Promoting health in Australia

The Australian health care system The Australian health care system focuses on the treatment of illness, the rehabilitation of the ill, prevention of illness and promotions of health. The system relies on both biomedical and preventative health care (social model). It is important to know which level of government provides which responsibilities in regards to the health care system https://www.youtube.com/watch?v=swSwRd86Xb0

On an average day in Australia, there are: 616 000 subsidised prescriptions dispensed 381 000 visits to a general practitioner (GP) 246 000 pathology tests 79 000 visits to a specialist 27 000 hospitalisations – 59 per cent in the public sector 27 000 allied health services provided 24 000 contacts made at community mental healthcare services 20 000 presentations to public hospital emergency departments – 30 per cent end up being admitted to hospital 1900 people admitted for elective surgery in public hospitals – 9 per cent for cataract surgery. Due to our ageing population and an increase in the number of people suffering from chronic disease, our healthcare system is getting busier each year.

S - Sustainability A - Access F - Funding E - Equity Australia's Health Care system works to promote health and wellbeing in relation to the following 4 areas S - Sustainability A - Access F - Funding E - Equity

Funding the health care system Funding the health system is essential to provide high-quality levels of care for all Australian, not just those who can afford it. Funding promotes health by: Providing infrastructure such as hospitals and medical technology such as scanning machines Provide ongoing training for health professionals so the quality of care remains high Subsidising health services through Medicare Subsidising essential medicines through the PBS Subsidising the cost of private health insurance for eligible policy holders Providing support through the NDIS Paying salaries of support and administrative staff Allowing the implementation of public health programs such as Quit and LiveLighter. Providing research and development relating to medical knowledge and technologies

Funding the health care system The health expenditure in Australia was estimated to be 155 billion over 2013-14 Almost 68% of this funding was by governments Health expenditure on Public Health activities has been declining since 07-08’, in 2013-14 spending was 1.4 per cent, or 2.2 billion of the total which included both public health and health promotion services. Of the 155 billion spent on healthcare in 2013-14, most was spent on hospitals, followed by primary healthcare (GP’s, nurses, allied health professionals, midwives, pharmacists)

Federal/Commonwealth Government Responsible for healthcare that impacts on all Australians including the following: Management and funding of Medicare Pharmaceutical Benefits Scheme (PBS) Allocating funds to state and territory governments for the running of public hospitals Providing financial incentives for those taking out private health insurance Funds the bulk of the nation’s health services e.g. Hospitals Develops and funds health policies e.g. NHPA, National Mental Health Strategy, Immunization etc. Quarantine services – protecting Australian borders Provides health funds for aged and war veterans Monitor food safety and regulations

State/ Territory Governments They are responsible for the following: Public hospitals Psychiatric hospitals The school health curriculum Delivery Health services e.g. Public dental health, maternal and child welfare clinics Ensures that the environment is healthy e.g. Regulates water cleanliness, sanitation and air quality Provision of information and education programs promoting health through government agencies such as VicHealth Ambulance services Provision of preventative and early detection programs such as breast cancer detection using mammograms. Legislation including road rules and smoking bans

Local Government Responsibilities include: Contribute to the health and wellbeing of their citizens by focusing on the needs and challenges faced by the local people. Commonly referred to as councils Responsibilities include: Health inspections of restaurants and other commercial kitchens Maintains clean public areas Collects garbage Recycles waste Provides emergency care shelters Organizes meals on wheels Maintain parks and sporting facilities and gardens to ensure they are safe and available for use. Local laws such as consumption of alcohol in public places Ensure public safety on roads and in public areas such as street lighting Delivering immunisation programs

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Australia’s universal health care system http://www. abc. net

Medicare What is it? Introduced in 1984 to provide eligible Australian and New Zealand residents with affordable, accessible and high-quality health care. Aims to improve access to adequate health care for all Australians in need of treatment regardless of age or income. Who can use this service? Everyone who lives in Australia and is an Australian or New Zealand citizen or has a permanent visa. Anyone over the age of 15 years may be enrolled to have their own Medicare card. – do you have your own card?

Medicare How is it funded? It is funded by the Federal Government, partly through contributions made via the 2% Medicare Levy. Refers to the amount of money paid by taxpayers based on taxable income that contributes to the funding of the health care system. Those with low income or specific circumstances may be exempt. People earning over a certain amount ($84,001 for individuals; $168,000 for families) WITHOUT private health insurance have to pay an extra 1% Medicare surcharge. https://www.youtube.com/watch?v=3_dDDfoajZM

Medicare Doctors consultation fees What is covered by Medicare? What is NOT covered by Medicare? Doctors consultation fees Treatment and accommodation as a public patient in a public hospital Tests and examinations needed to treat illness including x rays and blood tests. Eye tests Most procedures performed by doctor. Dental examinations Dental treatment Ambulance services Home nursing Physiotherapy Cosmetic or unnecessary treatments Hearing aids, contact lenses and glasses Medicines (Except those on PBS) Private hospital costs Alternative medicines such as acupuncture Medical examinations for employment purposes.

Schedule Fee The amount that Medicare contributes towards certain consultations and treatments. The government decides what each item is worth and that's what Medicare pays. Doctors and private hospitals may choose to charge more than the schedule fee. For example, the schedule fee for a GPs visit in January 2011 was $34.90. Based on this contribution, every time an individual goes to the doctor for a standard consultation, Medicare will contribute $34.90. 

Out-of-hospital expenses Medicare will pay all or some of the fees relating to many essential health care services: Consultation fees for doctors and specialists Tests and examinations needed to treat illnesses, including x-rays and pathology tests and eye tests Some surgical and therapeutic procedures performed by GP’s In-hospital expenses As a public patient in a public hospital, treatment by doctors and specialists is covered by Medicare, including: Initial treatment and aftercare If individuals chooses to be admitted to a private hospital or as a private patient in a public hospital, Medicare will pay 75 per cent of the schedule fee for treatment by doctors and specialists

Medicare Safety Net The Medicare Safety Net gives families and individuals financial assistance for out-of hospital Medicare services. Once you reach the threshold, having tests may cost you less for the rest of the calendar year. Covers a range of tests received out of hospital, x-rays and minor procedures NOT doctor visits because you get back 100% of schedule fee so no gap amount.

Pharmaceutical Benefit Scheme (PBS) Through the Pharmaceutical Benefit Scheme (PBS), the Australian Government makes a range of essential prescription medicines available at affordable prices to all Australian residents. From 1 January 2018, you pay up to $39.50 for most PBS medicines or $6.40 if you have a concession card. The Australian Government pays the remaining cost. PBS Safety Net - Once the individual (or family) has spent a certain amount within a calendar year on PBS listed medications, the patient then pays only a concessional payment Currently there are 2600 prescription medication on the list.

Subsidy to help battlers quit smoking By Mark Kenny THE price of a month's supply of nicotine patches will be slashed from $120 to $5.40 when they are finally listed on the Pharmaceutical Benefits Scheme next February. The Government says the subsidy will push down the cost of ‘transdermal patches’ from $120 a month at the pharmacy, down to just $5.40 for concession card holders. The listing, which has been long campaigned for by public health and anti-smoking groups, will apply to 70,000 low income concession card holders, giving them access to affordable treatment for nicotine addiction. QUIT executive director Fiona Sharkie said it was a major step forward. ‘Research suggests that subsidised Nicotine Replacement Therapy can increase the number of smokers using the products to help them quit, and the amount who have a successful quit attempt,’ she told The Advertiser. ‘This is great news for helping bring down smoking rates.’ The anti-smoking drug varenicline has also had its PBS listing extended and a drug for the treatment of benign — non-cancerous — prostate enlargement, will be included for the first time. Cabinet signed off on the PBS expansion this week at a cost of $320 million over four years, all of which is said to be offset by other savings. Health Minister Nicola Roxon will formally announce the changes today. ‘Supporting over 70 000 Australians to kick the habit next year is another part of the Gillard Government's innovative anti-smoking approach, including world-leading action to mandate plain packaging on tobacco products,’ she said. ‘Cancer scars the lives of too many Australians and we know that reducing the smoking rate is one of the most effective ways to reduce the rate of death from this terrible disease.’ Australia records about 15 000 smoking-related deaths per year. Transdermal, or ‘skin’ patches work by administering nicotine, the prime addictive agent of tobacco, through the skin, and when effective, can help wean people off the cancer-causing and inherently anti-social habit of smoking. The decision to include nicotine patches such as Nicorette, Nicabate P and Nicotinell, has been a long time coming, given the deadly health implications of tobacco smoking and the huge public costs associated with its myriad diseases. Australian Council for Action on Smoking and Health president Mike Daube described the subsidy of patches as ‘the last big piece of the puzzle’ to get people to quit. A steep $2.26 per packet tax rise on a packet of cigarettes ordered in this year's Budget, was sold as a health measure but slated to also deliver up to $5 billion in revenue. 8 December 2010 Case study review 1) Discuss why Nicotine Replacement Therapy has been included in the PBS. 2) Which population group is being targeted by the inclusion of Nicotine Replacement Therapy in the PBS? Explain why this group may have been targeted. 3) Briefly explain how the PBS can improve the health and wellbeing of Australians

Medicare Advantages of Medicare Disadvantages of Medicare

Medicare Advantages of Medicare Disadvantages of Medicare Available to all Australian and New Zealand residents No choice of doctor for in-hospitals services/treatments Free – accessible to everyone Waiting lists for many treatments Choice of doctor for out-of-hospital services Does not cover alternatives therapies/cosmetic services Covers tests and examinations, doctors and specialists fees (Schedule fee only) and some procedures such as x-rays and eye tests Often does not cover the full amount of the doctors visit (unless its bulk-billed)

Medicare Explain what Medicare is. Outline what is covered by Medicare. Explain what is not covered by Medicare. Outline the objectives of Medicare. Outline the advantages and disadvantages of Medicare. Explain what the Medicare safety net is. Explain how Medicare promotes health through ensuring sustainability, access and equity. Outline how Medicare is funded. Describe what a schedule fee is. Explain the difference between a gap payment and an out-of-pocket payment. Describe bulk-billing

Understanding the PBS Visit the Medicare website, then copy and complete the following table with the updated information for the current year. Table 5.1 Cost of PBS medications and the PBS safety net threshold   General patients Concession Cost of medication on PBS PBS safety net threshold Cost of medication once threshold is met

Private Health Insurance Private health insurance is a type of insurance under which members pay a premium (or fee) in return for payment towards health-related costs not covered by Medicare. It is additional insurance purchased on top of Medicare. Private health insurance cover is generally divided into hospital cover, extra cover and ambulance cover. If a patient pays for private health insurance cover, this enables patients to have access to public and private hospitals with the choice of their own doctor or specialist; choice about timing of treatment and shorter waiting times. https://www.youtube.com/watch?v=AZOAG2n7fWo

Private Health Insurance What’s so good about it? Individuals can choose the type of cover to suit their needs by opting for ‘extras’ cover which can cover services such as dentists, physiotherapists, and chiropractors. Pay a premium which can vary depending on how many people are covered by the policy and the options the policy includes. Private health insurance pay the additional costs associated with public hospital charges. Sometimes the total bill exceeds the amount contributed by the insurance company thus resulting in out of pocket costs.

Private Health Insurance Users pay a premium to join which provides flexibility in their health care; Will cover some or all of the extra costs associated with private hospitals Choice of hospital Choice of doctor Reduced waiting times Can opt for extras (cover for services not covered by medicare) https://www.youtube.com/watch?v=BsSwxFhB6MQ

Private Health Insurance incentive scheme As result of the declining number of people taking out Private health insurance, the federal government introduced a number of incentives. The purpose is to reduce the cost of private health insurance to make it more affordable and also to lighten the load on the public health system.

#1 Incentive - Lifetime Health Cover Government incentives for private health insurance #1 Incentive - Lifetime Health Cover People who take up private health insurance after the age of 31 pay an extra 2% on their premium for every year they are over the age of 30. So if you took out PHI at the age of 40 you would pay an extra 20% to those who took it out at 29. VIDEO – lifetime health cover https://www.youtube.com/watch?v=E2EtIDioXRk

#2 incentive - Medicare levy surcharge: Government incentives for private health insurance #2 incentive - Medicare levy surcharge: High income earners (over 90,000 for singles) can get taxed an extra 1%-1.5% if you choose to NOT take out private health insurance. ***INCOME TESTED*** https://www.youtube.com/watch?v=3_dDDfoajZM

#3 incentive – Government Rebate Government incentives for private health insurance #3 incentive – Government Rebate (can also be called Private Health Insurance Rebate) Under this scheme, policy holders receive a rebate (or refund) on their premiums for private health insurance depending on their income. ***As of July 2012, this is now means tested*** meaning higher income earners may not get their rebate https://www.youtube.com/watch?v=vxzUy0cKVbw

Advantages of Private Health Insurance Disadvantages of Private Health Insurance Quiz: http://www.jacplus.com.au/secure/Searchlight?searchbox=int-1616

Advantages of Private Health Insurance Disadvantages of Private Health Insurance Enables access to private hospital care Costly in the terms of the premiums that have to be paid Choice of doctor while in public or private hospitals Sometimes have a ‘gap’ payment Shorter waiting times, Waiting periods apply (for example; pregnancy) Depending on the level of cover purchased, services such as dental, chiropractic, physiotherapy, optometry and dietetics could be paid for High income earners with private health insurance do not have to pay the additional 1 per cent Medicare levy Lifetime cover, rebate back from the government Quiz: http://www.jacplus.com.au/secure/Searchlight?searchbox=int-1616

Private health insurance Describe each of the private health insurance incentives. Explain why the Commonwealth Government implemented the private health insurance incentive schemes. Refer to Figure 5.12 and explain the impact that the private health insurance incentive schemes have had on the percentage of people covered by private hospital insurance. Outline the advantages to individuals of having private health insurance.

National Disability Insurance Scheme - NDIS The National Disability Insurance Scheme (NDIS) was launched in July 2013 and is the Commonwealth Government’s new way of providing support for Australians with disability, their families and carers. The NDIS will provide about 460 000 Australians (aged under 65 years with a permanent and significant disability) with the support they need to live an ordinary life To receive it you must: be an Australian citizen or hold a permanent visa Live in Australia where the NDIS is available Meet the disability requirements (which basically state that your impairment affects your capacity to social and economic participation)

National Disability Insurance Scheme - NDIS The NDIS helps people with disability to: access mainstream services and supports, including healthcare, education, public housing, aged care and the justice system access community services and supports, including sporting clubs, libraries, charities and community groups maintain informal support arrangements, including the unpaid help they get from family and friends that is part of most people’s lives receive reasonable and necessary funded support, such as the financial support the NDIS will offer that is related to their disability and required for them to live an ordinary life. https://www.youtube.com/watch?v=1DMqCzdDzKM

NDIS Watch the video About the NDIS on YouTube. Outline features or advantages of the NDIS. Explain how the NDIS promotes sustainability, access and equity. Outline how the NDIS aims to promote the health of Australians.

Sustainability Medicare Private Health Insurance NDIS PBS -According to the United Nations, sustainability refers to meeting the needs of the present without compromising the ability of future generations to meet their own needs. The concept of sustainability will be discussed further in Chapter 8. Medicare is expensive to fund; however, it is hoped that by reducing or removing the cost of healthcare for individuals, they will access healthcare sooner, which will lead to improved health outcomes and reduce the cost of treatment in the long term. -Medicare only covers essential healthcare services, and does not cover other treatments such as elective surgery or most allied health services. It thus aims to provide the care that is deemed medically necessary without incurring additional expenses. This will help to meet the health needs of the current generation but also ensure that Australia will be able to financially support the health needs of future generations. Private Health Insurance -Private health insurance is economically sustainable, as it helps to meet the healthcare needs of the current generation (both those with private health insurance and those without) through placing less burden on the public system. It also aims to meet the needs of future generations by implementing incentive schemes to make access to private health insurance more affordable, and therefore decreasing the demand on the public system as our ageing population continues to grow. Less demand on the public system means that more people are able to be treated sooner, leading to better health outcomes. NDIS The NDIS is being introduced in stages around Australia over three years, rather than all at once, in order to ensure that it is successful and sustainable. This will assist in promoting the health of those with a disability over the long term, as they will have the support they need over the duration of their life. The extra 0.5 per cent added to the Medicare levy by the Commonwealth Government to support the NDIS will also make it more financially sustainable. PBS Ensuring that only reliable medications are added to the PBS, promoting sustainability as reliable medications are trialled and tested to ensure that they are able to work effectively in treating the condition that helps to meet the needs of the current generation, and improving the health of the current generation will also help improve health in the future, as people will be less likely to need ongoing treatment.

Access Medicare -Medicare is accessible, as rebates are provided for a range of healthcare services including GP visits, eye tests performed by an optometrist and some diagnostic tests such as x-rays. This makes these services more financially accessible, which can improve health as people are more likely to have their condition diagnosed and treated earlier if they can access these services at a reduced cost, which can help to reduce the impact of the condition and promote health. -Medicare allows an individual to be able to select their own doctor for out-of-hospital services, which makes such services more accessible as people will have the ability to select a doctor in their local area and will also be able to select a doctor who meets their social or cultural needs. This will help people to feel more comfortable in seeking healthcare, which again can lead to improved health outcomes. Private Health Insurance -Private health insurance promotes social access to healthcare, as people are able to select their own doctor for treatment in either a public or private hospital. This means that people are able to choose the doctor who best meets their needs. -Through implementing incentives such as the private health insurance rebate scheme, the government has tried to make private health insurance more financially accessible, with the aim of increasing the number of people who can afford to access private health insurance. This increases the number of people who will receive subsidised access to a wider range of services, which may contribute to improvements in health as people will have access to a wider range of treatment options with shorter waiting times. NDIS The NDIS aims to ensure that Australians with a disability receive the reasonable and necessary funded support required for them to financially access all the services they need to live an ordinary life and to achieve their goals and promote health. PBS The PBS provides timely access to medication at local pharmacies at a reduced cost, which can promote access as individuals are able to get the medication they need without having to travel. This means that individuals can access medication quickly to enable them to treat their condition. This should reduce the impact of the condition and reduce the amount of time spent in ill-health.

Equity Medicare -Medicare promotes equity, as it includes a safety net to protect those who experience higher costs of healthcare, those who have concession cards and big families from large out-of-pocket costs for healthcare services, thus providing extra support to those who need it most. -Medicare is available to all Australian citizens and it does not discriminate on the basis of age, gender, race, location, income or health status. This makes it equitable, as those people who most need to access the health services (the elderly, or those from low-socioeconomic groups, those in rural and remote areas and Aboriginal and Torres Strait Islander people) are able to access the care they need. Private Health Insurance Those who earn more pay more for their private health insurance, as they receive less or no rebate on their policies while those who earn less receive bigger rebates. The Medicare levy surcharge also protects those who earn less from paying a levy if they can’t afford private health insurance. This means that higher income earners are encouraged to take out private health insurance, which reduces the burden on the public hospital system, meaning that those who can’t afford private health insurance have better access to the public hospital system. NDIS Through ensuring that people with a disability and their carers receive full access to the support they need, the NDIS promotes equity, as there are more resources being provided to support those who need help the most. PBS -The PBS also includes a safety net to protect those who suffer chronic illness, those who need many medications or expensive medications, those who have concessions cards and large families from large out-of-pocket costs for PBS medications, thus providing extra support to those who need it most. - Finally, the PBS is available to all Australian citizens and does not discriminate on the basis of age, gender, race, location, income or health status. This makes it equitable, as those people who most need to access medication listed on the PBS are able to do so.

Practice Questions Briefly explain two ways in which Australia’s health care system promotes access to health care Explain how the NDIS could affect health and wellbeing Describe each of the private health insurance incentives. Outline 2 ways that sustainability is promoted in the health system