S00144769 Harrish Nair Seminar Paper on Health Policy in Australia

Introduction Health care policies have been going through many changes over the post-war period. At many instances in the Australian context, politics has played a major role in shaping policy reforms. In trying to the find right policies, governments have to balance their budget constraints with their obligation to provide a reasonable standard of care to its citizens. Brief history of health policies in Australia (Gardner & Barraclough, 2002, 28) The Chiefly was first government that amended the constitution to legislate health care in 1946. The legislative changes caused uproar amongst many doctors who had migrated from Britain to avoid the nationalization of health over there. Subsequently when the next government took over in 1949, the next Minister of health Earle Page modified some of the rules to emphasise greater individual responsibility over healthcare (p.28). Over time it became obvious that the system was failing many to provide affordable services and was operating on protectionist principles in the interest of medical professionals. Then in 1974 the Medibank scheme was introduced by the Whitlam government, which intended to provide universal health care irrespective of income. Medical practitioners were able to bulk bill the government for services provided. However by 1981, the Fraser government had deconstructed this plan and co-payment was reintroduced. Then in the early 1980 the Hawke Labor government introduced Medicare. Medicare provides free in-patient medical services at public hospitals and subsidises 85% of the cost of the scheduled fee for out of hospital medical costs. It also provides a 75% rebate on medical costs for patients of private hospitals (Duckett, 2004, p. 48). Medicare is funded from general tax and an additional Medicare levy of 1% on income was introduced, which has now risen to 1.5%. Then in 1997 a 1% levy surcharge was introduced for those who earn above the threshold amount and do not have private health insurance cover. Since the introduction of Medicare there has been a reduction in the reliance on private health insurance. Schofield as cited in Duckett (2004, p. 49) notes that most of those who dropped out of private insurance were middle income families and younger families. In response to this the government introduced the Lifetime Health Cover policy in 1999 which involved charging a premium based on the age of entry into purchasing private health insurance (Duckett, 2005). This policy was intended to encourage the public to take up private insurance earlier in their life and to maintain it across their lifetime. Duckett (2005) suggests that having a two- tiered system of public and private hospitals has generated problems of inequity. The opportunities for increased remuneration have caused many surgeons and doctors to move into private practice. As a result, patients who undergo elective surgery at public hospitals have longer waiting time than private hospital patients. Another issue that Duckett (2005) raises is that private insurance lobbyists have strong influence in getting financial support from the government and healthcare costs in the private sector are much more than the public sector.

S00144769 Harrish Nair Health of Indigenous Australians Current health statistics of Aboriginal people point to a huge disparity when compare to nonAboriginal Australians (Australian Indigenous HealthInfoNet, 2012). Palmer & Short (2000, p.274) are of the opinion that the issue deserves utmost importance amongst any other health policy issue. One of the issues faced by Aboriginal people in the past was the inability to access health care service because of fear of racism and discrimination. As a solution to this Aboriginal controlled health service was born. The first Aboriginal medical service was inaugurated in 1971 at Redfern (p.278). This was a landmark step towards Aboriginal self determination regarding their health. Another important role that was established was that of Aboriginal Health Workers (Mitchell & Hussey, 2006). These health workers play an important role in bridging the cultural gaps that separates Western medicine and Aboriginal health. Some of them have grown up within the communities and so share strong bonds of trust with community members (Mitchell & Hussey, 2006). They also are capable of providing translation to their native language to older Aboriginal people who may not understand English.

Comparative analysis of international policies Blank & Burau (2007, p.11) suggest that one way of simplifying the different types of health care systems around the world can be done by ordering them according to the level of governmental influence versus free market principles that guides the system. On one end we would have systems that are funded through private health insurance and on the other would be systems that are funded by government taxation income. In some systems particular sections of the population are treated differently. For example in the USA medical needs of children and the elderly are by the government, however the rest of the population have to rely on private insurance (Blank & Burau, 2007, p.13). In general most countries are experiencing increasing healthcare costs (Zwillich, 2001). One reason for this is the increasingly expensive medical equipment and drugs that are used in treatments (Baker, 2003). The development of health policies are affected by a variety of factors in each country. With regards to political systems, some countries have diverse political opinions which may result in slower changes in policies (p.36). The cultural belief prevalent in a nation also affects policy development. For example countries like New Zealand and Japan have a more communal based culture as compared to the more rugged individualistic culture of USA. As a result health may be viewed as a private or a public good. Funding of healthcare also can be privately or publicly funded. Public funding can come from government allocation of budget spending or though compulsory social

S00144769 Harrish Nair security schemes. Private funding can come from private insurances or out of pocket expenses by patients. Recommendations Duckett (2004, p.286) proposes that there are some key principles that can followed in creating the ideal health system. All Australians should have equal access and to medical care and standard of health. Statistics have shown that Indigenous people in this country have a shorter life span and are more susceptible to chronic illnesses (Palmer & Short, p.273, 2000). Duckett (2004) also suggest that medical care can learn from the disability movement in its progress towards deinstitutionalisation to a community based programs. He also highlights the importance of providing high quality care and respecting patients opinions and providing them the necessary knowledge and options to make informed choices. An ideal system also should be financially stable in the long term and have an efficient payment system. Limitations Creating the ideal health system poses a few challenges to policy makers. However as Stone (1999) suggests, observing policies and its effects in one country can be useful model for another. In creating policies we (p.229) have to recognise that there are often multiple vested interests involved. There are the patients who use the system, the payers who fund the system, the medical professionals that provide service and the government. Hence there is a tension between keeping costs low and maintain quality care. When learning from other countries, policy makers must however be aware of the differences in culture and how this may affect policy outcomes (Klein, 1997). Blank & Burau (2007) also reminds us that the perfect policy does not exist, and that every policy will inevitably result in some form of trade-offs. Conclusion