Seminar Paper on Health Policy in Australia

7/29/2019 Seminar Paper on Health Policy in Australia

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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 manyinstances 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 constitutionto 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.


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Health of Indigenous Australians

Current health statistics of Aboriginal people point to a huge disparity when compare to non-

Aboriginal 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 workersplay 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


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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 theideal 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

Documents

Seminar Paper on Health Policy in Australia