Defining the health care system and health care financing

Analyse the interaction between public and private health care funding and explain why you consider the complex Australian system as either a strength or weakness in health service delivery. Develop at least three ethically-based strategies that could be implemented to either build on strengths or address weaknesses relevant to the mix of public and private health care funding.

Lameire, (2012) defines health care system as the association and co-ordination of different entities so as to provide efficient medical care to the public. Therefore, the health care system of a particular country is the specific country government’s policy that assesses the citizens’ needs in terms of medical care and provides the citizens of the country access to medical care (Carey et al., 2015).  This paper will discuss the complex Australian health care system and analyze the interaction between   the public and private health care funding in Australia.

Health care financing is one of the major components of a health care system. It refers to the generation of funds to pay for health services. According to Lameire, (2012) every country employs public-private combinations to finance various sectors of their health care system. Public health care funding mainly involves the government through either tax or social security funding Fan & Savedoff, (2014). On the other hand Torchia, Calabro’, & Morner, (2015) write that private financing involves non-government entities such as private insurance arrangements or out of pocket payments.   

Health systems in the modern society have been improved and designed to ensure that all their citizens are entitled to a publicly supported health care package (Colombo & Tapay, 2013). The above mentioned authors further explain that this is to promote social equity, improve efficiency of health care service production and ensure client satisfaction with the services provided. According to Macri, (2016) incorporation of the private financing to the publicly supported health care system can seriously improve on the efficiency of the health care system. The private/public blend in health care financing simply has its background on the economics principle with the aim of maximizing benefits for the population as a whole from the existing resources within the two sectors (Pannarunothai, 2012). This has led to a more compromising debate of how to make both the systems work together.

According to Slipicevic & Malicbegovic, (2012), governments rely on private health insurance to help in addressing some health system challenges. On example is enhancing its role as an alternative source of financing so as to add health policy goals or to enhance individual responsibility of its citizens (Lameire, 2012). However, private health insurance is complex and it interacts with public systems in multiple ways. One way of functioning in the public-private blend is when a fee for service is available for those who pay the full cost of privately offered services instead of using the basic public health care (Götze & Schmid, 2012). Pannarunothai, (2012) adds another interaction as where the private sector is responsible for delivering service but the government is responsible for financing those services. in addition, there are mixed systems where both the government and the private finance for the services to be delivered in pre-determined percentages (Götze & Schmid, 2012).  However, Fan & Savedoff, (2014) state that the mix of public and private financing, distinguishing between the two always becomes a problem and causes the health system to be a complex one.

Interactions between public and private health care funding

The Australian health care system is a multidimensional web of public and private health care providers, settings and supporting mechanisms (Lu & Jonsson, 2010). The above mentioned author writes that health care is majorly financed by all government levels. In addition, Seah, Cheong, & Anstey,( 2013) write that this is supported by non-governmental organizations, private health insurers and out of pocket payments. The government finances medical care through a health insurance scheme, Medicare (Seah et al., 2013) which contains three medical components: medical services, prescription pharmaceuticals and treatment in the hospital as a public patient .  This system is supported by private medical insurance arrangements that are optional. The private health insurance allows for one to be treated in hospital as a private patient and also for additional services such as dental and physiotherapy services (Macri, 2016).

The Australian health system is complex in structure. The health financing responsibility is shared by state, federal and local governments (Macri, 2016). In addition, provision of health care is also divided between ‘primary care’ and ‘community health care’ (Colombo & Tapay, 2013). Also, as stated earlier, Australia has a publicly funded health system, Medicare, which allows for universal health coverage for its citizens. This allows the citizens to access subsidized treatment from specialized doctors as well as free treatment in public funded hospitals. In addition, the Australian government has given its citizens a choice to access private health insurance which provides coverage for specialists, private hospitals and other additional services (Seah et al., 2013). The Australian health system is among the best in the world ranking at sixth highest with an average life expectancy of 82 years (Colombo & Tapay, 2013). However, this system comes with a lot of weaknesses in heath service delivery. I will discuss some of the major challenges of this system that lead me to consider that the complex system is weak for service delivery.

The major weakness of the Australian health system is the high division of funding from different agencies. The highly fragmented system makes it difficult for the patients to navigate through the system. The split care co-ordination between the primary care and the community care easily leads to poor communication between the two and also lead to duplication of information (Lu & Jonsson, 2010). This as stated by Roehrich, Lewis, & George, (2014) further causes there to be lack of adequate and reliable data of the health patients exists in the system. The system also allows for difficulties in funding since the high fragmentation leads to lack of communication and cordination between the funding parties.

Analysis of the Australian health care system

There have been reports of poor co-ordination of service panning and delivery. Dwyer, (2015) where there are reported cases of ambulances being sent in the wrong direction or clients ending up paying more out of pocket than what are required. In addition, Seah et al.,( 2013) writes that the complexity of the health system also causes it to be poor in delivery of effective and timely health care. This has been worsened with the current changes in demographics and health problems facing the country. According to Dwyer, (2015) the increased numbers of the aging population. The above mentioned author also reports of increasing risk factors of chronic diseases such as high obesity levels and reduced physical activities. Chronic diseases have also been on the rise.

According to Colombo & Tapay, (2013) the use of medical technology in the Australian system has been extremely poor and slow. Poor co-ordination has also led to poor advancements in the field of health care service and delivery as well as health research. Other than the high cost of updating and implementing the use of technology in the system (Seah et al., 2013), Colombo & Tapay, (2013) add that the poor organizational abilities in the different parties that are responsible for financing health care have made it difficult for these advancements to be done.  In addition, Dwyer, (2015) writes that as much as the country has had a number of internationally recognized medical breakthroughs, it lacks efficient structures and stakeholder linkages that enable it to integrate national health and medical research plans.

Finally the involvement of the public-private blend has led equality issues and inequality in the provision of health care. The Australian health system has allowed the government to provide incentives for the rich to pay for their own private health arrangements (Macri, 2016). This arrangement allows the owners to access faster medical services as well as to choose the doctor and specialists to treat them. It has led to a significant difference in the health care treatment that affluent people receive as compared to that of the less affluent. Reports have shown that the life expectancy of the indigenous Australian population to be at 70 years which is significantly lower than that of the other people (Seah et al., 2013).

As much as the complex Australian Health system has been properly functional over the years, there is need for some strategies to be put up in order to improve on the weaknesses that come with the system.

Weaknesses of the Australian health care system

First, the government should centralize the governance and funding of health care in the country (McPake & Hanson, 2016).  In the current health care system, funding, care delivery, policy-making and governance of health care delivery and funding is highly fragmented and therefore very complicated. If we take the example of a patient with a chronic disease, he/she needs community care that is supported by the state government. The same patient also needs specialized treatment that is accessible through private insurance. It is therefore the work of the patient to bring together all this. A centralized system will allow easy governance and funding of the health services in the country (Roehrich et al., 2014). It will make it easier for patients to move through health care deliver. Implementing this policy will also enable the Australian government to have proper records of the health services, health funding and health expenditure in the country

A second policy that can help improve the Australian health system is pay for performance system (McPake & Hanson, 2016). This simply means that a doctor is paid according to the delivery he makes. In such a system the government and the private insurers join up and work together to pay doctors. The doctors are then required to see a set number of patients and produce adequate performance to be paid. It is a difficult policy to implement but it will go a long way in reducing the gap of health service delivery between the affluent and the less affluent people in the country.  Still using the example above, a person with a chronic illness who requires specialized treatment but does not have private insurance will not be able to get the treatment. This patient may end up no getting health care or end up paying out of pocket. In a system where the doctor is paid for performance, the doctor is allowed to see all patients regardless of whether or not they have private insurance arrangements (Colombo & Tapay, 2013). This will help ensure all Australians receive equal health care services at all times.

Finally, the Australian government can adopt a policy that advocates for keeping people out of hospital. In this case, the government supports primary health care at the community level and offers support to clinicians. This will reduce the bulk of people in the hospitals and allow for adequate and efficient use of available resources in the hospitals. In addition, clinicians can be used to monitor and assist the changing health needs of the Australian population especially during the demographic changes of the citizens. It also promotes home and community care of patients with chronic diseases and allows for people to visit hospital or be admitted only when there is need to. Clinicians and clinics will be available and accessible to all people regardless of their social status in the community.

Strategies to improve the Australian health care system

References

Carey, G., Malbon, E., Carey, N., Joyce, A., Crammond, B., & Carey, A. (2015). Systems science and systems thinking for public health: a systematic review of the field. BMJ Open (online). 5(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4710830/. Accessed 18 May, 2018)

Colombo, F., & Tapay, N. (2013). OECD HEALTH WORKING PAPERS (online). Available from: www.oecd.org,  (Accessed 17 May, 2018).

Dwyer, J. M. (2015). Australian health system restructuring – what problem is being solved? Australia and New Zealand Health Policy (online).  Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC544964/  (Accessed 18 May, 2018)

Fan, V. Y., & Savedoff, W. D. (2014). The health financing transition: A conceptual framework and empirical evidence. Social Science & Medicine (online). 105. Available from: https://www.sciencedirect.com/science/article/pii/S0277953614000392  (Accessed 18 May, 2018)

Götze, R., & Schmid, A. (2012). Healthcare Financing in OECD Countries beyond the Public-Private Split (online). Available from: https://papers.ssrn.com/abstract=1998037  (Accessed 18 May, 2018).

Lameire, N. (2012). Healthcare systems–an international review: an overview. Nephrology Dialysis Transplantation (online). 14 (6). Available from:  https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/14.suppl_6.3  (Accessed 18 May, 2018).

Lu, M., & Jonsson, E. (2010). Financing Health Care: New Ideas for a Changing Society (online). USA: John Wiley & Sons. Available from: https://www.Google-Books-ID.com   (Accessed 17 May, 2018)

Macri, J. (2016). Australia’s Health System: Some Issues and Challenges. Journal of Health & Medical Economics (online). 2(2). Available from: https://www.imedpub.com  (Accessed 17 May 2018).

McPake, B., & Hanson, K. (2016). Managing the public–private mix to achieve universal health coverage. The Lancet (online). 388(10044).  Available from: https://www.sciencedirect.com/science/article/pii/S0140673616003445  (Accessed 18 May, 2018)

Pannarunothai, S. (2012). Researching the public/private mix in health care in a Thai urban area: methodological approaches. Health Policy and Planning (online). 13(3). Available from: https://academic.oup.com/heapol/article-lookup/doi/10.1093/heapol/13.3.234 (Accessed 18 May, 2018).

Roehrich, J. K., Lewis, M. A., & George, G. (2014). Are public–private partnerships a healthy option? A systematic literature review. Social Science & Medicine (online). 113. Available from:  https://www.sciencedirect.com/science/article/pii/S0277953614002871  (Accessed 17 May, 2018).

Seah, D. S. E., Cheong, T. Z., & Anstey, M. H. R. (2013). The hidden cost of private health insurance in Australia. Australian Health Review (online). 37(1). Available from: https://www.publish.csiro.au/?paper=AH11126  (Accessed 18 May, 2018).

Slipicevic, O., & Malicbegovic, A. (2012). Public and Private Sector in the Health Care System of the Federation Bosnia and Herzegovina: Policy and Strategy. Materia Socio-Medica (online).  24(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633389/ (Accessed on 18 May, 2018).

Torchia, M., Calabro’, A., & Morner, M. (2015). Public–Private Partnerships in the Health Care Sector: A systematic review of the literature. Public Management Review (online). 17(2). Available from: https://www.sciencedirect.com/science/  (Accessed 18 May, 2018)