Surprisingly Australia is a civilized and developed country! We have universal health care (more or less)!

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1 Surprisingly Australia is a civilized and developed country! We have universal health care (more or less)! s About 21 million people live in a country of 7,692,024 square kilometers So we seem to have plenty of room but choose to live close together in cities (2/3 of us anyway) Even so we only have a few large cities. i 1

2 Australia Map Detail Australians 2

3 . 3.

4 . 4 All levels l of government provide a range of health h services Federal..ambulatory State hospitals Local..environmental non-clinical Federal government funds but does not directly administer health services Medicare and the PBS Australian Health Care Agreements

5 Medicare Levy 5 Medicare is the scheme that gives Australian residents access to health care. To help fund the scheme, most taxpayers pay a Medicare levy of 1.5% of their taxable income (Federal). For , the levy is reduced if taxable income is $22,163 or less (The thresholds are higher for seniors)

6 Medicare Levy Surcharge Medicare levy surcharge 6 Payable if income is above a certain threshold and you (or any of your dependants) don't have appropriate private patient hospital cover. In , the surcharge may apply if your income is more than $77,000 for a single person with no dependantsd $154,000 for a couple with no children or one dependent child, plus $1,500 for each additional dependent child.

7 Commonwealth The Commonwealth Government accounts for the largest proportion of expenditure on health goods and services (43% in ). The largest components funded dwere its own programs Medicare Benefits Schedule (MBS) Pharmaceutical Benefits Scheme (PBS) Total $29.4 billion of the $48.7 billion spent by the Commonwealth Government. (2008/9) 7

8 State State, territory and local governments contribute funding for, and deliver, a range of health care and services ($29.9 billion, or 27% of total health expenditure 2008/9) Public hospital services, Public health initiatives, Community health services, Public dental services, Mental health programs, Aged care, Health policy research and development 8

9 Non- Government Non-government sources for funding health goods and services ($34.2 billion 30% of total health expenditure in ) Costs incurred by individuals ($18.9 billion) Private health insurance funds ($8.8 billion) Other non-government sources such as injury compensation insurers 9

10 Access Many access issues and inconsistencies Geography rural challenges Indigenous health (about 1 in 40 Australians) Low income 10 Some clinical areas of supply demand inequality Mental Health Dental Drug and Alcohol l Justice Health

11 Major Challenges? Emergency Department Services Public Elective Surgery Public Hospital Inpatient Beds Intensive Care Beds 11

12 Doctors Nurses Allied Health Support Services Other Health Care Workforce 12

13 Medical School 13 A domestic student undertaking medical studies may occupy a Commonwealth Supported university place, where through the Higher Education Contribution Scheme, HECS, the student is required to pay for only part of the cost of the degree. In 2011 the contribution for medicine was $9,080. (Sydney) In 2005, a full-fee paying option was introduced for domestic students, however this ceased to be available to domestic medical students in Many universities also take international medical students all international medical students are full-fee paying students. Universities set the number of international full-fee paying medical students they take, without Commonwealth or other jurisdictional involvement. The fee for 2012 was $60,960

14 Undergraduate Undergraduate Medical School Undergraduate-entry program typically last 5 6 years, and permit entry from high school matriculation. Applicants are usually assessed by a combination of 14 High school leaving certificate performance, UMAT (Undergraduate Medicine and Health Sciences Admission Test) score Interview

15 Graduate Graduate medical programs typically ylast 4 years, and require the entrant to have attained a previous bachelor degree qualification at a certain level of achievement in addition to aptitude tests t and interviews. The most common selection test used is the GAMSAT (Graduate Australian Medical Schools Admission Test). 15

16 Internship All States and Territories require recently yqualified medical practitioners to successfully undertake and complete at least one year of supervised practice, generally known as an internship. Some states t (e.g. New South Wales) also require junior doctors to undertake a second generalist year, which is their first RMO year. Other states permit streaming from the first RMO year 16

17 Interns 17 Internship is undertaken in hospital positions accredited for this purpose. Interns in Australia are 'undifferentiated', meaning that they undertake rotations ti through h many different specialties. Rotations differ from hospital to hospital and state to state.

18 Interns 18 Most states require three core terms to be completed A medical term, surgery, and emergency medicine. In some states, a general practice term is offered instead of the Emergency Medicine i term.

19 Residency Upon successful conclusion of the intern year, doctors qualify for full registration in the Medical Board of their State or Territory, and are licensed to engage in independent d medical practice. However, because Provider Numbers are not issued to doctors who have not completed postgraduate studies, nearly all doctors continue their training as Resident Medical Officers (RMOs) in hospitals, which typically lasts two years. 19

20 Specialist Training 20 Specialist training varies considerably from specialist college to college. At the same time as working in hospitals or other healthcare environments, registrars also prepare for examinations for admission into specialist medical colleges, Those successful in completing the requirements of their college program become fellows of that college. They are now specialists in the case of most areas of medicine (and typically work in specialist private practice and/or as a consultant in a hospital).

21 A Provider Number is required to bill Medicare 21 Since 1996 the Commonwealth Government no 99 longer issues Provider Numbers to doctors who have not completed postgraduate training

22 Doctors In 2009 there were 82,895 doctors registered in Australia with the majority (90%) in the medical labor force (either working, looking for work or on leave). Of those in the medical labor force, almost all were working (72, or 98%) at the time of the survey. Most (93%) were working as clinicians, In 2009, approximately one-quarter of working doctors in Australia obtained their first medical qualification overseas. 22

23 GP s /10 Major Cities Inner regional 5130 Outer regional 2359 Remote Very Remote 414

24 Specialists 24 Specialists

25 Patient Contact 25 Primary and community health services are usually a patient s first contact with the health care system. These service providers, particularly GPs, play an important role in monitoring an individual s health and managing their health conditions According to the ABS 2009 Patient Experience Survey, four out of five people (81%) aged 15 years and over had seen a GP in the 12 months prior to the survey. Women were more likely than men to have seen a GP in the last 12 months (87% and 75% respectively).

26 Hospitals There are more than 1,300 public and private hospitals In 2009, just over 13% of the population aged 15 years and over were admitted to hospital 26

27 Emergency 27 Approximately 2.3 million people p (13%) aged 15 years and over reported going to a hospital Emergency Department in the 12 months prior to the ABS 2009 Patient t Experience Survey

28 Indemnity 28 Public Hospitals provide medical indemnity for work performed in the public hospital system Medical insurers provide indemnity for the rest Some overlap and grey areas?

29 Hospital Doctor s Salary 29 Salaries in Australia vary slightly from state to state but each state's Government fixes all doctors' salaries. Here are approximate figures for basic salaries in Australia. After overtime and on-call work these salaries will be approximately 15-25% higher.

30 Salary An intern (median base $57,422 ) earns somewhat ( 57,4 ) less than the junior accountant in payroll earns (median base $63,000) 30

31 USA - Medical Home 31 A MODEL OF MEDICAL PRACTICE, THE PATIENT CENTERED MEDICAL HOME, CLAIMS TO BE AN ADVANCEMENT IN PRIMARY CARE DELIVERY.

32 Medical Home 32 An electronic health record to help physicians manage patients Electronic decision support applications and patient care reminder systems. Systems for preventative medicine and management of chronic conditions Patient portals will allow patients to communicate with ih their physician via , schedule appointments, access their test results, and pay their bills. Online self management aids and personalized educational materials for patients

33 Medical Home 33 Sounds good but how do we maintain standards and can a doctor make a living with this system in place? Useful for the geographically remote? A significant investment which will take time to make an impact, might be difficult to monitor, assess and study?

34 Australian - Personally Controlled Electronic Health Records Personally Controlled Electronic Health Records for All Australians $466.7 million investment over the next two years Health lh summary view including conditions, i medications, i allergies, and vaccinations Indexed summary of specific healthcare events. 34 Summaries of patients health information including medications and immunizations and medical test results Secure access for patients and health care providers to their e- Health records via the internet regardless of their physical location Rigorous governance and oversight to maintain privacy

35 Australian - Personally Controlled Electronic Health Records 35 They will be able to present for treatment anywhere in the country, and give permission for health professionals to quickly access their relevant history. Patients will no longer have to remember every detail of their care history and retell it to every care provider they see. Patients will control what is stored on their medical records and will decide which medical professionals can view or add to their files.

36 Australian - Personally Controlled Electronic Health Records 36 Every Australian will be given a 16-digit electronic health number, which will only store a patient s name, address and date-of-birth. (No clinical information will be stored on the number, which is separate to an electronic health record) Implementation will initially target key groups likely to receive the most immediate benefit, including those suffering from chronic and complex conditions, older Australians, Indigenous Australians and mothers and newborn children.

37 Some Headlines 37

38 Some Headlines ED computer system a risk to patients. 38 Crippled by design flaws Compromising gpatient care Jon Patrick

39 Some Headlines A proposal p to restrict MBS rebates to only those services carried out by doctors signed up to the Government s PCEHR system had been recommended d by the National Health and Hospitals Reform Commission (NHHRC) 39

40 A Day in the life Ward Rounds A Day 40 See patients typically Cat 1 2 or 3 Supervise juniors Students Administration Research The rest

41 Fin 41.

42 Clinical Workforce The clinical workforce 42

43 Access 43 In 2009, 5.4% of the population p (937,800 people) p aged 15 years and over reported there had been times that they had been unable to access health services. 82% of these people, it had not been possible to visit a GP when one was required, 9.5% 95 of those who were unable to access health services could not see a medical specialist.

44 Access 44 A shortage of GPs may result in hospitals being the first place of call when medical treatment is required A quarter of those who visited an emergency department (556,400) thought at the time of the visit that the care could have been provided by a GP

45 Medical School 20 Medical Schools in Australia, 8 of which h are undergraduate. d 45 Australian National University Medical School [1] Bond University Faculty of Health Science and Medicine [2] Deakin University - Deakin University School of Medicine [3] Flinders University/Flinders Medical Centre School of Medicine [4] Griffith University School of Medicine [5] James Cook University School of Medicine [6] Monash University - Faculty of Medicine, Nursing & Health Sciences [7] Macquarie University Australian School of Advanced Medicine [8] The University of Notre Dame Australia College of Medicine: School of Medicine Fremantle [9] and School of Medicine Sydney [10] University of Adelaide Medical School [11] University of Melbourne - Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne [12] University of Newcastle School of Medicine & Public Health [13] University of New England School of Rural Medicine [14] - Joint Medical Program with University of Newcastle University of New South Wales Faculty of Medicine [15] University of Queensland School of Medicine [16] University of Sydney Sydney Medical School [17] University of Tasmania School of Medicine [18] University of Western Australia Faculty of Medicine and Dentistry [19] University of Western Sydney School of Medicine [20] University of Wollongong Graduate School of Medicine [21]

46 Medical school Medical school intakes have been expanding since 2000 and this is clearly reflected in the number of commencing medical students, which have more than doubled d from 1,660 in 2000 to 3,469 in

47 Salary Salary packaging allows all hospital employees in Australia to receive up to 30% of their salary tax-free under some circumstances. In addition to salary packaging, most hospitals will give all doctors working in Australia the following benefits: Sick Leave - up to 10 paid days per year Annual Leave - up to 5 weeks paid leave per year Superannuation all doctors working in Australia receive 47 superannuation payments to the value of 9% of their salary (This is paid in addition to salary and is not deducted from it.) p y ) Many hospitals will also provide subsidised meals, free or cheap accommodation and other benefits.

48 Salary Approximate Basic Salary Intern 60, Resident/SHO 60-75,000 Registrar ,000 Consultant (Specialist) ,000

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