many people are covered by the policy and the options the policy includes. Private health insurance pay the additional costs associated with public hospital charges. Sometimes the total bill exceeds the amount contributed by the insurance company

thus resulting in out of pocket costs. PRIVATE HEALTH INSURANCE Users pay a premium to join which provides flexibility in their health care; Will cover some or all of the extra costs associated with private hospitals Choice of hospital Choice of doctor Reduced waiting times Can opt for extras (cover for services not covered by medicare) 6MQ

PRIVATE HEALTH INSURANCE INCENTIVE SCHEME As result of the declining number of people taking out Private health insurance, the federal government introduced a number of incentives. The purpose is to reduce the cost of private health insurance to make it more affordable and also to lighten the load on the public health system. Government incentives for private health insurance #1 INCENTIVE - LIFETIME HEALTH COVER People who take up private health insurance after the age of 31 pay an extra 2% on their premium for every year

they are over the age of 30. So if you took out PHI at the age of 40 you would pay an extra 20% to those who took it out at 29. VIDEO lifetime health cover Government incentives for private health insurance #2 INCENTIVE - MEDICARE LEVY SURCHARGE: High income earners (over 90,000 for singles) can get taxed an extra 1%-1.5% if you choose to NOT take out private health insurance. ***INCOME TESTED***

Government incentives for private health insurance #3 incentive Government Rebate (can also be called Private Health Insurance Rebate) Under this scheme, policy holders receive a rebate (or refund) on their premiums for private health insurance depending on their income. ***As of July 2012, this is now means tested*** meaning higher income earners may not get their rebate Advantages of

Private Health Insurance Disadvantages of Private Health Insurance Advantages of Private Health Insurance Disadvantages of Private Health Insurance

Enables access to private hospital care Costly in the terms of the premiums that have to be paid Choice of doctor while in public or private hospitals Sometimes have a gap payment Shorter waiting times, Waiting periods apply (for example; pregnancy)

Depending on the level of cover purchased, services such as dental, chiropractic, physiotherapy, optometry and dietetics could be paid for High income earners with private health insurance do not have to pay the additional 1 per cent Medicare levy Lifetime cover, rebate back from the government RESEARCH TASK Complete the table for private health insurance for 18 year old self.

Think about hospital cover, ambulance cover & extras (dental) Name of the Cost per private health month insurance company What is included What is missing from the cover which you

would like. PRIVATE HEALTH INSURANCE 1. Describe each of the private health insurance incentives. 2. Explain why the Commonwealth Government implemented the private health insurance incentive schemes. 3. Refer to Figure 5.12 and explain the impact that the private health insurance incentive schemes have had on the percentage of people covered by private hospital insurance. 4. Outline the advantages to individuals of having private health insurance.

THE RANGE OF COMMUNITY SERVICES TO SUPPORT THE DIMENSIONS OF HEALTH AND WELLBEING Doctors, dentists, hospitals There are a large number and wide range of services within communities that support the dimensions of health and wellbeing. We will be exploring 6 key community services. Maternal and child

health services Volunteer organisat ion Communi ty services Sports or recreatio nal clubs Places of

worship Headspa ce LEARNING TASK Complete questions 1-6 page 302 of the textbook. RIGHTS AND RESPONSIBILITES OF ACCESS TO HEALTHCARE The Australian Charter of Healthcare Rights outlines the rights of patients, consumers and other people using the Australian Healthcare system. These rights are essential to ensure that all healthcare provided in Australia is of the highest standard. The charter of healthcare rights has three guiding principles,

1. Everyone has the right to be able to access healthcare 2. The Australian Government commits to international agreements about human rights, which recognize everyones right to have the highest possible standard of physical and mental health and wellbeing. 3. Australia is a society made up of different cultures and ways of life, and they need to be respected. WHAT CAN I EXPECT FROM THE AUSTRALIAN HEALTH SYSTEM? My rights Access I have a right to healthcare Safety I have a right to receive safe and high quality care Respect I have a right to be shown respect, dignity and consideration

Communication I have a right to be informed about services, treatment options and costs in a clear and open way. Participation I have a right to privacy and confidentially of my personal information. Privacy I have a right to privacy and confidentially of my personal information. Comment I have a right to comment on my care and to have my concerns addressed. PATIENT RIGHTS In accordance with those outlined in the Australian Charter of Healthcare Rights, a patient has the right to; - Information about their diagnosis - Information from the doctor or health service on the costs of the proposed treatment

- Seek other medical opinions - Privacy of and access to their own medical records - Make a comment or complaint about any aspect of their hospital or medical treatment PATIENT RESPONSIBILITIES Along with their rights, patients also have certain responsibilities when accessing healthcare. It is a patients responsibility to; - Provide information about their past and present illness - Ask questions if they dont understand eg. The risks and benefits of proposed healthcare - Treat medical staff with respect - Ask about the cost of treatment PRIVACY AND

CONFIDENTIALITY There are laws that outline how a patients medical records and information can be stored and shared in order to protect their personal identity. Medical confidentiality; is a set of rules that means that anything discussed between a doctor and patient must be kept private. This is known as doctor-patient confidentiality. Exemptions include; - If the patient or someone elses health and wellbeing or safety are seriously threatened. - When the information will reduce or prevent a serious threat to the public. * Read case study Smartphones raise privacy issues in healthcare page 307 LEARNING TASK

Complete questions 1-8 page 308 of the textbook.

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