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Health 101 Research Paper

Healthcare of Australia vs. United States

Kaylan Huff

Department of Health Science, California State University Channel Islands

HlTH 101-04: Overview of Healthcare and its Delivery

Professor Melissa Gutierrez-Jimenez

November 29, 2022

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Reflection

History of Australia

Australia is a country that resides in the southern hemisphere, between the Indian and

Pacific Ocean. The people of Britain primarily colonized Australia in the late 1780’s as a penal

colony, but free settlers began colonizing in Australia by the 1830’s. When gold was discovered

in Australia in the 1850’s, people from all around the globe immigrated to the country and it

eventually became a nation in the year 1901 (Australia in Brief, Pg. 9). In 1902, women were

granted the right to vote making Australia one of the first countries to promote gender equality.

Due to the diverse cultures that have immigrated to the land (over 30% born overseas), Australia

has a large variation of languages, proud history, and skilled workforce. Unlike the United States,

the attentiveness Australia has made to devote their time and effort into developing a secure and

peaceful society has, in turn, created a comprehensive healthcare system for residents.

Type of healthcare System in Place

The Australian population of now 25.74 million has formulated a healthcare system that

is ranked one of the best in the world in 2021 determined off the five performance domains:

access to care, care processes, administration efficiency, equity, and health outcomes (Schneider

et al, 2021). It is interesting the note, the United States is ranked second on their care process but

last on all four other performance domains. Australia may surpass America in these other

rankings due to government providing Medicare, a single-payer universal health care program,

that covers all citizens and residents of Australia. Medicare in Australia provides residents with

the benefits of public hospital care, sufficient physician coverage, and pharmaceuticals

necessary. The citizens of the U.S. must seek health care on their own through private insurance
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or federal and state programs. In other words, the U.S. healthcare system does not have a

universal coverage and residents have to pursue coverage on their own.

Means by Which the System is Financed

The Australian healthcare system funding can be divided through the public and private

insurance. Residents can choose to utilize one system over the other or choose to apply health

care services as a mixture of the two systems. The private health insurance finances are handled

just as it sounds, private through the customer; the public system, Medicare, is funded through

the local, state, and federal governments. While this seems as if the cost is mostly free, the public

is still technically providing the government with this income through what is called Medicare

levy. Residents who are employed in Australia, mostly everyone, as well as high income earners

without a suitable balance of private hospital insurance, will be charged Medicare levy as a

portion of their income tax (About Medicare, 2022).

In the United States, the healthcare funding can also be divided through private and

public insurance; although, both systems have branches and subbranches that can be very

confusing and cause billing nightmares. The public insurance programs in the U.S. are Medicare,

Medicaid, CHIP, and military insurances such as TRICARE. Essentially, all of these public

insurance programs are funded through federal taxes; however, each branch is funded slightly

different. Medicare has various funding resources such as general federal taxes, payroll tax

revenues, premiums paid by beneficiaries, taxes on social security benefits, payments from

states, and even interest (Cubanski & Neuman, Pg. 2). Medicare has four types: A, B, C

(Medicare advantage), and D which are all funded differently. Medicare part A covers hospital

visits, hospice care, home health visits, and skilled nursing facility stays; these coverages are

primarily funded from 90% of payroll taxes, with employers charged 2.9% and employees
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1.45%. Medicare part B, which covers physician visits and out-patient care, is funded through

approximately 73% general revenues, 25% beneficiary premiums, and 2% other sources.

Medicare advantage is paid primarily through the Medicare HI trust fund and cover beneficiaries

with the same benefits of Medicare part A, B, and D. Medicare part D has comparative fundings

to Medicare part B with 74% general revenues, 15% beneficiary premiums, and 11% state

revenues (Cubanski and Neuman, Pg. 2). Medicaid is funded by two-thirds federal taxes, but

state and local collections also play a part. CHIP can collect fundings through state premiums but

also grants from the federal government. The other branch of U.S. healthcare insurance is private

insurance, these fundings are collected mostly from employee sponsors, but can additionally

collect funding through non-profit carriers.

Scope of Services Provided and Health Care Funding Priorities

In one study, a comparison of Australia, New Zealand, and the United States were

observed to compare the scopes of services patients need and what they are successfully

receiving. The study concluded, patients who were seeking a primary care physician in the U.S.,

received the exposure they needed by over a third in Australia and half in New Zealand. This

exposure could consequently have a negative effect on the patients need for service due to

inadequate time spent throughout preventative care, chronic conditions, and acute injuries

(Bindman et al, Pg. 4). Thus, the scope of services in Australia has provided patients with a more

reasonable exposure that will balance out the scope of services and demands required for

residents. It is also suggested, this underperformance of demands in services throughout the U.S.

may conclude why the U.S. does not perform with adequate health outcomes for the investment

the healthcare system is funding.

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Another study compares top healthcare systems, such as Australia, to the U.S. in terms of

funding priorities and how it affects the countries healthcare outcomes. The study shows, the

U.S. spends less funding on primary care systems, social services, mental health, and cost

barriers. The U.S. has many duplication errors that are a consequence from inadequate planning,

direction, and coordination from the central agency. If the U.S. adapted a similar priority as

Australia does, they could avoid the high mortality rate expressed in statistics of the healthcare

system. For example, if America spent more on social services, this funding could provide a

better access to care in terms of nutrition, education, childcare, community safety, and even

worker benefits that Australia accomplishes (Schneider et al, 2021). The lack of funding

monitoring the U.S. has due to overlooking global budgets and utilizations reflects no central

agency. Insurances such as Medicare, Medicaid, and Chip are not adequately reimbursing

medical professionals due to the U.S. determining reimbursement rates from public-sector

expenses. In turn, this causes many medical professionals to deny service for patients with these

insurances due to the lack of reimbursement from the government; in addition, when medical

professionals deny service, the country will reflect a lack of access to care and overall success.

Amounts that Consumers Pay for Outpatient and Inpatient Care

Consumers in Australia have a significantly lower expense for healthcare than consumers

in the United States, due to Australia providing a universal coverage to the public. For example,

if an Australian has public coverage and they go to the public hospital, all costs will be covered

by Medicare; although, if the Australian has private insurance, Medicare will only pay for 75%

of hospital coverage and the patient will be left with the remaining 25%. However, the remaining

25% could potentially be picked up through the private insurance depending on the on the plan

(Department of Health and Human Services, 2015). The fundamental process that Australia
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provides that the U.S. lacks is simplicity in the system. The system in the United States, in

comparison to insurances, provides patients with a benefits schedule similar to Australia, but the

fundamental system is so complex it causes confusion to patients seeking care. The U.S. has

different Medicare plans, (A, B, C, and D), and does not provide proper execution to explain the

coverage benefits for the beneficiary. Residents of the U.S. are often left with a larger bill for

inpatient and outpatient care services due to the “define print” the government holds. If the U.S.

provided patients with a universal system and set rules that Australia does, the beneficiary would

receive fair billing and would possibly seek care with a more positive perspective of the system.

Primary Healthcare Providers in each System, their Respective Roles, and Training

While medical professional titles are generally the same when comparing Australia and

the U.S., the way medical professionals seek training and accreditation is different. In Australia,

the legislation provides a uniform regulation for primary healthcare providers and their scope of

practice. The structure of Australia’s medical professional roles is clear, consistent, and reflects a

specific code of conduct; this code of conduct for providers’ roles gives a clear description of

their unique scope of practice they must stay in the boundaries of. However, if a medical

professional chooses to seek additional training, such as a dentist receiving qualifications for

sedation, they may choose to do so through the National Boards. Not only does this regulation

provide consistency across the country, but it also provides flexibility to a universal scope of

practice. This was specifically beneficial during the COVID-19 pandemic because Australia was

able to facilitate short term sub-registers for aiding with telehealth (Leslie et al, Pg. 7). The U.S.

differs from this uniformity in training requirements and regulates roles and training for medical

professionals based off state and national rules. While some states may choose to base medical

training off a national licensure, states have constitutional authority to govern regulatory
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processes. In one study, challenges have been voiced in regard to the accreditation of health

professionals in the U.S., noting that health professionals are limited by the location they

received training rather than by their skills and competence (Leslie et al, Pg. 5). The variation of

medical professional training and requirements the U.S. has, consequently provides insufficient

healthcare services and limit to care the country could potentially receive.

Comparative Strengths and Weaknesses of the Two Healthcare Systems

The United States and Australia have extremely dissimilar healthcare outcomes due to

their chosen structure of system. In one study, the U.S. ranks last in healthcare outcomes and

Australia in the top three. Healthcare outcomes are based off significant domains such as infant

motility rate, life expectancy, preventable mortality, and maternal mortality rate. In one of these

domains, the U.S. had 17.4 deaths per 100,000 live births compared to Australia with only 4.8

deaths per 100,000 live births (Schneider et al, 2021). This maternity rate is one of the many

weaknesses the U.S. healthcare system holds and should be addressed through the structure of

the system. In the same study, Australia exhibited strength in the amount of healthcare spending

the country expended; in the percentage of GDP, Australia ranked 9.4% in spending and the U.S.

ranked 16.8% (Schneider et al, 2021). While it could be perceived that Australia’s healthcare

system does not direct enough funds toward the system throughout the years 1980-2019, this

should be perceived as a strength. Australia is proficient in low healthcare budgeting and high in

exceptional service, access to care, administrative efficiency, equity, and most importantly

healthcare outcomes. The U.S. providing funds to their healthcare system is an exceptional

strength that provides diverse access to research, technology, and advancements, but at what

cost? The balance of funding and care should be essential in any healthcare system structure in

order to pursue the best performance for patients who need it.
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Scopes of Services for Special Populations

One study discusses how Australia has transitioned from a traditional paternalistic

approach to a patient-center cared (PCC) approach that has benefited the scopes of services for

special populations. The study shows, an increase of medication adherence has been distributed

to chronic hypertension patients when Australia began the PCC approach. Special populations

such as children, LGBTQ+, rural populations, women, chronically ill, homeless, veterans, and

incarcerated require adequate attention to decrease stress and increase management due to their

unique situation. Delaney argues, “programmes that employ established PCC approaches

endeavor to empower patients to make lifestyle modifications and improve their overall health

and well-being” (Delaney, Pg. 120).

Special populations in America face challenges in seeking the appropriate scope of

service necessary for their situation. One study argues, every one in four Americans are faced

with chronic conditions, and with this number of individuals, a focus on high-quality care that

will not flux from the national healthcare system is essential (Bhatt, & Bathija, Pg. 1271).

Although America has special payment programs readily in place for special populations, what is

desperately needed is a focus on accessibility of care. A large portion of rural communities,

where special populations reside, only seek healthcare services from hospitals. Only seeking

service from hospitals, negatively affects individuals’ health and reflects negative health

outcomes due to the hospital having little incentive to respond to the patient demands. Hospitals

treat patients who have the most urgent medical conditions first, which will not provide patients

going in for a medical check-up with a high performance. Health strategies such as the PCC

approach that Australia uses, would better implicate positive health outcomes for the special

populations within the American community.

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Country's Major Health Concerns

Australia and the U.S. health concerns can be considered similar when investigating the

extreme weather events, natural disasters, and climate change. This may be due to the U.S. being

approximately 1.3 times larger than Australia causing more disasters to occur; however, the

environmental factors that occur in both countries have major impacts to the health of individuals

due to loss of food and essential service accessibility. For Australia, one of the most common

problems for people who reside there, is the intense heat waves. One study confirms within the

years 2007-2017, there was a 2% increase of deaths due to environmental conditions (Australian

Institute of Health and Welfare, 2022). Excessive heat can cause individuals to be at risk for heat

stroke, body cramps, rashes, and also increase problems for individuals diagnosed with chronic

diseases, such as diabetes, hypertension, kidney disease, or mental disorders. Beneficial

information for residents in Australia to access is found through the “Environmental Health

Standing Committee,” website; the enHealth committee advocates problems, solutions, and

resources for residents regarding anything environmental. While heat is a large issue for the

Australian community, the U.S. also sees approximately 1,300 deaths per year due to heat stroke;

however, 600 of the 1,300 deaths are related to underlying conditions such as cardiovascular

issues (CDC, 2022). Individuals in America can seek resources for preventing heat stroke

through the “Centers for Disease Control and Prevention,” website.

The impact of COVID-19 has critically impacted the healthcare system of countries all

across the globe; however, the statistics of Australia and the United States COVID-19 death rates

are astronomically different. Mathieu et al, confirms Australia’s death rate was only one-tenth of

what the United States confirmed death rate for COVID-19 was (2020). This may possibly be

due to the restrictions the government held on Australia’s traveling, personal interaction, and
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vaccine requirements that the U.S. did not enforce. Regardless of Australia having a lower death

rate than America, one study argues that Australia faces concerns regarding resource allocation

and performance during COVID-19. Due to Australia providing a public health insurance to their

residents, this results in longer wait times in receiving service of care. Although Australia rates

typically high in healthcare performance, studies show they may need to shift to a patient

centered business model to help improve patient satisfaction (Dixit SK, 2018). On the other

hand, the United States healthcare system has much more leniency for individuals and allows

them to choose their own healthcare choices (for the most part), but this choice consequently

affects the whole country negatively.

Summary, Conclusion, and What I learned

While there are many differences between the healthcare systems of Australia and the

United States, the attentiveness that Australia has provided for their residents has expressed a

significantly secure and peaceful society that has, in turn, created a comprehensive healthcare

system far healthier than the U.S. Australia uses a universal approach for providing residents

with public healthcare which creates a stable system that individuals can rely on. The U.S. does

not provide residents with access to public healthcare which consequently causes instability in

their fundamental structure. With each scope of service in Australia there are universal training

requirements which provide a common knowledge of healthcare. In the U.S., each scope of

service training requirement is set by the state and produces unpredictability for individuals

seeking healthcare. The chosen cost of healthcare funding in Australia is evenly balanced

between technology and administrative productivity, unlike the U.S., and aids the healthcare

system in providing exceptional care for residents. While the ratings of Australia’s healthcare

system are continuously positive throughout the last several decades, developed countries like
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the U.S. and Australia must learn to shift their system to adapt to ever-growing populations;

through each increasing population, there will be a higher demand for access to various health

professionals, and healthcare systems must be flexible in order to successfully deliver (Shi and

Singh, pg. 24).

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