Health System: Cancer Patients

Discuss about the Health System for Cancer Patients.

Introduction:

Providing excellent health care at the optimum cost should be the main agenda for every country. Health care system of any country is the reflection of the health status of that particular country. In this essay health status of Australia and U.S. are compared. Aim of this essay is to compare healthcare systems of two highly advanced and industrialised countries like Australia and U.S. Healthcare system of these two countries will be compared, based on funding mode, responsibilities of stakeholders, insurance policies, equity of the healthcare system and services. Also, existing current issues of these countries will be discussed. Healthcare system of these countries will be discussed with main focus on the primary health.

Discussion:

Australia and U.S. have 7.5 and 3.5 hospital beds per 1000 people are respectively,  Australia and U.S. people have life expectancy of 80 and 76 years respectively. Australia and U.S. have 2.5 and 2.3 physicians per 1000 people (AIHW, 2013). Percentage of total health spending compared to the Gross domestic product (GDP) is around 9 % and 17 % in Australia and US respectively. In Australia this healthcare spending is slightly lower than average of Organisation for Economic Co-operation and Development (OECD). Average spending by Australian citizen is around $750 per capita as compared to the spending of American citizen which is around $1000 per capita. In Australia, around 20 % people wait for their surgery, while in US this percentage is much lower at around 7 %. In Australia around 15 % people are experiencing obstacle to access healthcare practice due to cost and in U.S. this percentage is around 37 % due to high cost of healthcare in U.S. Number of deaths occurred per 100000 people that could have been possibly prevented in existing health care set up are around 55 and 95 in Australia and U.S. respectively (TCF, 2016). Though, with more healthcare cost, mortality rate is more in U.S. as compared to the Australia (Dalziel et al., 2008). In U.S. compulsion of more employment in the healthcare system cost more healthcare expenditure for citizens and people are paying more amount for the health insurance schemes (Jones et al., 2011).

Policy: Australia implemented national health care system called as Medicare in 1984 and prior to that Australia experienced privatisation of health care system. Also, there is the provision of availing private health care for those citizens who have their income more than certain threshold. This adjustment in the health care system was implemented mainly to lessen the disastrous loss in healthcare. Approximately 40 % people in the metropolitan in the Australia are availing private healthcare services. Australian health care system is mainly working based on the social justice and its government has to take care of aboriginal population and living mainly in the rural area of Australia. Australian government mainly working towards providing healthcare to every individual. American health care policy mainly working on the basis of market justice and American government believes in taking care of on their own by the citizens. In U.S. national health care programme is mainly for the senior citizens only, however in Australia Medicare policy is for all the age group people (Jones et al., 2011).

Funding: Australia’s health care system, Medicare is a public insurance policy which is tax-funded. This policy is free to everyone and it covers all the medical expenses including clinician and hospital cost and moreover, it also covers part of the expenses of the prescription medicine. Financial support is mainly provided by federal Australian government, however public hospital care is covered by state government. In this way funding to the Australian healthcare system is complex but efficient in providing healthcare services. Funding can be availed from federal and state governments, health insurance organisations and own money. On the other hand funding issue in U.S. has not been resolved completely. In US healthcare funding is dissimilar for each state. In most of states in the U.S. healthcare insurance is funded by private companies or sponsored by government funds either state or federal governments. In 1965, U.S. government has established Medicare and Medicaid programmes for people over 65 years age and for people of low socioeconomic status respectively. U.S. has established Affordable Care Act (ACA) or Obamacare in 2010 (Baicker and Finkelstein  2011). The Affordable Care Act was planned to proliferate health insurance quality and affordability, lessen the uninsured rate by increasing insurance coverage and lessen the costs of healthcare (CMS, 2014). However, this U.S. act is with few drawbacks like more provision for market for offering insurance to individuals than the government and it is supporting growth specific to the primary healthcare. Increased budget for providing health for all people of the different class is becoming a challenging task for all the developed countries including Australia and United States (U.S.).  Both countries have reacted in many ways to utilize legislation as a means of controlling escalating costs (Shi & Singh, 2010).

Services and professionals: In Australian healthcare system there is the problem in getting appointment for primary physician, however American citizen can get appointment of primary physician on the same day. U.S. and Australian healthcare system has the practice to enrol students in the clinical practice and this helps in improving the quality of medical education in both these countries. As a result, doctors can be readily available for medical practice after their education. However, in case of Australia exposure of the undergraduate medical students to the actual clinical practice is more as compared to the undergraduate medical students of the U.S. In Australia, general practitioner (GP) is considered as the manager of particular healthcare setup or hospital, however in U.S. medical system such enrolment is not there. In Australia, GP is usually refers patients to the specialist doctor, however in U.S. medical system there is the provision to patients to refer to the specialist doctor on their own. In U.S. there is the provision for specialists to perform the function primary care physician, while in Australian medical system, primary care physician can perform the function of GP, at the hospitals where large healthcare delivery is required. In Australia scope and practice of primary physician depends on the geography (rural vs urban), population (large vs small) and setup (hospital vs outpatient) and it varied according to the conditions and requirements (Elshaug et al., 2012; Jones et al., 2011). In U.S. in healthcare policy varies according to the states, however scope of the primary physician remains the same throughout the U.S. In terms of facility provision to the doctors, U.S. doctors possess approximately 4 rooms for the purpose of examinations, which are maintained and supported by skilful primary physicians and nursing staff. In case Australian doctor, there is the availability of one examination room for each doctor. Due to the availability of more examinations rooms, there is the possibility of optimum scheduling of patients in case of U.S. doctor. In U.S. all the stakeholders of the healthcare work as a team for example consultant psychiatrist, clinical psychologist and social workers work together for managing the mental and psychological health issues. Such teamwork is there in Australian healthcare system,  however it is limited only to the public sector and not to the private sector. In Australian medical system there is the scope for GP to perform basic surgical procedures particularly in rural areas (DHA, 2016). To support this practice, there is the provision for 12 weeks compulsory surgical training programme during their medical graduation and 2 years internship programme after completion of their graduation. As these training practices are not available in U.S. medical education system, GP cannot perform basic surgical procedures in U.S. In case of labor wards, in Australia clinical management is provided by midwives and in U.S. it is provided by resident house staff.      

Providing quality healthcare is mainly depends on the hospital and its healthcare staff because Australian government doesn’t provide healthcare in practice to each individual, however Australian government provides funds to healthcare management and hospitals (Duckett, 2012). Most of the people in Australia are availing insurance from private companies and these people are getting subsidy on the insurance policies of private sector. This makes easy for people in Australia to avail medical services provided by both government and public sector irrespective of their level of income. 

In Australia most of the doctors are following the trend of private practice and also they are receiving payment on fee-for-service basis for public hospitals. For physicians in Australia working in both private and public sector hospitals is very flexible. As physicians in the public sector hospitals can get their own salary and also can see the patients in private sector and charge for them (De Bruin et al., 2011; Greene, 2013). On the other had physicians in the private hospitals also can take care of patients in the public hospitals and charge for them. This type of policy helped to build to positive attitude in both public and private sector hospitals and they can work more efficiently. Also, there is more learning for these physicians as these physicians are getting more exposure of different type of patients. As a result death rate is lower in Australia is less as compared to the most of the developed countries. 

Effectiveness and Efficiency:

U.S. healthcare policy is not uniform for all classes of population and as a result every citizen is not getting reliable healthcare service. In U.S. there is imbalance in expenditure on healthcare and health outcome, hence this system is not efficient as expected. In U.S. there is the implementation of advanced technologies, innovation in healthcare and skilled workforce, hence U.S. healthcare system is effective in managing healthcare issues. As cost of healthcare service is not uniform throughout the U.S. this system is not effective and efficient in providing healthcare to all the population (Fenton  et al., 2012).

In Australian health care system some primary task can be effectively performed by other professional like primary physician can perform basic surgery. This type of workforce management increases efficiency of healthcare system in Australia. Spending on the prescription drugs is shared by the government and individual patient, so that it increases effectiveness of healthcare system in Australia (Clarke, 2012). Insurance policy is same for all citizens in Australia and it helps to improve effectiveness of healthcare system. Good sorce of information can augment efficiency of system, hence National reporting on hospital performance was established in Australia.

Current Issues:

Currently Australia is facing problem of waiting for the patient for long duration for few of the clinical procedures, mainly due to the less number of hospitals relative to the population. In the similar line, Australia also has very poor ranking in terms of appointment of primary health care physicians to common people, mainly due to the less number of doctors relative to the patient numbers (Beckmann et al., 2014). These both the issues can be resolved by increasing number of hospitals and doctors per 1000 persons. As, people in Australia are ready to visit both the public and privates sector hospitals, these issues can be resolved by promoting both type of hospitals either public or private. Rural healthcare is another issues, Australia is facing problem in providing quality services. As compared to the metropolitan region, life expectancy in the rural area is around 3-4 years less.

In American healthcare system, main issue is cost of the treatment. Cost of treatment per individual in U.S. is high as compared to any other developed country. However, corresponding outcome from the healthcare services are not encouraging. Healthcare plans and insurance policies are not uniform throughout the U.S. In U.S. uninsured population is more as compared to the insured people hence healthcare accessibility is less. Pricing rate for the healthcare services is not publically available and hence patients cannot select correct healthcare centre or physician.

Primary Care:

Medicare policy in Australia covers both primary care consultation of GP and co-payment. Also, Australian government arrange funds for prescription drugs in the primary care. Spending on the primary care in Australia is form own and if required insurance option is also available. Australian healthcare system is complicated by control of different authorities like federal government, state government, private hospitals, private companies and community. Medicare, pharmacy drugs and Medicare locals are financed by federal government and hospital charges are funded by state governments. On the other hand, primary healthcare was controlled by federal government of U.S. After the implementation of ACA, spending on the primary healthcare is shared by the government, patient oneself and employers. Primary healthcare in the U.S. is strengthened by strategic expansion in the clinical and community based investments (Martin  et al., 2012) . On 1st July 2015, Primary Health Networks (PHNs) were started in Australia to improve the patient services in that particular area and these were connected with the local hospital networks. In primary healthcare practice, insufficiency of number of GP relative to the total population in that particular area specifically in the rural and urban periphery is the major drawback in the primary healthcare system of Australia. In U.S. federal government and Medicaid programmes implemented different payment systems like medical homes and accountable care organisations (CMS, 2014). Through, these different mode of payment options, U.S. primary healthcare achieved flexibility in the payments and there is the significant reduction in the total healthcare cost. In Australia, primary care physicians are considered as GP and in U.S., general internists & paediatricians and family practioners are considered as GP. In U.S. less number of health problems are controlled in the primary care centres because there are more number of specialists are available as compared to the primary care physicians. In Australia case is reverse and most of the health problems are controlled in the primary care centres. This reflects there are more number of primary care physicians are available in Australia as compared to the U.S.  For primary healthcare, percentage of people with insurance is more in Australia, as compared to the U.S. In terms of clinical condition it has been observed that patients visits to primary health care centres in U.S. are more for cardiovascular and endocrinology conditions as compared to the Australia. Average duration of visits to U.S primary care physician and time spent in the primary care centre are more as compared to the Australia.       

Conclusion:

There are fundamental differences in Australia and U.S. health care system. There are differences in funding mode and responsibilities of stakeholders in the healthcare system. There is more spending per individual care in U.S. as compared to Australian individual. Healthcare system in U.S is more technologically advanced as compared to the Australian healthcare system. In Australia, there is shortage of healthcare professionals as compared to the U.S. Healthcare policies are uniform for all citizens in Australia. Although, few drawbacks are there, Australian health care system is more efficient than U.S. health by providing better health to Australian citizens at lower cost.

References:

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