Activity 1.

1 Where does Australia stand in comparison with other OECD countries in regard to infant mortality, life expectancy, subjective health status and access to health services? Construct a table which compares Australia with three other nations.
Infant Mortality Sources statistics taken from OECD.org Comparison of Infant mortality among these three OECD countries Life Expectancy Australia Japan Italy In Australia, the infant mortality In Japan, the infant mortality In Italy, the infant mortality rate rate is 4.3 infant deaths per rate is 2.4 infant deaths per is 3.7 infant deaths per thousand births according to thousand births according to thousand births according to 2009 statistics 2009 statistics 2009 statistics Japan has the lowest mortality rate of 2.4 per 1000 births, almost half of Australias mortality rate, which is the highest. Italys mortality is 3.7 deaths per 1000 births, which is significantly higher than Japans mortality rate but still slightly lower than Australias mortality rate. According to 2009 statistics, life According to 2009 statistics, life According to 2008 statistics, life expectancy for both sexes is expectancy for both sexes is expectancy for both sexes is 81.6. For males, life expectancy 83.0. For males, life expectancy 81.8. For males, life expectancy is at 79.3 and females, 83.9 is at 79.6 and females, 86.4 is at 79.1 and females, 84.5 years years years Japan has the highest overall life expectancy and has the highest life expectancies for both sexes. Its male life expectancy rate is only slightly higher than Australias, who also has a slightly higher male life expectancy than Italy. Australia however has the lowest female life expectancy, where Italys rate is marginally higher and yet again, Japan has the highest female life expectancy. Australians are generally The Japanese have the lowest Italians have reported their pleased with their health status, reported subjective health health status to be good, with a claiming it to be very good, status in the world and have a 63.6% satisfaction rate. reporting 84.9% satisfaction 32.7% satisfaction rate. rate. Although Australia has the highest mortality rate and lowest overall life expectancy, it has the best subjective health status percentile of the three. The opposite has been reported for Japan, whose percentile rate was the lowest with bad ratings. Italys percentile was double that of Japans and significantly lower than Australias percentile. http://www.conferenceboard.ca/hcp/details/health/self-reported-health-status.aspx The GP is the gatekeeper and GPs and specialists are loosely At point of delivery, GP charge FFS. Medicare bulk interchangeable. There are no treatment is free. However, GPs billing is observed and some family doctors, so first point of are paid on capitation basis. patients are charged, who are contact is with physicians from GPs are gatekeepers though then reimbursed 85%. Referrals hospitals. Services are provided with exceptions for psychiatric, to specialists are necessary. through public, private obstetricians, gynaecologic and Free accommodation for hospitals and clinics and preventative visits. For public Medicare eligible patients. patients have access to virtually consultations for visits to Private insurance covers most any facility and any doctor. specialists, flat rate payment is of the cost of private and public Patients accept responsibility of a must. Hospital care is free at hospitals. Patients with private 30% of costs whilst government point of delivery and provided health insurance can choose pays remaining 70% for medical by public hospitals. Local health their own doctors. School age and dental consultations. authorities are able to contract children and low income Hospitals tend to charge more out services to private persons are given free dental without referrals. Patients are hospitals, which if authorised, care. Otherwise, dental care is billed for hospital costs. By law, are reimbursed by NHS funds. self funded via private health all citizens are required to have Dentist consultations are insurance. health insurance. strictly private. Unlike Australia and Italy, where GPs are gatekeepers, the hospital is the first point of contact in Japan and whilst the former have specialists, Japans physicians are multidisciplinary. Treatment costs are similar in Australia and Japan, where both countries have a national health insurance though Australians are bulk billed whereas the Japanese pay 30% of the fees upfront. Italy on the other hand, has treatment costs which are free at the point of delivery and capitation is the form of payment. Referrals to specialists are required of Australians whilst for Japan and Italy; no referrals are needed as they are public consultations. Accommodation is free for Australians with Medicare though the Japanese need to pay. No information was given about hospital accommodation costs in Italy though hospital treatment is free at point of contact, whereas in Australia private and public health insurance covers hospital costs and the Japanese are billed and charged without referrals. The Australians and Japanese are able to choose their own doctors (Private health insurance only in Australias case) though no information was given for Italy. Dental case is free for low income and school children though self-funded with private health insurance in Australia; paid partially upfront in Japan and strictly private in Italy.

Comparison of life expectancy among these three OECD countries Subjective Health Status

Comparison of subjective health status among these three OECD countries Source Access to Health Services

Comparison of access to health services among these three OECD countries

Activity 1.2: Develop for yourself a working definition of health and of health systems and draw a diagram which demonstrates how in your view health status relates to health determinants and health services. Health: Health is the term encompassing a sound complete state of wellbeing, social, mental and physical wellness and not just the mere absence of illness. Health systems: Health systems is an umbrella term which comprises of multifunctional and multilateral public and private organisations governed in accordance to legislative regulations. Health systems are dedicated to improving health status, accessibility and wellbeing in populations in professional, traditional or informal settings.

Health Status

Specialised Public

Health Services

Integrated

Private

NonTraditional

Health Services Physical Environment

Social and economic environment

Income

Health Determinants

Personal Characteristics

Genetics Education

Gender

Activity1.3:
Write a one page description of the Australian Healthcare system such as you may use to describe the system to a new immigrant. Explain briefly why the system is structured as it is.
The Australian Healthcare system is a complex mixture of private and public services underpinned by three core pillars: the nations compulsory insurance Medicare, privately subsidised health insurance and the subsidised Pharmaceutical Benefits Scheme (PBS). The places where you can receive treatment include private and public hospitals, private medical practitioners, clinics, government and non-government run institutions. I will explain to you in much detail as possible, the structure of the healthcare system. The Australian healthcare system is based on the UK model due to the establishment of British penal settlement in Sydney 1788. Before, traditional healers and bush medicine was the main system for the Aboriginal communities. Initially, the government provided health services as its recipients were largely convicts or guards though as larger free settlement from the British colony grew, private medical practise grew. A board of health was soon established and government control of hospitals in NSW and subsequently other Australian states were observed. Health services were soon were provided by government services, religious services and charities, private practitioners working alone or in groups and profit private companies. This mixture of services meant that health providers worked independently though the small community size meant that large private investments for hospitals and health infrastructure were prohibited. Governments were thus responsible for providing this infrastructure for the free community as well as convicts and guards. The federation of Australia in 1901 led to the six colonies their respective delegating responsibilities to the Australian government, the exception being health responsibilities. Quarantine regulations were established to control influenza epidemics, the Federal council of the AMA was mobilised in favour of unrestricted private medical practice, the PBS was introduced in 1948, providing subsidised pharmaceuticals to those in need, hospitals were made free for all Australians in the 40s. Election of a conservative government in 1949 reversed policies and restoration of services fees (with the exception of QLD) and private health insurance was observed. Private health insurance was encouraged and with the election of the Whitlam Labor government in 1972 brought the national health insurance scheme (Medibank), which then following the election of the Fraser government in 1975 brought the dismantling of Medibank, which was then offered as subsidised private insurance instead. The election of the Hawke Labor Government in 1984 introduced Medicare, the national health insurance scheme, which has remained ever since. The Howard government, who noticed the falling rate of private health insurance, started to promote it through introduction of premium rebates and life insurance. The Rudd government in 2007 then led to a reform of the health system, which has been continued by the Gillard government to where we are now. The system is structured as it is to give you a choice of service. Australias healthcare system is based off the UK model and its traditions and cultural links have been ingrained in our system. The system is a balanced outcome of competing influences. Healthcare delivery is advanced by the growth in technology where the government monitors providers and ensure equitable access to health services. Personalised healthcare has experienced a large growth and the increasing trend towards the centralisation of control and responsibility has led to the increasing specialisation of specialist care with a focus on preventative strategies and education. The difference between structures is in health insurance. If you want extremely quick, personalised care, you might prefer the private healthcare system, which is covered by private health insurance. The private health care system is special in that you can go to both private and public hospitals and request your own doctor. You can be admitted to hospital when you want to, those without private health care cannot control when they are admitted to hospital. The public health care system is known as Medicare. The federal government pays 100% in-hospital costs, 75% GP services and 85% specialist services. In this system, some services such as clinical services are increasingly being outsources to private companies. Conversely, in the private sector, when patients are admitted to private hospitals, the doctors fees are partially publicly funded. As you can see the distinctions between the public and private health systems are gradually blurring as this is reinforced through the observations where private hospitals have collocated with public hospitals to share infrastructure and resources. The BOOT scheme as also promoted, blurring between the two systems by having the government contract with the private sectors to build organisations that operate under private ownership, which is then transferred back to the government after an elapsed period of time.

Activity 2.1Examine the health policy statements for the 2012 Qld state election published by the major parties and produce a table which highlights the differences. ALP
Access to Emergency Care $1.5 billion in funding to upgrade emergency departments, faster access

LNP
Access to emergency care should be on time, with patients treated as fast as possible Free consultations and home visits to monitor infant growth

Greens
Improved preparation for pandemics

Natal Care

Education for women regarding pregnancy and natal care

More birthing services, pregnancy termination services

Workforce numbers

Doubling GP places and funding for 1000 nurses Attractive incentives and retention bonuses for doctors to work in rural and regional Australia Australians should know where their tax monies are being spent and MyHospitals website allows for Australians to choose the best care for them

More doctors and nurses should be employed Proposes that Queensland Health Staff should be paid the correct amount at the right time Queenslanders should have a clearer picture of what the Australian Healthcare system is like

GP numbers should increase GPs should have increased pay

Workforce pay

System Transparency

Queenslanders have the right to know exactly what is going in in the health care system and should actively take part in it

Facilities

Infrastructure to be improved for easier autonomy and transport access LHN devolved to local level, clinicians in control of community services Increased funding for public hospitals (13 billion)

Queenslanders having access to world class healthcare and hospitals

Increase of multifunctional community health care centres People have the right over their own health care Increased funding for preventative measures to reduce smoking, drinking and obesity Private health insurance rebate to be abolished in favour of Medicare Ban on junk food advertising on childrens television

Control of Health Services

Local clinicians should regain control of delivering health services Increased funding for improved accessibility for health services Support for Medicare and medicines

Funding

Medicare

The public health system will continue to be under Medicare Preventative health programs in schools workplaces and community. $103 million binge drinking strategy

Promoting well being

Ban on junk food advertising on childrens television

Examine the following and identify the role, responsibility of each tier of government: Food quality Patient safety and quality Reporting to WHO on health system effectiveness Pandemic preparedness Education of health professionals

Australian (Federal Government) Responsible for the funding of health services, quarantine matters, vaccination productions, disease investigation, educating the public and health professionals regarding health policies and regulatory standards upheld by registration authorities. Reports to WHO on health system effectiveness and reports statistics and performance markers through AIHW and the Productivity Commissions report which focuses on government services and national registers Disseminates information regarding patient safety and quality and recommends national data sets and guidelines to advocate for to ensure optimum safety for citizens along with suggestions for improvement

State Local Responsible for provision and maintenance of health services (public health services in particular) such as environmental health, immunisation, food quality, and disease prevention strategies including the control of water quality and the disposal of waste. Responsible for environmental health, immunisation and screening programs, infectious disease control , health promotions and illness prevention and pandemic preparedness Health Services include community and emergency health services and public hospitals

Activity 2.3
Read 'Health Service Management and the Law and explain how Bates is offering caution to readers by indicating the legal consequences of decisions taken by health services managers. Bates is offering caution to readers as legislation is not equally authoritative, noting that ignorance of the law is no excuse for a valid defence brought against the persecuted. Bates is calming readers, ensuring them that they will be justified rightfully if malpractice of a medical professional occurs. Malpractice of clinicians has resulted in large ramifications for the workforce, where clinicians are more afraid of being sued than before. A preventative guideline has been suggested wherein clinicians are to act in accordance to patients wishes and to avoid imposing of views unduly onto patients, whose values must be respected. Confidentiality and professionalism are valued. Conundrums take place in situations regarding life-or-death scenarios and health professionals are faced with dilemmas which are ethically contentious or morally unacceptable such as euthanasia usage. Bates is telling the readers to be weary and emphasises this point by providing examples. He observes that patients are being used as guinea pigs for new and unevaluated treatments, known as assault and battery and without their knowledge and consent, warning readers to inquire more about their healthcare and treatments. If detained against their will (false imprisonment), not treated as necessary by legislative obligation (breach of statutory duty), doctors can be sued. Doctors have been sued for causing injuries to patients and harming patients under their care, known as civil negligence, having sexual relations with patients, defamation of patients and for disclosing confidential information about patients. Usually, the relationship between a doctor and patient is confidential. However, courts are able to demand access to patient records. In court, Medical practitioners must provide medical reports and oral evidence as expert witnesses. There was a once an anaesthetist who was guilty for criminal negligence, which resulted in manslaughter when he failed to detect the lack of oxygen reaching the patient in an operation. Bates uses this example to make readers wary of health professionals and make them realise that the court will rule in the patients favour. This example serves as a warning to health professionals, prompting them to be more focused and attentive to their patients needs. Even if medical professionals are attentive to their patients needs, they must also make it understood to their patients what treatments are possible and what risks are involved. The medical professional must not withhold information from the patient. For organ farming, a persons organs die at different times, and the organs are only taken after the patient is declared brain dead. It would not be suitable for clinical personnel to disconnect life support after attempts to save the patients life was unsuccessful.

Activity 2.4
Name 5 different types of health service organisations you are familiar with and create a table which describes the services provided and the ownership arrangements. For example: Organisation Services Provided/ownership

Private charitable hospital Acute medical care, food services, laundry, physiotherapy, outpatient department.

Organisation Mater Hospital Not for profit organisation which operates 7 hospitals

Services Provided/ Ownership Includes a range of hospitals Education Services Affiliated with universities Training for general practitioners Food, beauty, childcare services, acute medical care, allied health, occupational therapy, pathology, social work, speech therapy services Founded by Sisters of Mercy and run by the Mater Foundation. Owned by Mater Misericordiae Health Services Brisbane Limited

Invisalign Private company specialising in orthodontic services Luxottica Profitable business which runs eye care chain stores

QML Pathology Private pathology services.

Medibank Private health insurance company

Owned by Invisalign Australia Pty Ltd, marketed, designed by Align Technology, Inc Provides oral health , orthodontic and paediatric services, overbite correction Runs OPSM, Sunglasses Hut, Laubman and Park, Budget Eyewear and Bright Eyes. Provides information regarding Eye care health standards, franchising opportunities, provides warranties for eye products, employment services, frame dispensing services. Runs a profitable foundation called Onesight, which provides accessible and free eye care and eye wear around the globe. In partnership with Salvation Army. Owned by Bruce Gutteridge and Robert and James Duhig , the sons of the original founders. Drug and alcohol, workplace and safety, pre-employment, employee health screening. Veterinarian vaccination and pathology services. Diabetes care clinic. Named Medibank Private Ltd

Run by board of directors

Provides cover for dental, physiotherapy, chiropractic, naturopathy, acupuncture, optical items, osteopathy, overseas students and visitors coverservices and more Includes personal insurances such as life, pet and travel (both international and domestic) insurances.

Activity 2.5
Consider a public hospital. Mater Hospital 1. Who owns the hospital? The hospital is owned by the Sisters of Mercy 2. Who operates the hospital? The hospital is operated by Mater Misericordiae Health Services Brisbane Limited 3. What is the role of the CEO? The role of the CEO is to manage and regulate the management of the Mater Hospital. The CEO of Mater is Dr John ODonnell, who leads Maters executive team and has led Mater through a rapid growth. He ensures that Maters Mission of delivering compassionate care to the ill and needy are alive and well. Under his guidance, the Maters Mothers hospital was opened, and he oversaw the transition of Queensland Paediatric Cardiac Service from the Prince Charles hospital and lastly, he has led a course of innovative evidence based health care. The CEO is part of the board of directors, and he advises those under the board of directors and motivates his employees and drives change within the Mater Health Services. Who are the key stakeholders? The key stakeholders are people who have an interest in Mater, largely the patients, employees, board of directors, the government, administration, suppliers and the community. The patients are invested in having the best healthcare provided to them, the employees are interested in providing services following their job descriptions. The board of directors are interested in making the decisions behind the running of the hospital and how features can be improved. The government is invested in providing funding for the hospital and the administration is involved with running the hospital. The suppliers are interested in providing the hospital with medical devices, functional contraptions, bedding, computing technologies and essentials such as paper. The community is interested in participating actively in voicing their opinions regarding the care that Mater provides.

Activity 3.1
Australia spends an estimated 9.4% of GDP on health while the US spends 17%. 1. Identify and discuss at least five factors that may contribute to this variance. Taking into consideration social, economic, cultural and health factors, there are a lot of factors which contribute to this variance between estimated percentages of GDP spent on health. These factors include chronic disease, obesity, heart disease, smoking, alcohol and so on. There are many ways in which the Australian Health care system could constrain the growth in costs. 2. Discuss five ways in which the Australian Health care system could constrain the growth in costs. There should be education and preventative methods in place. This strategy would not only educate the public in improving lifestyle, but it would also be effective in reducing treatment costs. Through TV advertising, advertisements could be shown to the general public regarding the outcomes of unhealthy habits could make people feel averse to continuing or taking up these unhealthy habits and promote improvement in lifestyles. Operations should only be undertaken as a last resort though many people are taking up this option due to wanting a faster and immediate improvement to their lives. An instance of this would be gastric bypass surgery, which is not only costly, but is sometimes unneeded. To rectify this problem, medications should be used instead. Medications are not only cheaper than operations, but they are also much safer to use. Also, many people are visiting doctors and taking up hospital beds for unnecessary reasons. This is not only costly, but potentially dangerous as some people need those facilities and health services more than others. It could be suggested that people seek other professional alternatives first before going to the doctors or hospitals. Medical equipment has been overused and inappropriately used, increasing the growth of costs in the health system. To control this variable, medical technicians and professions should receive more training regarding device usage and medical practitioners should not refer their patients for services which are unnecessary for them. Budgeting, though already in place as casemix, should be furthermore emphasised to constrain the growth in costs. More thorough plans and outlines should be made and followed whilst transparency and regular progress reports should be made to monitor cost growth. Benchmarking should also be used to curb ever-growing increases in costs. Benchmarking effectively is a way of finding another way to do something which confers more benefits overall. It is based on understanding of things are done and adoption of similar practices would be beneficial for the Australian healthcare system. Benchmarking would set target benchmarks for the system, find comparisons between things and more.

Activity 3.2 1. Increased specialisation and the creation of new professions have been features of the workforce over the last 20 years. Suggest possible impacts on the delivery of health care from this trend. Increased specialisation has led to more specialised equipment and techniques. In all, the training gone into educating new professions and monies used to develop machinery has been extremely costly. Healthcare has become more complex with a network between clinicians and specialists. In order to accommodate specialisations, more facilities and infrastructure had to be built. Since health services are not delivered at the local GP as they used to, more travelling and postal services have been evident though time consuming. Healthcare has become more focused. 2. Discuss factors you believe contribute to the geographical misdistribution of health professionals in Australia. Rural areas are remote where smaller populations of people reside in, thus some specialised health professionals may not be needed. In urban areas, health professionals are more accessible in comparison and the populations are much greater than in rural areas. 3. Discuss why market forces fail to remedy the misdistribution of medical practitioners in Australia (that is, why does the oversupply of GPs in metropolitan areas and the undersupply in rural and remote areas persist?). The rural areas are thought to be remote, with little supplies or facilities for medical practitioners to carry out their jobs. Market forces fail to understand that GPs need larger scale support systems. There may be a smaller distribution of pharmaceutical drugs in rural areas, less transport options. 4. Discuss the challenges that would limit expanding the scope of health practitioners into areas that are traditionally those of another profession. E.g. Enrolled nurses, Nurse practitioners, radiographers diagnosing Xrays. There would be discrepancies if expanding of scope occurred, such like retraining of health practitioners which is time consuming and costly. New facilities and equipment may need to be built into already existing clinics, which calls for the need for refurbishment costs. People already in the existing professions would be displeased to see the amalgamation of health practitioners into another fields profession as their job security may be threatened. Protests and strikes may occur as a result. Some professions may end up becoming defunct, pushing people into retirement or redundancy. There will be a lot of pressure to take on more jobs that they didnt need to do before.

Activity 3.3
Identify and discuss the key strategies you consider could reduce the growth of cost of pharmaceuticals. To reduce the growth of cost of pharmaceuticals, we should understand that many diseases can be prevented before there is a need for pharmaceuticals. For diabetes, more advertising and education could help prevent this by encouraging people to improve their lifestyles to a healthier one. Poor diets can be treated by visiting dieticians and nutritionists, whose advice should be taken before taking pharmaceuticals. There should be more focus on advertising vegetables, which Australia has plenty of so there is no excuse for consumers not to buy any, as they are also very cheap. For lung disease and lung cancer, smoking habits need to be circumvented so that incidences decrease. Measures have already taken place where the costs of tobacco are rising very quickly. This deters consumers from buying these products as they have become extremely expensive. Graphical ads have also been placed on cigarette boxes as a means to disgust smokers and turn them off the product. Drinking problems have also been a large source of concern and preventative strategies have already been put in place by the Australian Government via use of television advertising. Increasing education in schools has also warned of the impacts of drinking and the problems that entails e.g. Cirrhosis. More strategies could be put into place by furthermore increasing prices of alcohol, which would prevent people from acquiring diseases, therefore lowering the amount of people taking drugs to curb their addiction. Growths in pharmaceutical costs can also be decreased through the workplace. In workplaces, especially offices, people work for long hours on ends with little breaks, which could lead to issues developing such as haemorrhoids, carpal tunnel syndrome, strained eyes etc. These conditions are treated by pharmaceuticals and can be reduced by increasing break times in offices, which would encourage employees to move around more and exercise. An exercise regime can also be incorporated into the workplace, promoting wellbeing. In schools, bad hygiene practices can lead to the circulation of viruses, illnesses and events like head lice, which are treated which pharmaceutical products. To reduce these incidences, hand washing must be thoroughly practiced. Teachers could supervise students when they go to toilets in order to enforce these practices. Also, canteens should place a ban on junk food and instead place fruit and vegetables on the menu. Teeth brushing should also be a MUST in schools as the costs of pharmaceuticals such as cold sores medicines, toothache drops and antibiotics are increasing. The usage of these pharmaceuticals can be reduced if dental health is kept up to standard. Overuse of pharmaceuticals is a large issue, wherein drugs are used excessively, and increasing pharmaceutical costs. To control this issue, clinicians should be consulted about dosage of medicines and education would help with informing people about the safe dosages associated with drugs like aspirin.

Activity 3.4
Consider some recent technologies and discuss the factors that should be taken into consideration in their implementation.. Some recent technologies have been numerous, comprising of technologies from the area of biotechnology, medical devices and pharmaceutical developments from the life sciences, e-health from information technology and many others. In the area of the life sciences, technologies have been largely therapeutic and diagnostic, including areas of stem cell research, gene therapy, organ farming and transplant technologies, genetic engineering and other technologies. These technologies, though extremely promising, are also a source of concern as to whether they should be implemented or not. These technologies may be ethically contentious and controversial. They are also extremely costly and are research based, which could be time consuming. Organ farming in particular, is a source of conflict. Also, specialists are limited and this can be an issue when demand for certain technologies is high. Medical devices include a large range of devices, ranging from angioplasty, cochlear implants, medical laser technologies; diagnostic imaging machines and lithotripsy machines have greatly advanced how diagnoses are made for the last 30 years. However, there are many factors which should be taken into consideration. Firstly, cost is a large factor and all of these technologies are extremely costly to manufacture and they are costly to set up. These are much specialised technologies, which may not be suitable for some populations. For example, it would not be reasonable to have MRIs in rural areas as populations are comparatively smaller to urban areas and the variable costs involved in setting up and running these technologies may never be covered. This is an instance where a slow rate of diffusion technologies is involved as demand serves as the impetus for the usage of these services. Information technologies have also advanced greatly in modern times though its application tends to lag. New information systems are continuously being developed to overcome efficiencies. Faster processors, a range of intelligent devices, reliable communication services and internet access will continue to develop and improve. However, software is not developing up to the same standard as these above technologies, which is an issue. Specialised computing such as wearable computing and wireless computing have already been developed. IT and communicative strategies have led to a more distributed health services with less reliance on centres of excellence and tertiary hospitals and a greater ability to treat patients nearer their homes. What is to be taken into consideration regarding the implementation of these technologies is that of the cost of implementation. Medical information can be accessed on the internet freely, which can have be detrimental as patients may wrongly diagnose themselves with diseases they do not have whilst doctors are receiving less patients as they diagnose themselves online. This may be potentially dangerous in risky in behaviour on the patients part.

Activity 3.5
Discuss five factors that will impact on the cost of consumables and identify how those costs may be minimised.
Chronic diseases impacts on the cost of consumables and these costs can be minimised by preventative strategies. More information regarding chronic diseases should be relayed to people. People should also change their lifestyles for the better and take up healthy habits like exercising and the refraining from smoking, drinking and unhealthy eating habits. Medicare Levies can be used to minimise consumable costs as they Health Insurance, when implemented, can also reduce cost of consumables. Health insurance, in particular private, allows easier, faster and more accessible care so that more patients are treated in a shorter amount of time, saving costs. The more people who have health insurance, the better the prospects for reducing consumable costs are. Drug Implementation could also help with cutting costs of consumables. As more drugs are available on the market, people will be able to take them as a means of treating diseases without resorting to operations. Also, the location of suburbs is another important factor in determining cost of consumables. In suburbs which are closer to densely populated places, the costs of consumables are much higher. In reducing these costs, there could be strategies implemented to close up the gaps between densely populated suburbs and sparsely populated suburbs. This way, there would be even numbers of populations in suburbs, reducing consumable costs as the demand for such consumables decreases. Population is also a factor which impacts on the cost of consumables where the larger the population, the larger the cost of consumables. Hospital beds are an issue though day surgeries are becoming increasingly common, gravely ill patients are being released earlier than they used to and are released back into the community, which is equipped with safe alternatives. Activity based funding could also help with reducing the cost of consumables. Firstly, planning and budgeting could highlight and serve as the impetus to show the most equitable way to allocate resources. An instance of this would be use previous hospital records and highlight the faults which are costing the system money. For example, the duplication of health services (which is extremely costly to the system) could be stopped if patient records are accessed more frequently. This would increase productivity of the system and reduce cost of consumables. Just-in-time deliveries, international and national approaches to standardisation, standardisation purchasing policies are strategies used to minimize consumable costs. One off products has become the norm, reducing system inventory and reducing the systems capacity to absorb surge.

Activity 4.1 Medicare: Universal Access or Safety Net?

In The current distribution of expenditure across the Australian health system, is sometimes described as hospital centric with less than 2% of total health expenditure occurring in public health activities (AIHW: 2006). As the population ages and chronic diseases like diabetes place increasing pressure on the hospital system, there will be a need to ensure investment is more appropriately balanced across the health continuum. 1. What are the barriers professional/institutional/political/financial to moving investment between care types?

The barriers to moving investment between care types are that of the scarcity of resources, knowing how much to spend without overspending resources and the fact that medical care and health insurance have tendencies to fail. Uncertainty in the number of incidences of disease diagnoses, treatment and prevention are other barriers which prevents the movement of investments between care types. Efficiency is another barrier, as it is hard to maximise benefits without compromising least costs. 2. Give an example of a health policy that seeks to redistribute health inputs between the private and public health sectors.

GPs are increasingly being redistributed back into the public health sector from the private health sector to narrow the gap between the large numbers of GPs in the private sector to the smaller number of GPs in the public sector. The transferral of public hospitals to private owners, contracting health services such as radiology and pathology services out of public employees is another example. The expansion of the private health sector should not be at the expense of publicly available health services. 3. What is the basis for how this policy would achieve greater allocative efficiency?

For this policy to achieve greater allocative efficiency, the basis for it would be that of networking and communicative technologies. If profits could be made out of this policy, greater allocative efficiency can be achieved, that is allocative efficiency is the product of the situation where health resources are unable to be redistributed to receive greater benefits. This policy can be improved to achieve the best possible outcomes when inputs are allocated in the health system.

Activity 4.2
Identify and discuss five issues that are challenging the future design and functioning of the Australian Healthcare System.
Issues that are challenging the future design and functioning of the Australian Healthcare System include that of the evergrowing aging population, increased incidences of obesity, chronic diseases and cancers; the increasing population, politics, advancing technologies, resources and capabilities of the healthcare system, equity of health services and equity of outcomes. The ever-growing aging population has placed the Australian health system under pressure as cost of consumables increase and demand for health services due to increased expectations increases particularly for this population. The functioning of the healthcare system may be changed in the future to provide more health services for the elderly. Also, if the population were to increase exponentially as it is now, the resources available to the healthcare system will become limited. Infrastructure will continue to be established in order to keep up with population growth. Changes in lifestyles are leading to lower levels of physical fitness and increased incidence of obesity, chronic diseases and cancers are partially the result of increased longevity, so these factors are linked to the ever-growing aging population. These factors are placing increasing pressure on the health care system as these populations tend to grow and live longer when they otherwise would have died decades ago as opposed to now where health care status and quality has improved immensely. The increasing population is also challenging the current model of the healthcare system, which may serve as the impetus for changes such as increased GDP and resources needed to sustain health status and wellbeing in Australia. Uneven standards are also an issue as health determinant differences, in conjunction with sociological and other factors have led to the indigenous, remote, rural populations and those with differing cultural, economic, socioeconomic backgrounds to have limited access to health care. This is detrimental to the healthcare system as equitable access to health services is a must and this places pressure on these populations, prompting the government to place more funding and research into these areas. Politics is also another factor which is challenging the healthcare system. With different political parties constantly changing, different health policies are coming up. As political parties change, the health care system is indirectly changed as a result. Quality and safety must be considered without being compromised due to politicians wanting to retain their seats. Advancing technologies can also potentially change the direction which the healthcare system is heading towards. Advanced technologies lead to highly specialised systems such as e-health, medical imaging techniques and so on which puts pressure on the healthcare system to improve and constantly upgrade to increasing standards and demands on technologies. Healthcare systems can lag behind continuously advancing technology, calling for the need for the healthcare system to improve. Differences in funding arrangements and systematic failures regarding planning and organisation are accountable for the fact that some areas of our healthcare system is not up to standard as some others. Dental health is primarily self-funded and mental health treatment is relatively new to our healthcare system and is fraught with organisational failures and longstanding altitudinal issues. There is pressure regarding system efficiency, affordability and costs and how outsourcing can help with reducing costs. Investments in new technology is also challenging the future design and functioning of our health care system as there is no evidence that suggests genuine outcomes at a systematic level. This means that costs are adding up rather than improved efficiency being observed, though improved access to health care can be shown through standardisation of procedures and supervision. Workforce shortages are also placing pressure on the system, which will lead to increase in training places and preventative health care though there will be issues with retaining the jobs of those currently employed, which could become an issue if too many training places are opened up. Management of change is still going to be a major issue in the future; job security could be threatened so employee and industrial relations will continue to be important.

Activity 5.1 Identify and briefly discuss the drivers and principal barriers to health reform in Australia.
The drivers and principals barriers to health reform are: Confusion: Uncertainty and ambiguous goals and values towards health reforms. Some politicians have ideological commitments whilst others just want to be re-elected Vested interests: The community demography is constantly changing and thus, the demands of the community are changing too, which makes it hard for health reform to be carried out as there will be a need for change sooner or later. o o o o o o Demands and expectations are increasing Immigration brings in attention to diseases of their communities The aging population are requiring increasing attention Urbanisation has led to the concentration of services in densely populated areas whilst decreasing health services available in rural areas Communities have little tolerance to increases in taxation, which supports higher level of services Chronic diseases have different modes of services, which includes participation of patients

Complacency o Job security and stability: Some health professionals may already feel satisfied with their jobs and the security they provide. They may feel that their job security may be threatened if health reforms are introduced due to competition. o Working hours: Health professionals may feel content with the amount of hours they work a week o Education required and on-going professional development: Health professionals may be satisfied by the level of education they have achieved and would rather not continue learning throughout the course of their professional lives as it places a lot of pressure on them. o Lifestyle driven changes o Uneven distribution between Poor Communication: o The lack of communication in the health system leads to problems arising, which in turn, costs the system a great deal of money o Leads in inadequacy in the system, which comes under scrutiny by the public o Reduces system transparency as information is not being conveyed to anyone, creating confusion Isolated Ideologues o Politicians opposing reform will say anything to mount their opposition by scrutinising the oppositions errors in their implementation of policies, selecting negative histories, making exaggerated claims regarding quality and safety, misinterpreting information, whether deliberate or not to create confusion so that they are viewed in a favourable light Inadequate Change Management o o Inadequate planning regarding a more planed workforce strategy where a broader scope of practice reflects teamwork has been observed Little management and poor planning regarding giving attention to the disadvantaged, who require specific health requirements, in particular the Torres Strait Islander and Aboriginal people. In conjunction with significant copayments, limits these persons access to health services Our system funds in a perverse way, with bizarre incentives for expensive services Overregulation where managers cannot guarantee to be completely compliant with obligations and the extent of regulations and standards are large. Some standards are supposed to standardise some elements though a contradictory effect can be seen, which impose a degree of resource commitment which cannot be possibly met by the health system

o o