Australian Health Care System

– Week 2 –
Healthcare systems
PUBH1382
Learning objectives
1. Understand the concept of health professionals and their regulation in Australia
2. Understand concepts related to types of health care systems and their reform
(refer to Tuohy theory 1999).
3. Explain the following concepts related to the Australian public health care system
a) Medicare
b) Pharmaceutical Benefits Scheme
c) Private health care system
4. Relate the US and the UK health care systems to the Australian health care
system.
Australia’s Health 2016 – a snapshot

Australia’s Health, 2016, p6-7

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Australia’s Health 2016 – a snapshot (2)

Australia’s Health, 2016, p6-7

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1. Health professionals
Professionalisation

“social process by which an occupation

transforms itself into a true profession of the
highest integrity and competency”

- specialised, unique body of knowledge

- valuable contribution to society
- “professional” body of qualified members

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Friedson’s (1970) definition of a profession

- 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

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Principles of professionalism

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

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Australian Health Practitioners Registration
Authority (AHPRA)

- Rules and regulations (government authorities +

professional bodies)
- Not just medical doctors!
- Graduates with specialised training & years of practice

Areas include: health prevention, promotion, diagnosis,

therapy choice, recovery, manage complications, enable
quality of life

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ACTIVITY

Go to www.ahpra.gov.au
Look at the 14 National Boards
http://www.ahpra.gov.au/Health-Professions.aspx
Is your chosen profession managed by AHPRA?

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2. Health care systems and reform
The welfare, market or mixed health care
system – Caroline Tuohy (1999)

- Welfare Model – Government funded

- Market Model – Individually funded (direct payment or
private health insurance)
- Mixed Model – e.g. Australia
Medicare + private health insurance

Responsibility for citizen’s health care –

government or individual

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Health care reform

- Change over time – both logical and unintentional

- Welfare increased after Second World War (education,
healthcare, disablity payments, public housing)
- Funding reduced 1980s
- Reform determined by ‘structural balance’ of
1. governments
2. private enterprise
3. professional bodies

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Economic rationalism – New Public
Management

- Primary driver of decisions:

- increase efficiencies, decrease costs
- Governments can:
- Privatise aspects of healthcare system OR
- Require sections of health care system to implement
private enterprise strategies.

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Economic rationalism – New Public
Management (1)

- Advantages
- efficiency, effectiveness, economy
- disaggregation of large government bureaucracies
- Disadvantages
- Reduction of services – just the essentials
- Fragmentation of services – complex cases treated by
separate systems.

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Economic rationalism – New Public
Management (2)

- An example: Australia’s Mixed model vs US market forces

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Total health care spending 2014

https://data.oecd.org/healthres/health-spending.htm#indicator-chart

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Life expectancy at 65 years (2013)

https://data.oecd.org/chart/4DZR
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3. Medicare, PBS & Private health
care
Medicare

- Introduced 1984 (Federal Labour Government under PM

Bob Hawke)
- Available to all Australians (and Permanent Residents)
- Aims to promote health equity
- Free access to universal health care
- Funding - through taxation

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What Medicare funds

- Public hospitals (managed by State and Territory

Governments)
- Drugs listed on Pharmaceutical Benefits Scheme (PBS)
- Direct health services
- GPs, medical specialists, some nurses
- Allied health professionals such as physiotherapists,
speech pathologists, audiologists, dieticians,
occupational therapists, psychologists and social
workers
- Medical Benefits Schedule (MBS) determines fees that
Medicare will pay

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Pharmaceutical Benefits Scheme (PBS)

- Reimburses pharmacists for certain medication

- List based on clinical effectiveness and cost-
effectiveness
- Purpose:
- Rationalise use of prescription drugs
- Contain costs
- Improve health outcomes
- Problems
- Not compared to non-drug treatments
- Minimal incentive for companies to develop new drugs
- Dosage

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Private health care

- Privately funded hospital treatment (public or private

hospital)
- Choice
- Doctor
- Hospital
- Timing
- ‘Extras’
- Physiotherapy
- Optometry
- Dentistry
- Psychology

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Private health care

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4. US & UK health care
UK health system

- Universal health care

- Paid through taxation
- Government employs healthcare professionals
- No fee for access
- Treatment regulated by National Institute for Health and Care Excellence
(NICE)
- Private treatments available when not on NHS (e.g. cosmetic surgery),
long waiting list, doctor choice.

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 US Health system

- Market model
- Privately funded
- Employers often pay
- Medicare (for elderly)
- Medicaid (for poor)
- Obamacare (Affordable Care Act) –
designed to ensure all are insured.

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Australia’s mixed - No fee at public hospitals
model – a real mix
- Fee for service at private
hospitals
- Many health professionals work
across both
- Bulk billing
- GPs and specialists can charge
the ‘market rate’
- Private health insurance optional
- Patients pay ‘gap’
- Funded by taxpayer and
Video explainer: Medicare levy and Medicare levy individual
surcharge (also in Course Notes)
- Private dental, ambulance
http://www.youtube.com/watch?v=3_dDDfoajZM

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Australian Health Care System
– Week 2 –
Healthcare systems
PUBH1382