PUBH1382 Australian Health Care System and

Introdcution to Mental Health - 2015

Content and assessment requirements for this week

Learning objective for this week

Supplementary information

Assessment requirements

Tasks
1. Using the 10 learning objectives as a guide, you should read and takes notes from
the relevant text
a. Introduction
b. The Australian Health Care System
c. Health care in the UK and USA: Welfare versus the Market
2. Answer the Learning objective in Part A
3. Read the supplementary material in this file and answer the question in Part B
4. Watch one of the videos and answer the question in Part C
5. Study your notes and test yourself with the true/false quiz these do not count toward
the final grade
6. Complete the timed, open book online Multiple Choice Test which is based on all of
the learning objectives this contributes to final grade

Learning objectives

Week 2
1. Who are health professionals?
2. Explain Carolyn Tuohys (1999) theory of health care reform including
a. The welfare, market or mixed health care system
b. Timing of health care reform
c. Concept of structural balance and institutional mix
3. How does new public management (NPM) and economic rationalism drive reform?
4. Explain the following concepts related to the Australian public health care system
a. Its relationship with welfare state and market models
b. What is Medicare?
c. Medicare funding by level of government
d. Medicare support
i. Hospitals
ii. Primary and community care
5. Conceptualize and explain the following extra health care funding
a. Commonwealth and Pharmaceutical Benefits Scheme
b. Local Government
c. Private health care system
d. Other health care services
6. Describe the development of the US health care system.
7. Describe the development of the UK health care system.
8. Illustrate the differences between the concepts of the welfare state and the market
models of health. [also refer to previous chapters]
9. Compare and contrast the key features of the US and the UK health care systems.
10. Relate the US and the UK health care systems to the Australian health care system.

PUBH1399 Australian Health Care System

Introduction: How to use this book
1. Who are health professionals?
Professionalization is the social process by which an occupation transforms
itself into a true profession of the highest integrity and competency. This process
involves the establishment of:

A specialized, unique body of knowledge that makes a valuable

contribution to society, and
A professional body of qualified members that is closed to entry from
unqualified amateurs

Friedsons (1970) classic definition of a profession includes the following:

A strong work service ethic with set standards/ideals

Specialized training with a scientific orientation to a unique body of
knowledge
Autonomy of practice where members self-regulate their
practice/behaviour

As represented in the following diagram, professional action involves unique

skills and abilities, profession-specific knowledge and understanding and a
professional and personal commitment to the highest set of standards

http://blog.ncpad.org/2013/05/09/principles-of-professionalism/

Health Care professionals are those graduates who have undergone specialised
training and many years of practice to become experts in their specialised field
of health. Their profession and behaviour are often shaped by government
authorities that, in consultation with professional bodies, provide rules and
regulations. Health professionals are set apart from other occupations due to
their expertise. Most often when we think of health care professionals, we think
of the oldest profession of Medicine. However, current health care teams are
made up of many professional groups.

Health care teams are made up of tertiary trained professionals who support
citizens in terms of
o health promotion
o prevention
o timely diagnosis
o choice of therapy
o recovery [including mobility and independence]
o decrease risk of complications [especially chronic conditions]
o enabling quality to life

In Australia, the Commonwealth Government regulates the Health professions

through a National registration and accreditation board. This board is call the
Australian Health Practitioners Registration Authority [web site: www.ahpra.gov.au ]
and is made up of 14 National Boards http://www.ahpra.gov.au/HealthProfessions.aspx
Activity
You should access this website and note each professional group, go to your
professional board and determine if the tertiary education program you are enrolled
in is registered

From your reading, - what is the difference between a professional staff member and other
workers in the Australian Healthcare system?

2. Explain Carolyn Tuohys (1999) theory of health care reform including

a. The welfare, market or mixed health care system
b. Timing of health care reform
c. Concept of structural balance and institutional mix
Caroline Tuohys theory on health care reform was developed in 1999 and
explores the need for a clear distinction for what roles the state and the market
play in providing health care. She discusses the two types of health care models
welfare system model and the market system model.
Welfare model of health
The welfare model is often referred to as universal health care. This is where
the government of a country provides free health care to all, funding it through
tax or levies. It is what we refer to in Australia as the public health system and
we can charge costs or claim back money for expenses through Medicare.
Market model of health
The market model is whereby individuals have to pay for their health care
through private organisations (that private health insurance - such as Medibank
Private).
Mixed model of health care
In Australia, there is a mixed model of health care. Australian citizens have the
option of using the public health system and bulk billing medical costs through
Medicare, or using their own private health insurer.

Timing of health care reform

Models of health care have changed over time. Tuohy suggests that some reform
was logical and purposeful, but some parts were unintentional.
After the Second World War, many countries, including Australia, began providing
free education and healthcare and other services such as disability payments.
This included public housing and unemployment benefits, aiming at increasing
government support of the people. This was supported by trade unions that
referred to it as the social wage and proclaimed that it was the role of the
government to provide these services and the right of the people to receive
these benefits.
In the 1980s however, governments began to reduce their assistance as it was
becoming unaffordable. Therefore, the health care systems of many countries
were reformed through policy change. These changes were determined by the
relative influence (structural balance) of three (competing) institutional forces
(governments, private enterprise, professional bodies)

Concept of structural balance and institutional mix

To change health policy, Tuohy proposed the need for two things: structural
balance and institutional mix.
Structural balance refers to which of the three institutional forces or groups holds
the power in the health care system. Power often comes down to money (private
enterprise), skill/expertise (professional bodies) or (political) support (current
Government). The private health care providers can hold the power if the market
is in their favour and they have the money to dominate. The health care

professionals can hold the power if their skill/expertise is in demand or the

government can hold the power if the people support them.
Institutional mix refers to the different ways these three bodies control health
care costs. Private health care providers use their wealth and their popularity in
the market to determine costs. One of their main strengths is providing choice of
service. Professionals charge what they deem fit based on their skills/expertise
and their unique contribution to the health of the nation. Government uses
policies and taxes to fund things such as Medicare, and rely on their popularity
with the voters to ensure their policies on reforms and costs to shape the health
care system through the people. In Australia, the two main political parties
favour one of the two major models of health. The Australian Labour Party
emphasizes universal health care and thus the welfare model, whereas the
Australian Liberal Party has private enterprise as its electoral base and therefore
favours the market model of health. Australias mixed model of health reflects
the influence of successive governments

The following table illustrates that the philosophy of political parties (Labour socialistwelfare versus Liberal capitalist- market) and how this influenced the balance between
Government and citizen responsibility for health payments

Question of interest
What is the current [2014] Liberal Federal government proposing to reform, is this consistent
with the economic and political philosophy of the liberal capitalist party

Activity
From the timeline above and the following graph, explain how Government policy influences
Australians uptake of private health insurance, and thus how Government policy influences
the adoption rates of private health insurance [private enterprise]

These policies also determined the percentage of citizens who were covered by private health
insurance, but also by total health expenditure

http://theconversation.com/things-you-should-know-about-private-health-insurance-rebates15560

3. How does new public management (NPM) and economic rationalism drive
reform?
New public management (NPM) has evolved over the last 30 years and is driven by
economic rationalism that is, primary decision making is containing costs through increased
efficiencies and increased productivity. Governments either

Sell off (privatize) parts of the health care system (for example, outsource the
provision of care for people experiencing mental ill-health) or
Require sections of the health care system (for example hospitals) to adopt and
implement private enterprise strategies. For example, Governments only providing
increased funding to hospitals that treat more patients and then utilization of case-mix
funding [standardising costs by type of patient illness]

Advantages
1. Best practice leading to efficiency, effectiveness and economy
2. Disaggregation of large government bureaucracies
Disadvantages
1. Reduction of services to the essentials
2. Fragmentation of services complex cases treated by separate systems

An example of a good outcome in new public management is Australias regulation of the

sale and distribution of pharmaceuticals
Consequences of Australias PBS versus the United States market forces. Per capita [person],
Australia

Expends less on pharmaceutical drugs

Prescribes less drugs
Has a better life expectancy over life time and after 65 years

http://www.quora.com/
What-is-the-difference-between-Obamacare-and-the-Australian-health-care-system

http://www.commonwealthfu
nd.org/grants-and-fellowships/fellowships/australian-american-health-policyfellowship/health-care-system-and-health-policy-in-australia

Graph that show Australian and US life expectancy and life expectancy at 65 years of age

The major concern of the Australian Health Care System

The major concern facing most governments providing public welfare health care is how to
pay for the increasing costs, given that populations are living longer, chronic disease is on the
increase and more educated consumers expect quality care. These concerns lead to questions
of efficiency and regulation of government services.
For example, one of these concerns is that as the population ages, there are less workers
paying tax [primary source of Medicare funds] and a greater percentage of older citizens who
require greater access to health services [escalating costs]

http://medicare.commission.gov/medi
care/index.html

http://medicare.commission.gov/medicar
e/factpage4.html

The current Liberal Government is proposing two changes

1. raise the age pension from 65 years to 70 years
2. Introduce a co-payment of $7.00 for every GP visit
What impact will these changes have on the above concern

In this section you should develop a complete understanding of the complex system of
Australian Healthcare. You need to understand:

Australias mixture of universal welfare coverage with the option for

citizens/consumers to purchase private health coverage
The involvement of all levels of governments in the provision of health care
How Medicare is funded and how this funding is allocated to different levels of
governments
How Medicare funds all public health care and much of private health care

Explain the following concepts related to the Australian public health care
system
a. Its relationship with welfare state and market models
b. What is Medicare?
c. Medicare funding by level of government
d. Medicare support
i. Hospitals
ii. Primary and community care

Australia has a mixed model of health care that is a combination of the welfare
and the market model of health care. All Australians have access to (tax-funded)
public health care. However, Australians have a choice to either use this free
public health care service or to access and pay for private health care. Public
health care is funded through the various levels of government and is primarily
managed by Medicare. Private health care does receive some government funds
but is primarily funded by either direct patient payment or through their private
health insurers
Medicare
Medicare was introduced into Australia in 1984 by the Federal Labour
Government under Prime Minister Bob Hawke. Medicare is available to all
Australians. It aims to promote health equality by providing free access to
universal health care.
Medicare funding
Medicare is funded through taxation including the consumer tax (GST General
Service Tax) and the Medicare Levy (a percentage of a citizens taxable income).
The Medicare Levy is a progressive tax it is currently set at 1.5% of annual
income, thus the more a tax payer earns the more they contribute to the
Medicare Levy. The level is increased to 2.5% for high income tax payers who do
not have private health insurance.
What does Medicare fund?
Medicare primarily funds all services within public hospitals and direct health
services. Public hospitals are managed by State and Territory Governments but

receive around 50% of the total income (to cover costs) from the Commonwealth
Government. Public hospitals provide free health services to all Australians.
Funding of direct health services in provided by the Commonwealth Government
and is managed by Medicare. Medicare provides direct payments to General
Practitioners (GPs), medical specialists, some nurses and a range of allied health
professionals including physiotherapists, speech pathologists, audiologists,
dieticians, occupational therapists, psychologists and social workers). The fees
for all medical services are set by the Government and are listed under MBS (the
Medical Benefits Schedule). Where the GP only charges this recommended fee
(called bulk billing), the patients does not pay any fee and the GP receives 85%
of the fee directly from Medicare. If the GP charges a higher fee, the patient pays
for the full consultation but then can claim a rebate directly from Medicare.
Further, if you obtain a referral to a specialist or allied health service through
your GP, you are also able to claim back 85% through Medicare. There is a safety
net for these out of pocket expenses. Once you reach a certain limit, 100% of
costs are covered by what is known as a Medicare Safety Net (MSN). This can be
accessed regardless of your income

In summary, Australia has a public health care system [funded by Commonwealth

Government taxation] and a private health care system [funded privately and funded
primarily by private health insurance].
The following short video introduces the Australian Health Care System

http://www.youtube.com/watch?v=Oqnmg2qKhDo
Australian health care system intro

In summary, Medicare

is a compulsory, universal health insurance scheme funded by Government taxation

and health care levies
funds [at least partially] all visits to the medical General Practitioners
funds referrals to Medical specialist and some allied health professionals [including
psychologists]
funds public hospital care
partially supports private hospital care
covers all drugs listed on the Pharmaceutical Benefits Scheme
o prescriptions through GPs and specialists
o prescriptions through hospital in-patients and out-patient services

The following video explain the Medicare levy and the Medicare levy surcharge
Understanding the Medicare levy and Medicare levy surcharge
http://www.youtube.com/watch?v=3_dDDfoajZM

5.

Conceptualize and explain the following extra health care funding

a. Commonwealth and Pharmaceutical Benefits Scheme
b. Local Government
c. Private health care system
d. Other health care services

The Pharmaceutical Benefits Scheme (PBS) is funded by the federal government

and is an initiative that promotes equal access to medications when they are
prescribed by a licenced health professional (GP, nurse, Psychiatrist, etc). The
PBS determines what medications are subsidised, how much the drug companies
receive, how much the federal government funds and how much individuals pay.
This is called a co-payment system the costs are shared to make it more
affordable for all. If you have a health care card or are on a pension you also pay
less than the rest of the population. Currently, the federal government covers
approximately 83% of the costs. Just like the MSN, there is also a PBS Safety Net,
which is reached once a family pays for 52 prescriptions in a year.

Pharmaceutical Benefits Scheme

o relies on government funding that reimburses pharmacists for a selected range of
prescription drugs
o drugs placed on list are based on their comparative clinical effectiveness and their costeffectiveness re treatment
o purpose is threefold: to rationalize use of prescription drugs; to contain costs; and, to
improve patient health outcomes
o problems arise from three applied clinical issues: the doses prescribed in community
may not match clinical trials; the cost-benefits of drug use are rarely compared with
non-drug treatments; and, there is minimal incentive for companies to develop new
drugs

Local government
Local government is normally referred to as your local council or shire. The main
focus of local government health care is public health. This includes things like
rubbish collection, environmental management (such as safe waste disposal) and

monitoring food safety in organisations (including public and private hospitals).

Health care run by local government is normally referred to as HACC programs
Health and Community Care. Local governments have a strong focus on health
promotion and prevention of both infectious and chronic disease

Local governments

garbage collection, sewerage, and food safety standards

health promotion through provision of sport/recreation facilities, bike/walking paths, park and
gardens

The private health care system

The private health care system provides access to private treatment in a public
or private hospital. When a medical practitioner provides care in a private
hospital, Medicare pays 75% of the fee and it is possible for patients to take out
private health insurance to cover some or the entire 25% gap. It should be noted
that while GPs and specialists working in the private sector are essentially in
private enterprise, they are primarily paid by the government through Medicare.
The main focus of private health care is providing the patient with choice:
choice of own doctor both in the private hospital or the private section of
a public hospital
choice of hospital (private patients can be treated in a public or private
hospital)
choice of timing in terms of when the procedure is done (avoiding a
waiting list)
and generally reduced waiting times
Private health care also provides extras that are covered by private health
insurance. The extra benefits (will depend on the policy you choose from your
provider) include services such as physiotherapy, ophthalmology, dentistry or
nursing in the home.
The aim of (some) government funding of private health care is the reduction of
the strain on the public system in terms of funding (cheaper as private health
insurance contributes) and waiting times (more services can be provided)

Private health care system

while established to provide alternate care for citizens with private health insurance,
Medicare pays a substantial (up to 75%) of consultation fees for patients being treated
in the private health care system

How Australian mixed model of health care funds health care:

Medicare and private health insurance coverage

https://www.gmhba.com.au/about-health-insurance/private-vs-public

Of the three versions above, do you know what coverage you have?

Other services
There are many other health care services that greatly differ in funding and
design. Many services are funded by donations or partial federal funding
combined with donations such as The Royal Flying Doctor Service and Ronald
McDonald House. There are also funding bodies designed for the type of health
care you need, for example TAC funds health care post traffic accident and Work
Cover funds health care post work place injury. There are also 100 Aboriginal
and Torres Strait Islander Community Controlled Health Services (ACCHOS)
across Australia.

Other health care schemes

some schemes are funded by Medicare Indigenous health centres

some schemes are partially funded by Medicare Royal Flying Doctor Service
some schemes are funded independently Workers compensation and compulsory third
party motor vehicle insurance

Health care in the UK and USA: Welfare versus the Market

Countries throughout the world have developed different health care systems, shaped by the
policy decisions of their particular governments. Generally, health care systems can be
thought of as being either:
1. a welfare-based (or public) system where the government provides the health
care system for all citizens, or
2. a market-driven (or private) system where the services are run by private
providers, and citizens pay for their own health care. Many health care
systems such as Australias are mixed systems, with both public and private
elements.

The Australian Healthcare system is a mixture with both welfare [Medicare]

and market [private insurance] components. Interestingly, as healthcare
reforms continue worldwide, the UK welfare model is introducing the
Australian option of citizens being able to opt for private health cover and the
USA market model (under Obamacare) has legislated to ensure that all US
citizens have some form of coverage [if they are not covered by their
Medicare, then they must have some form of private health insurance]

World map on universal health care

http://thepoliticsofdebt.com/2007/12/12/universal-health-care-how-stupid-have-theyfigured-out-we-are/

A summary list of countries with no universal health care system would include the United
States of America, all of Africa, all but two Central and South American Nations, most of
Arabia and all of South and South East Asia.

6.

Describe the development of the US health care system.

There have been two historical themes associated with the US health care
system. The first is maintaining the traditional private fee for service relationship
between doctor and patient. The second theme was the requirement that
hospitals were to be self-supporting but not run at a financial loss. One of the
major historical events that largely shaped the US health system was the Great
Depression. Less people could afford to go to the doctors and this was impacting
on wages of health care professionals and the financing of hospitals. Companies
were formed to protect the hospitals (Blue Cross) and the health providers (Blue
Shield). Note, these were not established to protect or provide services for
patients. The Blues providers set premiums linked to the level of risk of the
community (that is, the well and the sick paid a universal rate). However, after
the second world war (the latter half of the 1940s) private health care providers
were formed by employers (large companies) to cover their workers (part of the
salary package). An unintended consequence of this strategy was that these
companies were in direct competition with the Blue Cross and Blue Shield
programs. These private insurance providers offered lower premiums because
they could exclude and avoid the increased costs associated with insuring

citizens that were the already ill. Since these private providers dominated the
market with low premiums, public hospitals felt the strain. They were funded by
organisations whose main focus was to turn a profit. This dramatically shaped
the US health care system and over time has decreased the variety of services
available for the general public. This created an ever-increasing number of
people who did not have health cover.
In 1965, Medicare/Medicaid was introduced in the US. Medicare was Government
sponsored system for US citizens over the age of 65. While it covered health care
services it did not cover medication nor long term nursing care. Medicaid was
introduced to provide health cover for US citizens under the age of 65 with low
income. This included the unemployed, people only earning minimal wages, and
casual and sessional workers without employer sponsored health insurance. It
also covered people with physical disability. Medicaid is funded through a mix of
federal and state funding.
From the1930s, Health Management Organisations (HMOs) were created to
provide pre-paid and fixed rate plans for health insurance in an attempt to make
health services affordable to the general public. However, by the 1990s, the
HMOs started to manage and restrict services patients were allowed to be
offered that is, made medical decisions on the amount of treatment patients
could receive.
Currently, Obamacare (or the Patient Protection and Affordable Care Act) has
increased the number of people with private health insurance, controlled the
activities of health insurers, changed Medicare payments, increased funding for
training primary health care physicians, and, is overseeing hospital management
practices. The aim of Obamacare is to reduce the number of people without
private health insurance. Currently, 40 million US citizens do not have private
health insurance. Without insurance, many US citizens struggle to access and
afford health care, and more often than not, simply do not access it. Thus,
compared to the rest of first world nations, the US has very poor health
outcomes overall. The US health care system operates under a market model.

http://www.youtube.com/watch?v=FzCrzZcqd5g
Australian Health care system versus USA

7.

Describe the development of the UK health care system.

The UK health care system, called the National Health Service (NHS) is primarily
based on the Welfare model of health care. Historically, health care in the UK was
provided through two different means:
voluntary hospitals hospitals for the upper and middle class and privately
funded by wealthy families
public hospitals funded by the government, created in public housing
type complexes and designed for basic medical care of the poor [lower
classes].
Under both systems, doctors operated on a fee for service basis. However, even
under this system, the upper class, middle class and government officials were
receiving appropriate health care while the majority of citizens were missing out.
It wasnt until 1939 (beginning of the Second World War) that the NHS was
created. The UK government combined the two separate means of health care
and took control of them including funding and management. The NHS was a
free health care system for all UK citizens and was mainly created meet the
higher demand for medical services due to battle injuries (both returning soldiers
and civilian casualties from the battle of Britain). The main resistance to the
Nationalization of health care were the doctors who became salaried but
continued to have a strong preference for the traditional fee for service
arrangement.
The founding principle of the NHS was universal health care, that is, all UK
citizens should have equal access to high quality medical treatments. The
system, however, created a profession dominated paternalistic system where
patients had no choices and were not consulted on the type of services they
were offered. From the 1940s to the 1980s, this free health care for all resulted in
great overspending and increasing tension between primary health care
(hospitals and GP services) and community preventative health care services.
In 1990, Trusts (independent organizations within the NHS) were formed. These
Trust became health care providers competed with each other to purchase
services from the NHS. In this system, GPs also became trusts and were required
to purchase services for their patients. In an attempt to control debt,
privatization of services has been accelerating. This includes the provision of
many services (providing affluence patients to purchase private health care) and
the construction of new services (including hospitals). While public health debt
remains out of control, the UK government still provides a comprehensive free
health care service, but now patients have more control over the types of
treatment that are available and have the choice to purchase private health care.

http://www.youtube.com/watch?v=BUSU6OsNxQk
Comparison of the UK and US health care systems

8. Illustrate the differences between the concepts of the welfare state and the
market models of health. [also refer to previous material in this week]
The welfare state model is often referred to as universal health care. Under this
system, the government of a country provides free or highly subsidised health
care to all, funding it through taxation or levies. The following world map
illustrates which nations provide universal health care to their citizens. In the
welfare state model patients have limited choice in terms of health care
practitioner and are generally subject to waiting lists
The market model minimizes the role of the government in providing health care.
In the market model, health care is provided by private enterprise the
individual citizen either
Directly pays for their health care or
Purchase health insurance and then claim their health care costs via the
insurance company.
Under the Market model the patient maintains their doctor patient relationship
and have choices about what treatment and when treatment should occur
The key difference between the models is the basic philosophy that is
responsible for a citizens health care. In the Welfare model, the Government
takes the responsibility and indicates that society is responsible for the care of its
citizens. In the Market model, the Government argues that individual citizens
need to take responsibility for their health and that market forces should drive
the provision of health care.

9. Compare and contrast the key features of the UK, the US and the Australian
health care systems.
The UK system operates on the Welfare model and focuses on equal access for all citizens to
affordable health care (free in most cases). The US operates on the Market model of health
care which is based on private enterprise (for-profit organizations) and leaves health care
choices to individual citizens. The Australian health care system is a mixed system, where the
Government provides universal health care (Welfare model), but provides taxation incentives
for wealthy citizens to purchase private health cover (Market model). This mixed system
ensures that all citizens have access to high quality health services and by providing choices
(to those who can afford it) also helps contains costs and reduce waiting list times
From a historical viewpoint, the development of each of these systems was dependent upon
structural balance and institutional mix [see Tuohys 1999 theory]. The following
comparative analysis of these national health care systems emphasizes the role of both
National culture and the structural balance (of power) between governments, private
enterprise and professional bodies.
UK Welfare model
The UK government nationalized the health care system in a time of emergency (World War
2) and created and forced social control on both the market driven private enterprise ( who
were focusing on supplying the war) and key health professionals (who like all other citizens
were conscripted into the war effort). Reforms since the creation of the NHS have
redressed the structural imbalance by introducing privatization of health services and
allowing the medical profession to negotiate their own health care role
USA Market model
In the USA, private enterprise dominated the evolution of the nations healthcare system. The
introduction of Blue Cross and Blue Shield were designed to protect health care providers
(hospitals and doctors respectively) and not citizens. After World War 2, large industrial
organizations introduced private health insurance as part of the salary package to attract
employees. This initiative minimized the role of the Government in the provision of health
care and allowed health professionals to remain independent and maintain their fee for
service relationship with patients. The existence of 40 million Americans without health
cover (neither private health insurance nor Medicare or Medicaid) has allowed the current
Government to gain some institutional social control and impose the requirement that all
citizens must have some form of health cover (mainly by providing government sponsored
private health insurance).
Australia Mixed model
In Australia, the distance of war (much less social impact within Australia) and
the relative prosperity (full employment) maintained the status quo in terms of
structural balance and institutional mix until the 1970s. The introduction of
Medibank and then Medicare (by subsequent Labour governments) increased the
tension between all three social forces within the institutional mix. While the
Government provided Universal free health care, the medical profession
originally continued charging their own fees and thus maintained their fee for
service relationship with patients (most of whom had to source fee rebates). The
introduction of bulk billing and the Medical Benefits Schedule reduced the social

control of the health professional. For the private enterprise providers (especially
the private health insurers) their market share gradually declined. However, with
the rising cost of health care and longer waiting lists to be treated, the
Government introduced the Medicare Levy (to help pay for health care) and then
the Medicare Levy Surcharge (to encourage the uptake of private health
insurance and move people who could afford it to the private health system).

How would you interpret the following score cards?????

The Mixed model of health care

[represented by Australia] has:
o The highest life expectancy at
birth
o Equal lowest probability of dying
before five years of age
o Lowest probability of dying
between the ages of 15 and 60
years
o Median in terms of total health
cost expenditure [both per capita
and as a percentage of Gross
Domestic Product

Overall, the quality of patient health

care is superior under the Welfare
Model followed by the Mixed Model of
health care.
The principle exception is that the
Welfare Model ranks lowest in patient
centred care

Note: Rank of 1 is highest

performance

http://www.who.int/whosis/en/
http://www.forbes.com/sites/danmunro/2014/06/16/u-s-healthcare-ranked-dead-lastcompared-to-10-other-countries/

10. Relate the US and the UK health care systems to the Australian health care
system.
In response to these the demands of rising costs and the provision of adequate
services to all citizens, both the UK and the US health care systems are shifting
toward this mixed model of health care. UK health care has become more
privatised over the years in an attempt to increase the revenue base and thus
contain costs to the general public. In face of a rising number of citizens without
health cover, the US has introduced new legislation to increases the
governments responsibility in ensuring there is universal health care coverage
and for providing more affordable health care to the people. Both UK and US
health care systems are adopting positive elements of the mixed system that is
currently being adopted in Australia.
The Australian health care system is a combination of both the Welfare and the
Market model of health care. Using a mixed model, Australian government has
sought to take the best aspects of both models and provide options for health
care that suit the needs of the Australian public. Medicare and the public system
allow affordable and heavily subsidised health care for all, promoting equality of
care and increased access to services as required. Whereas the private health
care sector in Australia allows freedom of choice and reduces the strain on the
public health system, including reducing waiting times for many specialist
services.
Moving into the future, the key aspect of this is to find the best balance of the
welfare state model and the market model. As a nation with an aging population,
there will be increased demand on health care, therefore to avoid increasing
costs and future debt, governments need to contain rising costs and broaden the
revenue base via the private health sector.

World map re life expectancy

http://www.worldlifeexpectancy.com/world-life-expectancy-map

World ranking by life expectancy [note interactive]

http://www.worldlifeexpectancy.com/world-life-expectancy-map

Activity
From the interactive website on world rankings re life expectancy, select a
number of nations and list their life expectancy make sure you select nations
that vary from high life expectancy [>80 years] to very low life expectancy [< 50
years] Using other data sources can you indicate what factors may influence life
expectancy.
List web sites for
List and then use the following web page

http://www.worldlifeexpectancy.com/world-health-rankings#world-cause-map