Chapter 4. Role of health-care facilities and services

Transcription

1 Chapter 4 Role of health-care facilities and services Overview The role of health-care facilities and services in achieving better health The nature of health care in Australia The role of health care Types of health-care facility and service Institutional care Non-institutional care Community supports Access to health-care facilities and services Responsibility for health care Funding of health care in Australia Health insurance The costs of health care to consumers Health-care expenditure versus health-promotion expenditure Alternative health-care approaches Reasons for the growth of alternative medicine The range of alternative medicine services Making informed consumer choices CRITICAL QUESTION What roles do health-care facilities and services play in achieving better health for all Australians? Outcomes On completion of this chapter, you will be able to: explain the different roles and responsibilities of individuals, communities and governments in addressing Australia s health priorities (H5) argue the benefits of health-promoting actions and choices that promote social justice (H14) critically analyse key issues affecting the health of Australians and propose ways of working towards better health for all (H15) devise methods of gathering, interpreting and communicating information about health and physical activity concepts (H16) show a willingness to question issues that have an impact on health and performance. (V&A)

2 THE ROLE OF HEALTH-CARE FACILITIES AND SERVICES IN ACHIEVING BETTER HEALTH Health-care facilities and services play a vital role in achieving better health for all Australians. They provide the essential services of diagnosing, treating and rehabilitating the ill and injured. As we saw in chapter 3, they also have an important role in preventing illness and promoting health. It is much more cost-effective to promote positive health and prevent illness from occurring. Traditional health facilities such as hospitals and doctors surgeries are increasingly being used to provide accurate health information to the public. The state and territory governments provide services specifically aimed at both the prevention of disease and the promotion of health for example, immunisation programs, anti-smoking campaigns, and school medical and dental health services. The health of Australians depends not only on the provision of quality health-care services and facilities, but also on factors such as housing, employment, education, hygiene, income and environmental safety. For health-care services and facilities to be effective in both curing and preventing disease, the health care sector must develop partnerships with other sectors of the community to implement health-related activities that promote health. Governments: Commonwealth state local Institutions: hospitals clinics nursing homes... THE NATURE OF HEALTH CARE IN AUSTRALIA The health-care system in Australia is both extensive and diverse in nature. Traditionally, it has provided: diagnosis treatment rehabilitation care for people with long-term illness or disability. Since the mid 1990s, the Australian government has strengthened its commitment to involving the wider health-care system in improving health outcomes and health gains (illness prevention and health promotion), rather than simply providing health-care Health-care roles: prevention promotion diagnosis treatment rehabilitation care Figure 4.1: Features and roles of the health-care system Health providers: doctors nurses dentists physiotherapists... Organisations: community health services support groups charities... services. Thus, our health-care system involves complex interrelationships between: Commonwealth, state and local governments health insurance funds public and private providers of services (for example, doctors, dentists, optometrists, psychologists and physiotherapists) institutions (for example, public hospitals and nursing homes) other organisations (for example, community health services, self-help groups and community support groups). 106 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

3 Advocacy is the act of championing or arguing for a particular issue or cause. The role of health care The role of the health-care system in Australia is to provide quality health facilities and services to meet the health needs of all Australians. Health services are organised, financed and delivered by both public (government) and private (fee-for-service) sources. Health care is dominated by medicine in Australia. Emphasis has been placed on the diagnosis and treatment of illness by the medical profession. This medical dominance means medical professionals largely control and deliver health care. Some medical practitioners have acknowledged the potential positive impact of alternative medicine on health and have referred patients. Health care within Australia is mostly about clinical diagnosis, treatment and rehabilitation. Historically, health has lacked a preventative focus, but the emphasis began to change with the new public health approach. The influence of the media and an increasing emphasis on health education and promotion have led to a greater understanding of health within the community. We are increasingly recognising the important role of preventative health care in the promotion of health. Health practitioners are recognising the importance of their role in health education, community empowerment, advocacy and public health policy. Types of health-care facility and service The many health-care services provided in Australia can be divided into two broad types: institutional and non-institutional. Institutional services include: public hospitals, which provide acute care for people with temporary, often severe ailments who stay in hospital for relatively short periods for example, medical, surgical or obstetric services psychiatric hospitals, which treat and care primarily for patients with psychiatric, mental or behavioural disorders private hospitals and other privately owned and operated institutions that provide either acute or psychiatric care nursing homes, which provide long-term care for chronically ill, frail, convalescent or senile inpatients or those with a disability other services, such as ambulance. Figure 4.2: Hospitals are an example of an institutional health facility. CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 107

4 Elective procedures are those operations that are not classified as emergencies. Equity is the allocation of resources according to the needs of individuals and populations the goal being to achieve equality of outcomes. Non-institutional health services include: medical services, which are provided by medical practitioners and specialists health-related services for example, pharmaceutical, dental, optical, physiotherapy and podiatry community and public health services community health promotion and illness prevention for example, community home care programs the provision of aids and appliances for example, hearing aids and spectacles research for example, the National Health and Medical Research Council s (NHMRC) coordination of information on major health problems administration. Institutional care Hospitals public and private In Australia, hospitals conduct the major proportion of institutional care. Hospitals are classified as either public or private, and the majority are accredited with the Australian Council on Healthcare Standards (which monitors the quality of care provided and the health outcomes of patients). Public hospitals are operated and financed by the state governments and the Commonwealth Government. They serve a greater proportion of elderly and very young patients. Public hospitals also appear to provide more highly specialised and complex services, such as heart and lung transplants in the large teaching hospitals. They also provide same-day surgery and take most of the non-admitted patients (outpatients). Private hospitals are owned and operated by individuals and community groups. They also provide same-day surgery and perform more shortstay surgery, elective procedures and less complex procedures requiring less expensive equipment, such as operations on the eye, ear, nose, mouth, throat, musculoskeletal system and breast. Patients in all hospitals are classified as being either private or public, according to their choice of service. If they choose to be in a public ward in a public hospital, then they are allocated a doctor by the hospital and provided with a bed all free of charge. If they choose private treatment, either in a public or private hospital, then they may choose their own doctor but must pay for the service and accommodation provided by the hospital and the doctor. Medicare and any private health insurance of the patient will refund much of this expense. The issue of equity of access to public hospitals has been debated in recent years. Some evidence suggests that private patients have more rapid access to elective surgery (such as plastic, ear, nose and throat, and orthopaedic surgery) than do public patients. Urgency categories have therefore been applied to patients conditions. Australia s use of acute hospitals is outlined in table 4.1. Rates of admission are comparatively high, but balanced by the short average length of stay. Factors that contribute to the reductions in the length of stay include: the less frequent placing into acute hospitals of people requiring nursing home care better anaesthetics the use of less invasive surgical techniques 108 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

5 incentives for hospitals to increase the proportion of same-day patients treated the expansion of early discharge programs that provide follow-up care for patients at home an increasing trend towards day surgery improved drug treatments. There has been dramatic growth in health technologies used in diagnostic procedures, such as ultrasound and magnetic resonance imaging (MRI). In Australia, non-invasive surgery (laparoscopy, for example) is preferred in many cases to conventional open surgical procedures. It generally results in less pain, shorter hospital stays and faster recovery times. These advantages are particularly significant for the elderly, because they face reduced risks and improved recovery from surgery. The highest number of patient admissions is to public acute hospitals (see table 4.1). There is a trend for people who are financially able to use private hospitals and those less advantaged to use public hospitals. Table 4.1: Hospital use, Hospitals Admitted patients Average length of stay Public acute 4.1 million 6.4 days Private 2.6 million 5.6 days Figure 4.3: Improved hospital treatments, techniques and follow-up care have led to a general reduction in the length of stay. Public psychiatric n/a Source: Australian Institute of Health and Welfare, Australia s Health 2006, Canberra, pp Nursing homes Nursing homes provide care and long-term nursing attention for those who are unable to look after themselves the aged, the chronically ill, people with dementia and people with a disability. Some nursing homes cater specifically for young people with a disability. There are three types of nursing home private charitable, private for profit and state government but the Commonwealth Government assumes responsibility for most of the financial cost of running nursing homes in Australia. Aged-care assessment teams have been established to ensure only highly dependent people are placed in residential care. They also recommend the placement of a large proportion of clients in accommodation outside of institutions, such as hostels. Hostels provide long-term accommodation and a basic level of health care for young people with a disability, and the aged and frail. Figure 4.4: Nursing homes are an important health-care facility for the aged, the chronically ill and people with a disability. CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 109

6 Psychiatric hospitals Treatment of people with severe mental illness has changed over recent years, moving away from institutional care to a system of care that integrates both hospital services and continuing care within community settings. Given the resulting reduction in extended hospitalisation of people with mental illness, the number of public psychiatric hospitals has fallen. At the same time there has been a corresponding increase in the number of beds in community-based residential services. The range of service providers for mental health care today includes general practitioners (GPs), private psychiatrists, communitybased public mental health services and specialised residential mental healthcare facilities. Non-institutional care Medical services Doctors, specialists and other health professionals provide a number of services. The most extensively used service is that of the GPs who diagnose and treat minor illnesses. According to the National Health Survey ( ), about 23 per cent of the population had visited a GP or specialist during the two weeks prior to the survey. GPs work in medical centres, hospitals and many private surgeries throughout Australia. Under Medicare, all Australians are eligible to claim refunds for their payments for medical services outside hospitals (and for services as private patients in hospitals). The whole or part of the cost of a GP consultation is reimbursed by Medicare. The number of consultations with GPs has increased over the last two decades. This can be attributed to improved access to doctors and the increased promotion and awareness of individual illness prevention strategies, such as immunisation, Pap smears and general health check-ups. General practitioners sometimes refer their patients to specialists, who have specialised skills in a particular field of medicine as well as the usual medical training. Some specialists are explained in the following list. Allergist treats conditions related to allergies Anaesthetist administers anaesthetics and pain-relieving drugs during operations Cardiologist treats diseases of the heart and circulatory system Dermatologist treats skin ailments Gynaecologist treats disorders of the female reproductive system Neurologist treats diseases of the nervous system Obstetrician specialises in delivering babies and treating pregnant women Orthopaedic surgeon treats fractures and diseases of the bones, joints and tendons, ligaments and muscles Pathologist specialises in examining body tissue, blood and urine Psychiatrist specialises in diagnosing and treating mental illness Radiologist diagnoses diseases and bone fractures using X-rays Urologist specialises in treating diseases of the urogenital system Health-related services Health-related services include ambulance work, chiropody, dentistry, health inspection, nursing, occupational and speech therapy, pharmacy, physiotherapy, optometry, radiography, counselling, social work, and dietary 110 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

7 planning and advice. The number of dental services has risen in recent years as an increasing number of people retain their natural teeth, and also as a result of the trend towards preventative dental care. Pharmaceuticals In Australia, pharmaceutical drugs are supplied through hospitals and doctors by private prescription and over the counter in shops. Over-the-counter medicines account for about one third of all sales. Most prescription drugs sold in Australia are subsidised through the Commonwealth Government s Pharmaceutical Benefits Scheme (PBS). Through this scheme, the patient pays a set amount for a prescription drug ($29.50 in 2007) and the government pays the balance of the cost of the drug to the pharmaceutical manufacturer. Drugs are subsidised further for people with special needs, including pensioners and concession cardholders, for example, low-income earners, war veterans and invalids. This subsidy reduces the cost of a prescription to under $5. Some people who are chronically ill or require regular long-term medications are protected from excessive cost by the PBS Safety Net. If the accumulated cost of their prescriptions exceeds a particular amount within a year, called the threshold, the individual or family can then obtain their prescriptions for the rest of the calendar year at a low cost ($4.70 in 2007). The aim of the Safety Net scheme is to ensure no-one is precluded Figure 4.5: Pharmacists dispense drugs prescribed by general for financial reasons from access to the practitioners. Most drugs are subsidised under the PBS. medicines they need. Community supports Community supports are a significant factor in the provision of an environment that is conducive to positive health. These supports promote health but are not a recognised part of the health-care system. The food industry, for example, implements policies to ensure the production and delivery of food that meets health regulation and food safety standards, and displays nutrition information on food packaging to inform the public about nutrition. As another example, town planners and engineers have a role in providing infrastructure that is safe and promotes positive health for example safe roads, adequate sanitation and sewage facilities, areas for physical activity such as playgrounds and sports fields and the clear signage of environmental hazards. Investigating health-care facilities Identify the major health-care facilities available to you. Choose one and investigate the services offered at that facility. Report your findings to the class. CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 111

8 Health-care facilities and services 1. Considering the health-care facilities and services that are available to you, which is most relevant to you? Why? 2. Critically analyse the accessibility of this health-care service to you. 3. Would this health-care service be useful to all members of the community? Why? 4. Explain the factors that could act as barriers to access to this facility. 5. Is this service specifically aimed at curing illness or does it also provide health promotion information? 6. Outline the features of an effective community health-care service. Access to health-care facilities and services Access to health facilities and services is about the health system s ability to provide affordable and appropriate health care to people when they require it. Access might be affected by issues such as: v shortages of qualified staff v lack of funding or equipment v patient waiting lists for surgery or other treatment in public hospitals v waiting times in outpatient clinics or emergency departments. Access also refers to equitable distribution of health-care facilities and services to all sections of the Australian population. An individual s ability to access health-care facilities and services can reflect their: socioeconomic status knowledge of available services geographic isolation cultural and religious beliefs. The majority of Australians have access to fundamental medical care through the national health insurance system Medicare. This health insurance system does not cover all health services, so some health services are inaccessible to those who cannot afford them. An individual s ability to access services and facilities can also be influenced by their knowledge and understanding of health information and the services available to help them. A knowledge gap may exist as a result of the individual s lack of education, their poor literacy skills or, in the case of migrants and some indigenous groups, a language barrier. The two snapshots on pages examine different approaches to addressing problems of access to mental health care. Better access to mental health care Read the snapshot Better access to mental health care then answer the following questions. 1. Which groups will benefit from the additional funds contributed by the federal government to the COAG mental health package? 2. Which health professionals are involved in the team approach to improving access to mental health care? 3. List the changes that have been made to Medicare in relation to rebates and benefits for treating mental illness. 4. How will this mental health package improve access to mental health care? 112 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

9 Better access to mental health care On 5 April 2006, the Prime Minister announced the Australian government s contribution to the Council of Australian Governments (COAG) mental health package. Costing $1.9 billion over five years, the Australian government s contribution will provide families, schools and health professionals with more support in recognising and addressing mental illness, and new assistance to people living with mental illness and their families. The government will deliver a major part of the COAG mental health package on 1 November 2006, with the introduction of important new Medicare items to provide better and more affordable mental health care. These new Medicare services, costing $538 million over five years, promote a team approach to mental health care, with general practitioners encouraged to work with psychiatrists, clinical psychologists, and other allied mental health professionals to increase the availability of care. Under the changes, Medicare rebates will be available for GPs to provide early intervention, assessment and management of patients with mental disorders as part of a GP Mental Health Care Plan. A new GP Mental Health Care Consultation item will be available for GPs to provide continuing management of patients with mental disorders. New Medicare items will support psychiatrists to see more new patients. The rebates for items 291 and 293, for psychiatrists to undertake patient assessment and preparation or review of a management plan to be carried out by the referring GP, will be increased significantly to support management of patients by GPs where appropriate. Medicare items will be available to provide rebates for psychological assessment and therapy services provided by clinical psychologists. Medicare items will also cover the provision of focused psychological strategies by appropriately trained allied mental health professionals, including psychologists, occupational therapists and social workers. The new Medicare Benefits Schedule (MBS) items will pave the way for a range of other Australian government mental health initiatives to be implemented over the coming months, including $191.6 million over five years for mental health nurses to support private psychiatrists and GPs in caring for people with severe mental illness. A further $51.7 million will be provided over the next five years to increase access to mental health services in rural and remote areas. Source: Australian Government Department of Health and Ageing, media release, 9 October After doctors, they need dollars By Ruth Pollard Their day begins with an early morning flight from Sydney to the bush, to towns such as Lightning Ridge, Brewarrina or Bourke. There are eight hours of consultations with patients, a sandwich at lunch, a rush to the airport for a flight home. This fly-in, fly-out model of medical service that rural communities endure in place of locally based specialist staff means doctors see only some of a community s health problems. They have little time to meet local health-care workers and never know a town beyond the confines of their office. A project in the Greater Western Area Health Service, a vast area covering more than 55 per cent of the state, has developed better mental health care for the population. It uses experienced fly-in specialists to both treat patients and develop the skills of local workers, who then provide continuing care after the specialist leaves. Instead of leaving town when the sun goes down, these psychiatrists stay for two days, to socialise with other health workers, see more patients and get a feel for the town and its people. The result: a local workforce that feels supported, a community that has more and better treatment available, and a group of city psychiatrists whose lives have been changed by their experiences. (continued ) CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 113

10 Julian Short runs a busy private practice in St Leonards, on Sydney s North Shore, seeing people who suffer from depression and relationship difficulties, and providing services at hospitals. He started flying to Bourke seven years ago, and now spends two days every two months in the town, sharing the work with a colleague on alternate months. They previously had a very sporadic service and there was a great deal of untreated mental illness, Short says. Now we are able to do community liaison, talk to the police, talk to the local Aboriginal medical service and nurses, as well as see more patients. Out there you are really needed by the community you are really wanted and really appreciated. Teamwork is the focus in Bourke, and Short meets his colleagues professionally during his stay and socially, at the pub, once consultations have finished for the day. I see a lot of depression, lots of stressed relationships, schizophrenia, bipolar disorder, drugrelated problems and disruptions because of external stresses such as the drought, he says. The fly-in, fly-out model was providing very limited value, says David Perkins, from the Centre for Equity and Primary Health Research at the University of NSW. Mental health crises don t just happen when the psychiatrist flies in... [they happen] at different times, and often these are long-term chronic conditions. Perkins, who led the evaluation of the program s trial in the state s far west, says local staff also feel more valued and are more likely to stay in their job if they receive support, training and supervision from the visiting psychiatrist. Since the project began, thousands more patients have been afforded regular specialist psychiatric care. Twenty psychiatrists now fly to the area. But the project is in jeopardy, says Russell Roberts, the director of mental health, and drug and alcohol care at the Greater Western Area Health Service. The five-year trial, funded by the state and federal governments and the area health service, has come to an end. The state and federal governments have not guaranteed funding. Instead, the program is using money cobbled together by the area health service while Roberts and Perkins work on securing the project s future. The community has become used to having a service like this over the past 6 ½ years and it is not morally right to take it away when all indications are the mental health issues are becoming more common and more acute, Roberts says. Source: Sydney Morning Herald, 30 November 2006, Health and Science section, p. 16. After doctors, they need dollars Read the snapshot After doctors, they need dollars and answer the following questions. 1. Identify from the article: (a) the health issues for the communities concerned (b) the strategies put in place to address the issues. 2. How have the equity issues been addressed? 3. What have been the benefits of the scheme? 4. From a social justice perspective, why is it important for such programs to be continued? The issue of access 1. Critically analyse the differences in access to health facilities and services that exist between rural and metropolitan populations. 2. Explain how these differences in access have affected the health status of these two groups of people. 3. Discuss how the government s funding of health-care facilities and services affects access to our health system. 4. Why do people from lower socioeconomic groups have lower levels of access to health-care facilities and services? 114 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

11 Researching access inequities Choose one population group that suffers inequities in health status, for example: (a) Aboriginal and Torres Strait Islander people (b) migrants (c) rural dwellers (d) people who are homeless. Research information and statistics about your selected group s access to healthcare facilities and services (you will find some information in chapter 15). Create a PowerPoint presentation or an oral report on the impact of the level of access on the health status of your selected population group. Present it to your class. Responsibility for health care Various bodies provide and fund health services in Australia. Here, we examine the five existing levels of responsibility. 1. Commonwealth Government The Commonwealth Government is concerned with mainly the formation of national health policies and the control of health system financing through the collection of taxes. It provides funds to the state and territory governments for health care, and influences their health policy making and delivery. The Commonwealth Government also has direct responsibility for special community services, such as health programs and services for war veterans and the Aboriginal community. 2. State and territory governments The various state and territory governments have the prime responsibility for providing health and community services. The principal functions of state and territory health authorities include: hospital services mental health programs dental health services home and community care child, adolescent and family health services women s health programs health promotion rehabilitation systems regulation, inspection, licensing and monitoring of premises, institutions and personnel. 3. Private sector The private sector provides a wide range of services, such as private hospitals, dentists and alternative health services (for example, chiropractors). Privately owned and operated, these services are approved by the Commonwealth Department of Health and Ageing. Many religious organisations, charity groups and private practitioners run such services. Some private organisations such as the National Heart Foundation and the Cancer Council receive funding from both state governments and the Commonwealth Government. 4. Local government The health responsibilities of local governments vary from state to state, but mainly concern environmental control and a range of personal, CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 115

12 preventative and home care services. They include the monitoring of sanitation and hygiene standards in food outlets; waste disposal; the monitoring of building standards; immunisation; Meals on Wheels; and antenatal clinics. The state health department controls some of these services (immunisation, for example), while local councils are responsible for implementing them. 5. Community groups Many community groups also promote health for example, the Asthma Foundation and Diabetes Australia. Commonwealth Government (policies, finance, health programs etc.) Health insurance Private Public MBF Medicare HCF NIB FAI Medibank Private HBA Australian Unity Health Fund State government Local government Health-care providers Institutional care Hospitals repatriation public private psychiatric Nursing homes Non-institutional care Community health services Medical services Health promotion agencies Pharmaceutical services Figure 4.6: The health-care system in Australia involves the interrelationship of many government and non-government bodies. 116 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

13 Responsibility for health care 1. Identify the health services and facilities funded by the state or local government available in your local area. 2. Discuss the responsibility of the Commonwealth Government and state governments in providing adequate health-care services to the community. 3. Discuss the level of responsibility that the community should assume for individual health problems. FUNDING OF HEALTH CARE IN AUSTRALIA Health expenditure is the allocation of funding and other economic resources for the provision and consumption of health services. State and territory governments 20.4% Non-government sources 33.1% Commonwealth Government 46.5% Figure 4.7: Recurrent health expenditure by sector, Health expenditure refers to the allocation of funding and other economic resources for the provision and consumption of health services. Mainly the Commonwealth Government and state governments finance our health system, using our taxes. The cost to taxpayers for the health care of the Australian people is significant, and it is in everyone s interests to keep our health expen diture as low as possible. This involves being responsible for our own health by making positive health decisions and adopting appropriate lifestyles. The Commonwealth Government contributes major funds to: v high level residential care v medical services v health research v public hospitals v public health activities. The state and territory governments contribute major funds to: v community health services v public hospitals v public health activities. Pharmaceuticals are funded by both the Commonwealth Government and non-government sources. The total expenditure on health care consists of recurrent and capital expenditure: 1. recurrent expenditure the regular ongoing costs, including doctors and nurses salaries, bandages, meals and other overheads 2. capital expenditure the infrequent costs, including new hospital buildings, diagnostic equipment and pathology laboratories. Recurrent health expenditure for health services in (see figure 4.7) was funded by: v non-government sources ($ million) v state and territory governments ($ million) v Commonwealth Government ($ million). Health insurance Accidents and illness can cost individuals a considerable amount of money. The Commonwealth Government is committed to providing equitable health services to all people, which it attempts to achieve through its basic health insurance scheme, Medicare (introduced in 1984). CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 117

14 Medicare is Australia s universal system of health care to provide services that are accessible to all Australians. Levy is a payment collected by the government from a person s income. Medicare Medicare is Australia s universal health-care system, established to provide Australians with affordable and accessible health care. The funds to operate the Medicare system are obtained from income taxes and the Medicare levy, paid according to income level. Medicare provides individuals with access to: v free treatment as a public patient in a public hospital v free or subsidised treatment by medical practitioners, including GPs, specialists, and some specified services of optometrists and dentists. Regardless of what doctors or specialists charge, every Australian is covered for 85 per cent of an amount that is set down by the government as a common (scheduled) fee. Some doctors charge more than the scheduled fee. Many doctors bulk bill patients, which means the patient pays nothing and the doctor receives up to 100 per cent (85 per cent in the case of specialists) of the scheduled fee from Medicare. Medicare benefits also cover optometrist services and oral surgery, but not private dentistry, physiotherapy, chiropractic treatment and appliances. Private health insurance Many people choose to top up their health cover by taking out private health insurance. The extra insurance allows people to cover private hospital and ancillary expenses (such as dental, physiotherapy and chiropractic services) and aids and appliances (such as glasses). People choose private health insurance for a number of reasons, including: shorter waiting times for treatment being able to stay in a hospital of one s own choice being able to have a doctor of one s own choice in hospital ancillary benefits, such as dental cover security, protection, peace of mind private rooms in hospital insurance cover while overseas. Lower levels of private health insurance are found among the young, the elderly and other groups that have less available income. After the introduction of Medicare in 1984, many people opted out of private health insurance (see figure 4.8). The fall in the membership of private health insurance funds created pressures on the public health system, leading to lengthy debate by politicians and health authorities. The strain on the health system was caused mainly by the increasing demands for service from an ageing population and the increased numbers of free Medicare patients. In 1998, to decrease this burden on the public health system, the Commonwealth Government introduced a 30 per cent rebate for people who have private health insurance. It also introduced a 1 per cent levy (on top of the 1.5 per cent Medicare levy on single people) on people who earn $ or more a year and who do not have hospital insurance. A further change was the lifetime health-care incentive, which was introduced from 1 July This incentive encouraged people to take out and retain private health insurance by ensuring eligibility for the 30 per cent rebate if they became insured before the 1 July start-up date. It also gives lower lifetime premiums to people who join a health insurance fund early in life and maintain their hospital cover, compared with the premiums for someone who joins after age 30 (see the snapshot on page 120). These policies are aimed at attracting people to private health insurance. 118 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

15 In early 2007, the Australian Health Insurance Association stated there were 8.9 million Australians (43.4 per cent of the population) with private health insurance that covered surgery in private hospitals (see figure 4.8) Percentage of population Table 4.2: A comparison of Medicare and private health insurance Year Figure 4.8: Percentage of the population in Australia covered by registered private health insurance funds, (Source: Australian Health Insurance Association, February 2007, data from Private Health Insurance Administration Council.) Who pays? Medicare Commonwealth Government Taxpayers Private health insurance Commonwealth Government Private contributors How paid for? Levy or tax linked to salary Monthly premiums for various forms of cover What benefits? Basic medical services (doctors and specialists) Choice of general practitioner Basic hospital services in public hospitals Specialist health care Cover for 85 per cent of the scheduled fee for medical services Hospital cover hospital services doctor of choice hospital of choice private or public hospital Ancillary services for example, dental, optical, chiropractic Some special benefi ts for example, sports equipment Cover while overseas Medicare and private health insurance 1. Explain Medicare. 2. Describe the benefi ts of the Medicare system. 3. Explain why private health insurance is benefi cial to some people. 4. What are the advantages of having private health insurance? 5. Use fi gure 4.8 to describe the trends in the number of people with private health insurance. 6. Outline government strategies for attracting people to private health insurance. CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 119

16 Private health insurance tips Your health fund premiums went up for the last four years in a row. In the same period some funds have been cutting benefits and eroding the value of your cover. It is not all bad news because it is possible to save hundreds of dollars just by shopping around. A word of warning, however. Be cautious when changing funds you may have to serve benefit limitation periods and waiting times. It s important to remember that, under Medicare, all Australians are entitled to free treatment in a public hospital, regardless of their insurance status. Private health insurance gives you: access to a private hospital, which might be more luxurious than a public hospital greater choice of doctor than you would get if you were treated in the public system possibly shorter waiting times for some forms of elective (non-urgent) surgery. Another thing to consider is the government incentives: Lifetime health cover penalises people who take out health insurance later in life with higher premiums. If you join after your 31st birthday you pay a 2 per cent surcharge per year up to a maximum surcharge of 70 per cent. So, for example, if you join at 45 you pay 30 per cent more than someone who joined at 30. Medicare levy surcharge: singles earning more than $ and couples/families with incomes over $ (plus $1500 for each child after the first) pay an extra 1 per cent Medicare surcharge on top of the 1.5 per cent Medicare levy most people pay. That means at least an extra $500 or $1000 each year. You can avoid this by taking out hospital insurance. Which policy should I choose? Health funds brochures can be difficult to understand and to compare but there are some general things to remember. You can save money on your premium by: v Buying a product with an excess (an excess is an amount of money a member agrees to pay for a hospital stay before benefits are payable). v Buying a product where you pay a co-payment if you go into hospital (the member agrees to pay an agreed amount each time a service is provided usually a set amount per day). v Buying a product that excludes treatment for some conditions. v Buying a product that covers you only as a private patient in a public hospital. You should check how many times the excess applies per calendar year. Sometimes it applies once, sometimes three times. As a general rule it s better to save money by choosing a product with a high excess rather than choosing a product that excludes treatment for some conditions. A number of policies also place limits on some treatments (which means that the fund will meet only part of the costs) and may exclude coverage for some treatments altogether. Commonly limited and excluded treatments include: v assisted reproduction v coronary bypass and major heart surgery v cosmetic surgery v cataract surgery v hip, knee and other joint replacements v obstetrics and birth-related care v psychiatric care v rehabilitation. So remember, if you specifically want coverage for any of these things, make sure you check and double check with your health fund to make sure they aren t excluded or limited in any way. Source: Report by CHOICE Online, Australian Consumers Association, February 2007, The costs of health care to consumers The extent of preventable illness and premature death in Australia indicates great potential for improving health through preventative activities. Given the high cost of health services and the continuing financial burden on governments (and thus taxpayers), programs aimed at prevention rather than cure have gained wide acceptance. Funding for health promotion and illness prevention has increased in recent years. 120 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

17 Governments, individuals and communities are being made more accountable for their expenditures. Many people who have sound levels of health because they practise positive health behaviours (exercising, not smoking, eating a nutritious diet and so on) resent paying increased taxes to support those who choose inappropriate lifestyles. Insurance companies recognise the problem, and charge higher premiums for smokers who wish to be covered for life insurance. Lifestyle factors could cause up to an estimated 70 per cent of all premature deaths. Yet, more than 90 per cent of Australia s health expenditure is allocated to treating and curing illnesses. Unfortunately, it often takes some years for prevention measures to translate into a reduction in the incidence of lifestyle-related diseases. However, preventative programs for cardiovascular disease and traffic accidents have been visible over the past two decades for example, Quit for Life, Stop/Revive/Survive and drink-driving campaigns. Together with treatment, they seem to have contributed to marked falls in mortality and morbidity rates from these problems. Strategies that could be used to prevent illness and death in the community include the education of school children about positive health behaviours; better coordination among the various levels of government; restrictions on advertising; legislation; higher taxes on products such as alcohol and tobacco; and the provision of support programs to help people give up addictive habits such as smoking and alcoholism. There are strong arguments for increasing the funding and support for preventative health strategies. 1. Cost-effectiveness preventing illness and injury would result in huge savings in funds and resources used for acute health care. 2. Improvement to quality of life the positive health outcomes for individuals that result from prevention include improvements in morbidity rates and longevity that is, a longer and healthier life. 3. Containment of increasing costs prevention is the best way of containing the continually increasing costs of health care. Otherwise, these costs could result in adequate health care being unaffordable for ordinary Australians. 4. Maintenance of social equity a policy of prevention helps to provide greater equity (in the health-care system), which otherwise would be under threat as health costs continue to rise significantly. 5. Use of existing structures prevention activities use existing and accessible community structures (such as general practitioners) rather than relying on special services and technological procedures. General practitioners are in a good position to measure risk factors and educate their patients on illness prevention and health promotion. 6. Reinforcement of individual responsibility for health the use of prevention strategies empowers people to take control of their personal health by modifying their behaviour. The arguments for preventing various lifestyle diseases are convincing, but the quality of the extended life span experienced is an issue to be considered. Some researchers are investigating whether delaying the onset of illness through preventative strategies and extending the life span has the effect of increasing the rates of sickness and prolonging the period of illness in the later years of life. CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 121

18 Health-care expenditure versus healthpromotion expenditure Health-care expenditure in Australia far exceeds expenditure on illness prevention and health promotion. An emphasis on medical treatments to cure illness dominates the allocation of public health resources and spending. The new public health model focuses on the social factors that lead to ill health. This model places the emphasis on health promotion as the most costeffective way in which to address the social issues of health. The price of a life Read the snapshot The price of a life and answer the following questions. 1. List the arguments presented in the article that support greater health spending on health promotion and illness prevention. 2. What strategies are suggested for improving health prevention measures? 3. Why is spending much higher for treating illness than for preventing it? 4. Do you think that spending on health promotion and illness prevention is a good investment for the Australian people? Why or why not? The price of a life By Ruth Pollard If we are not, as the poet John Milton wrote, to live a life half dead, how do we judge what a life is worth and how much should be spent to preserve it? As governments wring their hands over the spiralling cost of health care now running at twice the rate of economic growth the obvious but long-term brake that could be applied is the creation of a healthier population. Chronic disease accounts for almost three-quarters of all health expenditure and that, along with the impact of ill health on labour force productivity, increases the real cost of poor health, at a personal and an economic level. The bulk of health expenditure continues to be directed at the acute end of the health system, treating people after they get sick with expensive pharmaceuticals and diagnostic technology, rather than preventing the illness from occurring or at least delaying its onset. We spend 2 to 3 per cent of our budget on 40 to 50 per cent of the disease burden, which is preventable, says Dr Rob Moodie, the chief executive officer of VicHealth, the Victorian Health Promotion Foundation. A classic example is the anti-smoking drug Zyban. When it first became available through the Pharmaceutical Benefits Scheme in 2000, Australia spent $83 million in one year with a very limited effect, Moodie says. A 2002 study found that while 10 per cent of smokers had tried Zyban since 2000, 80 per cent of people did not complete a full course of treatment. Moodie argues the money could have been better spent for example $10 million was invested in anti-smoking programs in 2000, resulting in people quitting and saving 1000 people from dying, he says. Why is the system so skewed that money pours out to pharmaceutical interventions and not much to public health interventions that can reduce the disease burden? Health economists have worked out to the dollar what a life is worth. The answer? In Australia, $3.7 million, or $ a year, says Lynne Pezzullo, a senior health analyst and associate director of Access Economics. Taking into account factors such as what people are prepared to trade off for money working in a risky profession or paying to install a smoke alarm, for example along with potential earnings and other measures, the value of a life is an important figure to consider when working out how much to spend saving it. Added to that, the World Health Organization has developed a standard for the amount of money 122 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

19 governments should reasonably spend to gain one year of life, a quality-adjusted life year, or QALY. In Australia it is a minimum of $ If we can purchase a quality-adjusted life year for less than $ we will do it, almost always, says Pezzullo. That $ is spent on anything from pharmaceutical interventions, to awareness programs, to Pap smear registers and reminder letters about breast checks. Often, though, governments will go well above the $ mark, spending up to $ to buy a year of quality life. The new breast cancer drug Herceptin costs more than $ per quality-adjusted life year saved a cost Pezzullo says should be weighed carefully. The Prime Minister, premiers and chief ministers dipped their toes in the water last month, agreeing to focus on promoting healthy lifestyles and the early detection of chronic disease. There were good signs of there being more of an understanding that productivity is important and the link between health and productivity, Pezzullo says. Unfortunately we still very much have a silo attitude, where only the savings you get in the health system are taken into account when funding interventions clearly we need an economy-wide view. She cites psychotic illnesses as an area where there is huge scope to intervene. If bipolar and schizophrenia are treated... you can prevent a lot of episodes and have a good, productive working life. Pezzullo says health interventions such as counselling and support groups are highly cost-effective every dollar spent saves $7. Vision loss from cataracts, glaucoma and diabetic retinopathy is another area where prevention programs can produce significant cost savings. The most cost-effective move to make is to have an eye check, so diseases 70 per cent of which are preventable are picked up in the early stages. Visual impairment is linked to falls or getting hit by motor vehicles, as well as depression... there is higher comorbidity and death rates for people who are visually impaired. Giving up smoking, getting tested for diabetes, wearing sunglasses and using protective eyewear when playing sport all produce cost savings throughout the economy, Pezzullo says. Glenn Salkeld, an associate professor in health economics at the University of Sydney, said one of the problems of health promotion and disease prevention was that the benefits were often invisible. The money saved from preventing a death from smoking or obesity is not money that reaches the pockets of voters, like a tax cut or dividend, he says. So it is important for people to understand that the return on public investment is not just money saved it is also good health, survival; it is the fact that we are all living longer. It means we are productive members of society, we contribute to the production and delivery of goods and services and that is good for the health of the economy. Salkeld urges public health activists to discard the notion that industry is the enemy. Public health needs to be a real player, not sitting earnestly on the edges, and that means dealing with the private sector. Clinical and curative medicine has been a whole lot smarter and better at getting the money, selling ideas and promoting what they do, [while] public health struggles to sell what it is about in the good times. It is only in the bad times, when, for example, there is an outbreak of communicable disease, that the benefit of good public health campaigns become obvious. Another snag is that you have to spend money to save money. Much of the cancer screening done in Australia not only saves lives, but also costs money if cancer is picked up early then the cost of treating someone must also be taken into account, even though that person would have been treated eventually. That will flow on to someone s productive capacity and quality of life, but you still have to spend quite a considerable sum to achieve that, Salkeld says. Australia spends close to 10 per cent of its gross domestic product on health but Salkeld warns we have hit the accelerator. Pharmaceuticals make up 12 to 15 per cent of expenditure, hospitals and acute care make up the bulk of the rest, and each year people are paying more and more out of their own pockets in private health insurance premiums. There is a sense that we are letting prices get away from us, and as our expenditure increases there is no evidence that we are getting a whole lot more out of the system. That means we must look at how much we put into prevention versus cure even if the pay-off is some way down the track. The private health insurance industry now involving more than 40 per cent of Australians also has a role to play, Salkeld says. They are asleep at the wheel when it comes to prevention; they do not (continued ) CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 123

20 offer the right incentives or provide the right services to encourage their members to take up preventive activity. We give them more than $3 billion per year in government-funded price subsidies surely in return they could invest a little bit more in prevention. Society is happy about paying for prevention when it is based on a pill, because it doesn t require a lifestyle change, says Stephen Leeder, a professor of public health at the University of Sydney. Look at cholesterol-lowering drugs there is no great objection I hear from people about taking a statin, there is no antipathy towards the notion of prevention but there is antipathy about changing your diet and lifestyle. Leeder, co-chairman of the NSW Government s Public Health Priority Taskforce, says 2006 is a make or break year, admitting that to date we have made very little progress. We either get on with it or join the ranks of those who tried and failed, he says. A real preventive approach to health would look at the food we eat and ensure access to fresh fruit and vegetables was as easy and affordable as junk food. It would look at cities and towns and the way they are planned, ensuring they were designed to encourage people to walk, to make use of parks, and to meet as a community to look after our mental health, Leeder says. NSW Health is interested in bringing other people to the table people who design our cities, who design our transport systems and who make, produce and sell food products, and advertisers they are the people who help create the social circumstance in which most non-communicable diseases emerge, he says. Business can make a big contribution. McDonald s spends about $8 billion on advertising in the US a year if McDonald s could be convinced that it spend 1 per cent of that money on health promotion then you could be spending a whole lot more money on health promotion without it costing government anything extra. A tiny 2 per cent of the public health budget is invested in health promotion; the rest goes on chronic care and the acute end of the health system. Australia s lack of investment in physical activity will also come back to haunt us, says Moodie. We have done a terrific job in changing our behaviour on road trauma and tobacco use these programs have really shifted the norms of behaviour and to say that it is not possible in other areas is tossing in the towel too early. But the prevention of obesity requires a significant investment in policy change, in media, in effective regulation and legislation and in research, monitoring and evaluation, he says. Governments must invest, Moodie says, if not to avert spiralling health costs, then to improve labour market participation.... It is really tough for health ministers you have got communities demanding that they have hospitals open in small country towns, when it would be far better to invest that money in a community health centre to manage the diabetes before they end up in hospital. Australia is not alone with its disease burden. The World Health Organization notes that a few largely preventable risk factors account for most of the world s disease burden. Chronic diseases including cardiovascular conditions, diabetes, stroke, cancers and respiratory diseases account for 59 per cent of the 57 million deaths annually, and 46 per cent of the global disease burden. The organisation says only a population-wide prevention-based strategy will save us. Convincing governments to change course and invest in it could be the toughest campaign of all. What s costing v Bipolar disorder: direct costs of $400 million, with indirect costs rising to $1.6 billion by v Schizophrenia: direct costs of $661 million per year, predicted to rise to $1 billion by v Obesity: direct costs are $1.3 billion per year v Heart disease: direct costs will be $11.5 billion by What s working v Needle distribution. Estimated HIV infections prevented among injecting drug users by 2010: Estimated lives saved: v Anti-smoking education. Estimated benefit of reducing smoking rate to below 20 per cent of population: $12.3 billion per year. v National Pap smear screening program: death rate from cervical cancer has dropped from 13.3 per women to 7.7 per v Safe sex program: focus on behaviour change and condom use has contained Australia s HIV prevalence rate to less than 1 per cent of the population. Source: Sydney Morning Herald, 2 March 2006, p HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

21 ALTERNATIVE HEALTH-CARE APPROACHES Alternative medicine has existed for many centuries, particularly in many Asian countries. Traditional Chinese medicines account for per cent of all medicines consumed in China. Japan has the highest consumption of herbal medicines in the world. Populations of developed countries have steadily grown more interested in alternative treatments and medicines over the past decade. Herbal medicines are becoming a popular alternative to modern medicine in developed countries, resulting in an increase in international trade in herbal medicines. Australians spend an estimated $930 million per year on alternative medications or practitioners. Practitioners of modern medicine are starting to recognise the value of alternative health-care approaches and are incorporating some of these into their treatments of clients. The World Health Organization supports countries in their development of national policies on alternative medicine to study its potential usefulness. Australians are increasingly buying herbal remedies and consulting alternative health-care practitioners such as chiropractors, homeopaths, naturopaths and Chinese herbalists. Reasons for the growth of alternative medicine The increasing popularity of alternative medicine in developed countries can be attributed to a number of factors. These include: the World Health Organization s recognition of the usefulness of many alternative approaches and its endorsement of a list of medicinal plants to be used in the preparation of herbal medicines recognition that alternative medicines are the traditional medicines of the majority of the world s population the effectiveness of treatment for many people for whom modern medicine has proved ineffective the desire of many people to have natural or herbal medicines rather than synthetically produced medicines the holistic nature of alternative medicine, which is attractive to many people the strength of traditional beliefs for many cultures the increasing acceptance by Australians of the value of multicultural i n fl u e n c e s. Figure 4.9: Acupuncture can assist with pain management. The range of alternative medicine services The following examples are from the wide range of alternative health-care approaches. Acupuncture is an ancient system of healing that has developed over thousands of years as part of the traditional medicine of eastern countries. Acupuncture treatment involves inserting very fine needles into the skin. They are left in either briefly or for up to minutes. Acupuncture is claimed to be effective in a wide range of conditions, stimulating the mind and the body s own healing response. CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 125

22 Aromatherapy is the use of pure essential oils to seek to influence or modify the mind, body or spirit. Aromatherapy acts in accordance with holistic principles by strengthening the person s vital energies and self-healing capabilities, thus having a direct effect on the mind and body. Essential oils can be inhaled through vapourisers and applied through baths and massage. Aromatherapy is used in the treatment of depression, sleep disorders, stress symptoms and anxiety. The Bowen Therapeutic Technique is a system of muscle and connective tissue movements that gently realigns the body and balances and stimulates energy flow. This has the effect of supporting the self-healing properties of the body. The technique is believed to be effective in the treatment of soft-tissue injuries, musculoskeletal problems, back and neck aches, arthritic symptoms, stress, migraines, asthma, sinus and bronchial symptoms, and menstrual irregularities. Chiropractic is based on the relationship between the spine and the functioning of the nervous and musculoskeletal system. Chiropractors adjust the spine, using specific rapid thrusts delivered by the hand or small instruments. The adjustments are aimed at correcting subluxations, removing interference to normal nervous system control over bodily function, and promoting healing and better health. Herbalism uses plants and herbs exclusively. The oldest form of medicine, it is still used as a primary source of medicine for over 75 per cent of the world s population. Herbalists use the whole plant form of a medicine rather than chemical extracts from plants. They believe that we have an innate ability to heal ourselves. Thus, herbal medicines are used to restore and support the body s own defence mechanisms. Herbal treatment is based on the individual s symptoms, lifestyle and overall health. Homeopathy is a system of medicine that recognises the symptoms unique to each person. It aims to stimulate the individual s healing powers to overcome the condition. Homeopathic medicines work gently and rapidly to alleviate symptoms. Iridology is the analysis of the human eye to detect signs of the individual s physical, emotional and spiritual wellbeing. A range of naturopathic treatments can then be prescribed to improve general and immune system health. Massage is one of the oldest and simplest forms of therapy. It is an excellent method of inducing relaxation. It helps reduce blood pressure, stress and anxiety levels, and overall it is beneficial to the immune system. Forms of massage include remedial massage, therapeutic massage, sports massage and Swedish massage. Meditation is a state of inner stillness. It involves focusing on an object, breathing or verbally repeating a word (a mantra). With practice, the individual can reach a meditative state, in which they experience inner peace and stillness. The benefits of meditation include strengthening of the immune system, improved sleep, lower blood pressure and increased motivation and self-esteem. Naturopathy focuses on the holistic treatment of the individual by seeking to address symptoms of illness as well as resolve underlying causes of illness. Naturopaths recognise the importance of developing a partnership with their clients, because it is important for Figure 4.10: The many forms of massage the individual to take responsibility for making positive lifestyle help to relax and reduce stress. changes. 126 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

23 Find your way, naturally By Anne Fawcett In the not so distant past there wasn t much training for students wanting a career in natural therapies. According to Jim Olds, president of the Australian Natural Therapists Association (ANTA), the quality and level of training has increased in the past decade, along with public demand for skilled practitioners. We re finding that a lot of people are disenchanted with the mainstream medical model, so we ve seen a huge amount of growth in demand for alternative modalities like herbal medicine, remedial massage, homeopathy, naturopathy and traditional Chinese medicine, Olds says. Where the highest level of training in a particular modality might have been a certificate, there is a growing number of diploma and degree-level courses run by universities and private colleges. Students can choose from programs such as the University of Technology s Bachelor of Health Science in Traditional Chinese Medicine, the University of Western Sydney s Bachelor of Health Science in Herbal Medicine, or Nature Care College s Bachelor of Naturopathy. Degrees were once seen as the pinnacle of training [in natural therapies], but they re now becoming almost the baseline, Olds says. As of this year, for example, ANTA no longer recognises acupuncturists without a degree. Graduates have a very good standard of education and very sound clinical training, but it also gives clients quality assurance. There s also a growing number of institutions applying to the association for recognition of advanced diploma and degree programs. Graduates of recognised courses are eligible to become members of the association, which provides professional indemnity and public liability insurance. Services by member practitioners may be recognised by health funds and WorkCover. Tamsin Rossiter, who teaches remedial massage at TAFE NSW s Western Sydney Institute, says health fund recognition has led to a big increase in demand for natural therapies. Fifteen years ago, one or two health funds offered rebates for natural therapies, Rossiter says. Now almost all of them do, and people on worker s compensation can claim remedial massage as part of their ongoing medical expenses.... But Rossiter warns studying natural therapies is not a soft option. I think there is a big shock for people when they start the course and realise they have to learn anatomy and physiology to understand the principles of natural therapy. These programs are very practical, but they are founded in science.... After finishing the advanced diploma in naturopathy at Nature Care College in North Sydney, Ruelle Down intends to study for a further year to attain her Bachelor of Naturopathy degree. There s definitely greater demand for higher qualifications in the industry, she says... Down enjoys the variety of the course, which includes subjects such as nutrition, herbal medicine, homeopathy and iridology. The workload can be heavy, with weekly assignments, course readings, practical classes to prepare for and about 16 contact hours a week... The course has a large practical emphasis, allowing students to develop skills early. You re studying something you can immediately use in life. I ve helped family members overcome gastric problems, heartburn, a tight neck and shoulders things people usually put up with and may not realise we can do a lot about. Source: Sydney Morning Herald, 12 October 2005, Radar, p. 12. Alternative health-care approaches Use the internet to research one type of alternative health care. Write a report and present your findings to the class. Include information on: (a) the history of the therapy (b) its nature (c) the benefits (d) the treatments involved (e) the cost (f) the level of training required to be a practitioner (g) groups of people whom it would benefit. CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 127

24 Making informed consumer choices When choosing any type of health or medical service it is important to investigate the service offered and the credibility of the practitioner. A client needs to ask the following questions. What is the treatment you offer? How can it benefit me? What experience and training do you have? What are your qualifications? How much will the treatment cost? Can this treatment be combined with conventional medication? An important first step in making informed choices is to gather such specific information about the nature of the alternative medicine, its credibility as an effective type of treatment, and the qualifications and experience of practitioners. Asking friends and community members about their experiences and recommendations can also be valuable. Some of the alternative medicines are considered to be very effective, and the World Health Organization recognises them to be valuable and significant treatments. Chiropractic medicine, naturopathy and acupuncture, for example, are offered as university courses within Australia. Other forms of alternative medicines have endeavoured to ensure the highest quality of treatment by providing courses within their organisations; for example, the Bowen Therapy Academy of Australia offers an introductory course followed by a six-month practitioner course to obtain accreditation. Developing personal consumer skills Using the questions listed above as a guide, or your own questions, investigate the credibility of one type of alternative medicine. Your investigation methods may include: (a) gathering information from local practitioners (b) experiencing the chosen treatment (c) researching the qualifications required to practise (d) contacting training organisations to collect information (e) interviewing people who regularly use this treatment. Present your findings as a report and share this with the class. Making informed consumer choices 1. When selecting an alternative medicine, what information would you require to make an informed choice? 2. Discuss methods of accessing correct and relevant information about alternative medicines in your local area. 3. How do you know which practitioners and health-care organisations to believe? 4. In small groups or in pairs, create a PMI chart as follows to summarise the advantages and any drawbacks of alternative medicines. Plus Minus Interesting 128 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA

25 Health-care facilities and services are essential in diagnosing, treating and rehabilitating the ill and injured. They also play an important role in preventing illness and promoting health. Efficient and effective health-care services, along with adequate public housing, employment, education, hygiene and environmental safety, are all crucial factors that have an impact on levels of health. The role of health care in Australia is to provide quality health facilities and services that meet the needs of all Australians. The range of health-care facilities and services in Australia include public and private hospitals, psychiatric hospitals, nursing homes, medical practitioners and specialists, community programs, health-promotion services and other health professionals who offer alternative health care. Access to health-care facilities and services is affected by a number of factors, including affordability, location, knowledge of service and language barriers. These factors result in inequity in access to health care. The private sector within the community plays an important part in providing health services such as the health promotion strategies undertaken by the National Heart Foundation. Individuals have a responsibility to take actions to promote their own health, thus lessening the financial burden on taxpayers. Medicare is the national health insurance program that was introduced to support the health of all Australians. It covers a proportion of basic medical and public hospital expenses. Medicare is funded by Australian taxpayers. Private health insurance allows people to be covered for extra medical and private hospital costs. The Commonwealth Government has introduced a 30 per cent rebate as an incentive for people to join private health insurance. It has also introduced a levy on individuals who earn over $ and who do not have private health insurance. Most recently, it set up the lifetime health cover scheme to encourage membership. Ill health is costly to the government and the individual. Our taxes fund the medical system within Australia. A large proportion of health expenditure in Australia is devoted to curative services, with a small fraction allocated to health promotion. Health promotion is a much more cost-effective means of reducing disease and illness in the long term. Alternative medicine is growing in popularity in developed countries. Many people are becoming disillusioned with the biomedical treatments on offer. There are a range of alternative health-care approaches, such as acupuncture, chiropractic, herbalism, naturopathy and iridology. It is important to make informed decisions when choosing an alternative health-care approach. The individual needs to investigate the services on offer, the costs, the qualifications and experience of the practitioner, and the health claims being made before committing to it. CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 129

26 Revision 1. Explain the role of health care within Australia. (H5) 2. Explain the differences between institutional and non-institutional health-care facilities and services. What services does each provide to promote health? (H5) 3. Describe the roles and responsibilities of the following groups in the provision of health services. (a) Commonwealth Government (b) State and territory governments (c) Local governments (d) Private sector (H5) 4. Is access to health-care facilities and services equitable across the Australian population? Explain. (H14) 5. Explain how Medicare attempts to provide equity in access to health care. (H14) 6. Discuss the benefits of private health insurance. (H14) 7. How has the Commonwealth Government attempted to support private health insurance? (H15) 8. Explain what you can do, as an individual, to reduce the cost of health care to taxpayers. (H5) 9. Explain why alternative health-care approaches have grown in popularity in developed countries over recent years. (H14) 10. Identify and discuss the information you need to make informed decisions about alternative healthcare approaches. (H16) Extension 1. How can the Commonwealth Government justify spending more of its total health expenditure on illness prevention and health promotion than on curative services? (H15) 2. Argue the benefit of adopting health promotion actions that promote social justice. (H14) 3. Identify and analyse the key factors affecting the health of Australians. Suggest strategies that could lead to improved health for all Australians. (H15) 130 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA