The key principle underlying Australian healthcare system is equity to universal access to

most health care regardless of the situation or ability to pay. This is achieved since revenue
for this healthcare comes from taxation. Health services are funded through Medicare and
pharmaceuticals schemes which are highly subsidized by the government while public
hospitals and public healthcare are partly funded by commonwealth and state funding
agreements. The schemes are founded on the spirit to make public health accessible by all the
citizens irrespective of their financial ability (Healy & Hilless, 2001). The purpose of this
paper is to expound on the concepts of equity of access of healthcare in relation to
effectiveness and efficiency and the relationships that exists among these concepts.

Equity of access

Equity is all about ensuring that all people have the support that they need to access,
participate and achieve the same level. Access and equity are two concepts that go hand in
hand they imply removing barriers and opening up opportunities. In the field of health these
concepts mean that people with differing needs and abilities have the same opportunities to
be attended to professionally by the medical practioners whether private or public at any time
irrespective of their age, disability, color, race, gender, religion, sexuality, or location. It
means addressing the healthcare need of everyone (Department of education and equity
standards branch, 2003).

The Australian government through its insurance schemes have tried to make healthcare
accessible to all, however, it has been found that compressive insurance coverage is not
always sufficient to ensure equitable access to health services since other factors such as
shortages or mal-distribution of health services providers or constraints presented by
language or cultural differences limit access to medically necessary care for apportion of the
population (Docteur, 2004). In fact there is a wide agreement that rural and remote Australian
communities are underserved by appropriately trained health professionals compared to those
who live in the urban areas. Further, most remote Districts of Australia communities are
unable to attract medical practioners and they are dependent upon rural remote area nurses to
provide their healthcare. The shortage of rural registered nurses also impacts negatively on
health care delivery. Despite these short comings, Australian population enjoys good health
relative to other countries with an increasing life expectancy of an average of 78 years and
low incidences of life threatening infectious diseases. Although the spirit of the government
healthcare policy to provide equity and access to healthcare has not been fully achieved, this
policy has contributed greatly to the health status of its citizens. For instance over 85% of the
people consider themselves to have excellent health status. In order to achieve the equity of
access to health care it’s important that distribution of the health officers be checked
and implements tele health services that will ensure that those Australians in remote areas
have access to relevant healthcare (Jackson et al., 2009).

Effectiveness

There is no unanimity on how the concept of effectiveness can be defined, as a result of this
there is inconsistency among scholars in their definition of the concept for instance. Some
scholars view effectiveness as the degree by which organization achieves their goals, while
others view it as the survival of the organization (Sudan & Chand, 2004; Stephen, 2008).
Other feels that effectiveness is present as long as an organization uses its resources
efficiently and continues to contribute to the large system. Despite the inconsistencies,
scholars have agreed on some points that may be applicable in measuring effectiveness. For
instance how well has expectations of the society been met as per societal regulations and
rules, the time dimension of how the system meets its goals in near future. Intermediate or in
distant future and the decline or growth of the system can also be an indicator of effectiveness
(Sudan & Chad, 2004).

Increasing the effectiveness of health care systems in Australia is growing priority for policy
makers. The notion of effectiveness encompasses a broad and growing number of
dimensions, reflecting increasing expectations in Australia in such away that health system
must do more than just improve population health and reduce disability. The effectiveness of
the access of health care by rural and remote communities in Australia has been enabled by
the outreach models initiated; these are periodic supplies of the services from one location
especially in towns to other location in this case remote areas. Other problems associated
with heath care system especially in secondary and tertiary services such as surgery are not
available to the people for instance Kimberley region has higher mortality rates than in the
state level due to lack of access of specialist services like surgery which takes to long to be
availed. The state rural community lacks enough medical personnel which mean that access
to healthcare is also a problem. Compared to major towns like Melbourne, Kimberly the
Australia’s most northern region with the highest proportion of aboriginal people
always have a shortage of not lees than 20 medical doctors (OECD, 2002).

Efficiency

Measuring efficiency in healthcare is concerned with comparison of inputs with outputs or

outcomes of the health care system to access the degree to which goals are achieved while
minimizing resource usage. From economic perspective, efficiency put two elements into
consideration that is allocative efficiency and dynamic efficiency.Allocative efficiency is
aimed at allocation of resources so that the input invested in heath care system yield the best
output. To achieve this technical efficiency, effectiveness and priority setting must be
addressed. Effectiveness is aimed at maximizing outputs to a limited amount of inputs.
Priority setting involves deciding amount of resources to be allocated in each and every
disease while technical efficiency is achieved by ensuring that the staff serves to their full
potential. Efficiency can also be measured in three levels i.e. the disease, subsector and
system level. The disease level focuses on each disease on the gains in heath status brought
by healthcare system, while the subsector level focuses on gains brought specifically by
hospitals, outpatient care and pharmaceuticals and the system level relies on the holistic view
of the system (OECD, 2010).

Large hospitals and multi general practioners practice and specialist medical centers are most
common in urban Australia and rare in rural Australia and services that look similar are
actually structured differently. These healthcares deliver different services and cater for
different populations. Rural residents are not equal participants in the primary health system
since there are few general practioners in rural areas, they also make few visits in healthcare
centers and they spend much to seek health care than their urban counterparts this means that
the Medicare scheme of the government is not efficient in providing equity of access of
health care to all citizens. The cost of time, transport and greater competition for services in
regional centers contributes to lower utilization rates of those in smaller isolated communities
(Luck, 2011). In addition the experienced pre-exist nurses in rural area can be up-skilled to
serve a broader range of primary health care hence reducing the burden of the general
practitioners rather than trying to fill every vacancy of general practitioner. The nurses serve
by complementing the work of medical practitioner.
Interrelationships

A properly functioning health system can be evaluated in terms of equity of access, efficiency
and effectiveness of all the components of the system. Although there are a number of
challenges in these dimensions, Australian health care system has strengths which manifests
that the government has made efforts to maintain the proper functioning of the system in
recognition that all these aspects are necessary and inseparable in a good health system.
Efficiency, effectiveness and equity of access concepts are thus interrelated and their matrix
is important when formulating policies of a system.

Healthcare has remained a focal point for discussion throughout the history. However with
entitlement spending dramatically increasing, poised for further increases, healthcare has
been placed at the fore front of public policy. Globally very few countries have achieved an
efficient and equitable healthcare industry. Australia serves as an excellent example in their
health care policy because its system balances for equity of access and efficiency through the
adoption of the free market policies in health provision as well as the base safety net for
individuals who cannot afford free market rates hence making sure that the biggest
population can be able to access the health services.

According to Duckett (2008) efficiency compare outputs to inputs in this case, the number of
health care staff to the number of people seeking health care services putting in to
consideration the satisfaction the patients. It’s possible to estimate the number of
health staff required to attend patients satisfactorily in every region if efficiency ratios are
known. In the efforts to achieve efficiency and effectiveness of the medical staff the policies
of the government ensures that the citizens can access adequate and qualified medical
personnel equitably. For instance in rural Australia there is an average of one medical doctor
in a population of one thousand people. This is in contrast with the urban settings where the
number of medical doctors is higher in the same population. While doctors in rural area may
be efficient due to high number of patients they attend to access to them by citizens is limited
hence contributing to the in effectiveness of the system due to citizens’ dissatisfaction.

Australia government and private sector has invested heavily in construction of health
facilities in all regions so that citizens can access them easily and equitably. For instance it
had 1051 acute care hospitals of which 734 were public hospitals providing 70% of the bed
stock and 317 were private hospitals. Public hospitals are funded by the government or by
charitable organizations while private hospitals are privately funded (Healy, 2001). Due to
large number of public hospital with many facilities and resources they at times underutilized
hence operating inefficiently. To ensure that efficiency is achieved public hospitals liaise
with private hospitals to provide private services that are not available in private hospitals.
This way efficiency is achieved and at the same time the satisfaction of the citizens by the
kind of collaboration that exist between private and public hospitals indicates that the
hospitals are effective in accordance with social rules and regulations. Efficiency of hospitals
has also been achieved through the policy of regional hospitals constructed in regional
centers especially to cater for rural population. The regional hospitals also help the citizens to
access specialist health care with ease. All this efforts contributes to the success of the health
system in the spirit on universal access to health care (Duckett, 2008).

For the societal satisfaction with the health care system the founding principles of the
Australian health care system must work hand in hand. Effectiveness, efficiency and equity
of access principles should be demonstrable in a perfect system. Although perfection cannot
be achieved the governments through its insurance policies have tried to make accessibility a
reality. In addition to accessibility the efficiency of the health workers has been tried to be
achieved through encouraging the general practitioners to work in the remote areas where
there is shortage of practitioners this is done through incentives, perks and allowances offered
to those who practice in rural areas in addition to this tele health care services are adopted
such that health care services are moved closer to the people from the urban areas where it
concentrated these practices are done periodically.

Conclusion

The underlying principle in Australian healthcare system is equity to universal access to most
health care regardless of the situation or ability to pay. This is achieved since most health
care system get revenue from taxation thus promoting equity of access of the health system.
The concept of equity of access in relation to effectiveness and efficiency is also explored in
Australian heath care system (Healy, 2001). In this case efficiency is measured by degree to
which goals are achieved in health care system while minimizing resource usage while
effectiveness is measured by degree to which health care system achieve their goals. Large
hospitals and multi general practitioners practice and specialist medical centers are most
common in urban Australia and rare in rural Australia. This indicates that the Medicare
scheme of the government is not efficient and effective in providing equity of access of
health care to all citizens.

In Australia

In Australia, Allied Health Professions Australia (AHPA) is the national peak body for allied
health professionals. AHPA defines that allied health professionals are required to complete
recognized Bachelor of Science or Applied Science degrees. It enable them to obtain
State/Territory registration, license or accreditation to practice, or eligible to join the relevant
professional association, before being legally entitled to work. The members mainly include
audiologists, chiropractors, dietitians, exercise physiologists, occupational therapists,
orthoptists, orthotists and prosthetists, osteopaths, pharmacists, podiatrists, psychologists,
radiographers, radiation therapists and sonographers, social workers and speech pathologists.
They must often prove their skills through diplomas, certified credentials, and continuing
education. Overall, allied health disciplines include clinical healthcare professions distinct
from medicine, dentistry, nursing and medical scientists (Allied health professions Australia,
2008).

In 2006, Services for Australian Rural and Remote Allied Health (S.A.R.R.A.H) proposed
some criteria for allied health professional workforce in order to fulfill health policy
development. The health professionals must be graduated from an accredited degree course
of recognized university. They can apply their skills and knowledge to assist patients to
restore and maintain optimal physical, sensory, psychological, cognitive and social function.
They should be recognized by State or Territory registration, licensure or accreditation to
practice, or registration in the relevant professional association. Allied health professionals
collaborate with other health professional workforce, community or work as part of a
multidisciplinary team to achieve the best function of health system. (Lowe, Adams &
O'Kane, 2007).
The Australian Institute of Medical Scientists (AIMS) is another professional association
representing medical scientists. Professional membership of the association is recognized by
employers as indicating professional status. AIMS conducts scientific meetings, conferences
and seminars at national, state and local levels, all of these can keep the continued
professional development of members of the profession. (Australian Institute of Medical
Scientists, 2010)

However, in rural and remote areas, the cost of such continuing education is particularly high.
The medical scientists in rural communities are faced with particular problems in attempting
to upgrade their skills to keep pace with rapidly developing of new technologies. On the other
hand, after graduation from a recognized university, the medical scientists need on-the-job
training that may lead to differing standards of training depending on the competence
laboratories or small laboratories in rural area. Under the limited resource in small
laboratories, particularly in rural area, only part time medical scientists or technicians are
employed. They are difficult to maintain and apply their skills to develop new technologies.
By the way, allied health professions in Australia are not uniformly required to be registered
to practice. Poor salaries and poor career path reflect low profession's value and low
professional status. (Australian Institute of Medical Scientists, n.d.)

Use of Communication Skill in Health & Social Care Context

Communication skills are of great importance in any field. It is very much necessary to
communicate with the target audience in the way they comprehend it and also it is of great
significance to comprehend the intellectual and physical limitations of the targeted audience.

Let us simplify it by taking an example: Let us take a hypothetical situation, consider you are
a doctor and practicing on a child and the child is having some heart problem. In this case
you will not expect that child to comprehend the lengthy report on his heart functioning test.
So definitely you would "water" it down.

Many such examples can be given to understand the importance of communication to health
and social care.

Communication skill helps in organising a conversation, helps in probing the opposite person,
it also helps in keeping the conversation going. Also communication skills are necessary in
order to build up a good and health relation with the people using your services, also it helps
in comprehending and meeting the needs of the person as well as can bond up with their
friends and families. It helps in sending and receiving the information with the people taking
up your services.

There are many different types of communication named one-to-one communication, group
communication, formal communication and informal communication, written
communication.

In health and social care generally a formal communication is used, which generally starts
with the greeting. It is generally used to show respect towards the person and it is also a
communication starter. A professional person generally in health and social care uses formal
communication in order to speak to opposite person in regards to the services. It is exact,
clear and avoids misunderstandings.
Another communication, which is generally used in health and social care, is written
communication. In health and social care environment, written communication is central to
the work of any person when keeping records or in writing any reports. Different styles of
writing are needed for different types of communication but the basic of all is the requirement
of literacy skills. When recording any information about a patient a very formal style of
writing is required.

Barriers to Communication in Health & Social Care

Many things contribute in stopping an effective communication. People working with health
and social care should comprehend the barriers in order to overcome them. Effective
communication is very much necessary in health and social care setting; if the
communication is not effective or understandable than it would be difficult for a service user
to involve in the discussion regarding the care or planning the future. Similarly, it would be
difficult for a service provider to help the service user if he do not understand what the person
is trying to ask.

Few of the barriers are language problems, jargons, acronyms, health issues, stress, emotional
difficulties, environmental problems, misinterpretation, aggression, etc.

Let us briefly understand all the above-mentioned barriers:

Language Problem (Foreign Language): Using a language other than local or using sign
language creates problem for both the service provider and user in comprehending each other.
Even if someone tries and helps out in translating the message, it is again difficult to pass the
message clearly.

Jargons: Technical words used by the service provider, may not be understandable by service
user. For example, if a patient rushes to doctor and to diagnose the problem doctor asks the
patient to do a MRI scan and blood test than that would certainly sound scary to that patient.
Instead of directly imposing what to do if the doctor explain what the MRI scan is and why it
is required than the patient would be more relaxed.

Acronyms: Acronyms are the initials of the shortened words. In health and social care lots of
acronyms are used and they are confusing too. Sometimes subconsciously the use of
acronyms is made which makes the opposite person feels left out. For example, if a health
care professional says that " you have to take these tablets TDS". What did you comprehend
from this sentence? So we feels left out her. Here TDS means three times a day. It is also
related to jargon.

Health issue: When a person is not feeling well or is not in the best of his health, it becomes
difficult for him to communicate effectively as he is not well. This definitely affects the
service user and colleagues too. So the people who are being taken care in the hospital due to
some illness might not be able to communicate like normal. Also the patients who are being
treated in the hospital for their long-term sickness like Parkinson's disease also affect their
ability to communicate. So if you are working in health and social care than you should be
aware about such scenarios and should be capable enough to handle it.
Stress: Stress also causes difficulty in communication. A person if stressed out might not
listen properly and so he might misunderstand or misinterpret the conversation. Stress also
cause difficulty in speaking or might be tearful as well.

Emotional difficulties: At times everyone faces emotional difficulties and get upset. For
example, a fight between husband and wife, a split up between boyfriend and a girl friend or
a bad new; all these contributes towards emotional difficulties. Here as the person is already
preoccupied he might not hear to what is being said and so this might lead to
misunderstanding.

Environmental Problems: It is the communication affected by environment. For example, if

someone is having reading problem (due to weak eyesight) than the person will surely
struggle in reading the written information in low light. A person on a wheelchair may face
problem in talking to a receptionist if the desk is too high.

Aggression: Unpleasant and frightening behaviour is aggression. It can be mental, verbal or

physical and can cause emotional harm or pain. For example, a person working in health and
social care irritated or annoyed due to some reasons than the person to whom he is providing
service might feel threatened or dominated and so might not be able to respond. This results
in the offering of the bad services.

Ways to deal with inappropriate Interpersonal Communication

Selection of wrong words or use of passive vocabulary, body language misinterpretation or
cultural insensitivity leads to inappropriate interpersonal communication. In such case what
can be done to avoid such problem is:

Always rephrase in simpler and different words to whatever has been said in order to avoid
unnecessary confusion and misunderstand.

One of the way to deal with inappropriate communication in focusing, it also helps in
preventing communication barriers.

Attentive listening without interrupting is also one of the ways to deal with it.

Respectful respond should be given to person's opinion and listener's view should not be
imposed.

One of the communication strategies for providing comfort is empathy; an empathic approach
helps in comprehending.

Factors influencing Communication Process in Health & Social

Care
Communication process is influenced in several ways. According to Watson, the action of
caring includes communication, support, positive regards or physical interventions by the
nurse (1985 cited in Kozier at el, 2004, p.419). A sense of care is felt through
communication, although a lot depends on interpersonal attitude as well. A sense of
importance and worth is felt when respect is given and opinions and ideas are accepted and
not judged. Also a terrible feel during an interaction is also a factor of communication barrier.
Judgemental action, probing, agreeing/disagreeing, stereotyping, rejecting are the non-
therapeutic responses (Kozier at el, 2004, p.432).

Cultural Factors Influencing Communication Process

What is Culture? Culture refers to beliefs, shared and learned values and behaviour, which is
common to a particular group of people (Orbe & Bruess, 2005). Music, food, dress, customs
and celebration are also included in culture. Communication and culture are the two
inseparable. Culture is a significant part of our perspective through which we see the world.
Culture is shaped by communication and is also learned through communication.
Communicating with people from same culture is different and communicating with people
from different culture is a different experience. Although culture is powerful, they are
frequently influencing conflicts and unconscious. Always remember two things about culture;
one is that culture are always changing and the other is they communicate to symbolic
dimension of life.

According to Stella Ting there are three ways where communication process is affected by
culture. First is "Cognitive Constraint" which is the reference frame that provides
surrounding that all new information is compared to or inserted into. Second is "Behaviour
Constraint"; it is about culture having their own rules of behaviour regarding verbal and
nonverbal communications. For example, how much distance should be maintained when
talking to the other person, whether to look in the other person eye or not, etc? The final one
is "Emotional Constraint"; every culture has their own way of showing emotions. For
example, there are many cultures that get emotional when debating on an issue; they yell, cry,
etc. While many cultures tend to remain calm and keep their emotions hidden. All these
cultural difference leads to communication problems. This is more likely to happen when
dealing with cross cultures. To overcome these problem only awareness regarding the
cultures is needed.

Legislation, Code of Practice and Policies in Health & Social

Care
Legislation- Legislation are the laws made by parliaments, these laws shows the right of an
individual, group or an organisation. All the health & social care settings should comprehend
the significance of sticking to legal guidance as this can defend against the poor practice. For
example, the data protection acts, freedom of information act, care standards act, race relation
act, etc.

Policies- In order to promote equal opportunities and strengthen the code of practice of
particular professional bodies it is must for an organisation to have policies and procedures.
Policies includes confidentiality, harassment and bullying, health and safety, equal
opportunities, risk assessment, etc.

Code of Practice- Since 2000, it has become vital for all health and social care settings to
have a professional code of practice. In order to inform the practitioner about their rights and
responsibilities and to guide the code of practice is kept. It is mandatory for all health and
social care worker to carry out an induction period where the proper training leading to
appropriate qualification is given. Same code of practice is followed by Wales, Scotland,
Northern Ireland and England.

Health & Social Care Services with specific Communication

needs
People having cognitive impairment, language and sensory deficit, structural deficits and
paralysis need specific communication (Kozier et al. 2004, p.438). In general, the care worker
uses the SOLER technique by Egan (1986), it helps in effective communication with the
clients, and makes them feel safe and trust the caregiver.

SOLER stands for:

S- Sit squarely in relation to the patient

O- Open position

L- Lean slightly towards the patient

E- Eye contact

R- Relax

This technique helps in good interaction and can be used for both; people with or without any
special needs. Depending on the type of communication impairment different strategies and
techniques can be used.

For people with hearing problem or who are deaf, BSL (British Sign Language) was
introduced which was eventually accepted by UK government officially in 2003 and now this
sign language has become universal. But it is different in each place of origin. Not only
people with hearing impairment learn this language but also the people who interact with
these people learn this language. For example, friends and families. Also Lip-speaking is a
technique used for deaf. In lip-speaking interaction through facial expression, gesture and
mouth is done without making any sound.

There is one more technique, which is used for people with learning difficulties such as
structural deficit and paralysis and cognitive impairment. It is known as Makaton. Makaton
uses common vocabulary and is much simple. It uses symbol, action as well as speech, unlike
BSL. This is a very helpful technique for people with limited ability to communicate.

For Blind people reading and writing method through Braille is used. It is useful for every
individual who is completely dependent on sense.

Finally, Human Aids, Human aids are the people helping communicate with each other.
Translator, interpreter, etc are the examples of human aids.
Information & Communication Technology (ICT) in Health &
Social Care
ICT provides great support for care professional and other staff in order to provide effective,
fast and convenient care. Visible and workable ICT is required in order to deliver high
standards. In order to get the quality outcome data and to give the best possible care to people
it is needed to exploit ICT.

Individual's quality care depends on easy access to care plans and electronic records. It must
be capable enough to distribute information across health and social care. ICT helps in
delivering more effective and better healthcare services. ICT helps doctors, hospitals and
pharmacist for taking better care of our health. ICT helps in saving lives, improving patients
care, helps in reducing cost in health care.

For example, a patient with heart problem will be carrying a monitor, which will alarm the
doctor if any changes in patient condition and will let them do their task.

ICT use is central to social work, which is concerned with sharing assessments and
exchanging information with other professionals and practitioners. Quickly and securely
medical data can be exchanged. ICT has made the operation simpler than before.

The basic ICT at health & social care includes:

Quality care (efficient and effective care service)

Empowerment (patients involving in their own care activities)

Availability (waiting time, access and better utilization of resources)

Care continuity (information sharing and coordinating with care provider)

Patient safety (risk is reduced in regards to patient harm)

Some of the technologies used at health care are CDMS (Chronic Disease Management
System), CPOE (Computerised Practitioner Order Entry), CDS (Clinical Decision Support),
ETP (Electronic Transfer of Prescription), Electronic Appointment Booking, PHR (Personal
Health Record), Telemedicine's, RFID (Radio Frequency Identification) & Bar-coding, etc.

ICT is used everyday at health care. ICT is used in administrative department to keep a check
on in and out of the patients, to keep the records of the patients & staff as well.
Analysing the Australian Health Care System
The National Health and Hospital Reform Commission report for Australia is based on three
important tenets that in a nut shell summarizes the findings and recommendations of the
report. It seeks to address the traditional underlying health services inequality among the
citizens. Realign the national health programs in a way that would best tackle present
challenges and agitate health sector growth and reforms in the private sector as well (Bennet,
2009). The commission report is a culmination of other two reports that were done earlier.

In general the hallmarks of any health reform policy should include four basic concepts. One
it should seek to increase health care coverage area by diversifying the range of services that
are offered by both the public and private sector. Two, an effective health care policy should
encourage market growth by inviting private and other stakeholders within the industry in
order to match population demand. Three, It should facilitate training of healthcare
practitioners in all major disciplines so as to prevent a short fall of health professionals.
Finally a very important feature of a health reform plan pertains to it cost (Holvorson, 2009).

Health care services should be affordable to majority of the population, thus it cost should be
as low as possible without compromising in anyway its health services quality (Taylor,
2003). Underlying all these ideal features of an effective health reform is the cost. Ultimately
the cost and funding that goes towards implementing and financing a workable healthcare
plan very much determines if the healthcare plan would be successful.

Australia Health Care Reform Policies

The National Health and Hospital Reform Commission report summarizes a list of not less
than one hundred recommendations from the public and stakeholders (Bennet, 2009). The
recommendations so far compiled seek to introduce new aspects to the current health care
plan as well as change others. The recommendations that the commission has put forth will
require over whole in the way the current health care is being done in Australia. The National
Health and Hospital Reform report has therefore come up with three key areas that must be
addressed by the new health care system.

Foremost the health care plan should tackle the factors that hinder free access to healthcare
by the majority of the population, in doing so it must also address healthcare inequality in the
current healthcare system. Secondly, the healthcare plans should consider current emerging
issues and challenges that which it must incorporate within it frameworks. And finally the
healthcare plan should strive to come up with a system that would meet the needs of the
peoples in every possible way (Bennet, 2009). These three aspirations are the tenets of a
model of a healthcare plan that dictated the way that Australia healthcare reforms were
approached, and which are also used widely elsewhere in the world to design healthcare
reforms (Garey, and Lorber, 2008). More importantly they acted as the values that the new
healthcare system will uphold.

One of the many recommendations that the commission made to the government regarding
the Australian healthcare reform is contained within the Healthy Australian Accord (Bennet,
2009).
This accord is a combination of several recommendations that pertains to healthcare funding
responsibilities within the government. Healthy Australia Accord specifically defines the role
that each government institution must play to implement the healthcare system (Bennet,
2009). It focus is on funding and it outlines in details the funding obligations between the
federal government and the state.

The approach that the accord has taken in this regard is a system where both the
commonwealth government and the state must contribute towards financing the healthcare
reforms. In these arrangement healthcare services funding has been shifted to the
commonwealth government for implementation as well as funding. The healthy Australian
Accord clearly identifies the health sectors that the commonwealth government is
accountable for, i.e. primary health care, elderly care, dental care and financing health care
for Torres Straight Island residents as well as the Aboriginal people (Bennet, 2009).

In addition the commonwealth would provide full funds required to finance these sectors
contained within the Australian healthcare reforms. Another point that the Healthy Australian
Accord covers regards public hospitals and healthcare services. Towards this end the
commonwealth government is also required to take up responsibilities for financing
healthcare services and hospitals as well (Bennet, 2009). The accord suggests that the
commonwealth government should consider carrying out reductions in grants or funding
towards other agencies within the state so as to meet these financial obligations.

Besides this the accord major suggestion requires that the healthcare system be revised in
such a way that would consolidate healthcare services within a central location.

The idea therefore is a “one health system" that is financed and managed from a central point
of location which is nationally, that applies devolution model of healthcare services to the
grassroots level. The Healthy Australian Accord will be our major focus in this paper which
we shall analyse in details so as to us understand the benefits and the challenges that
implementation of the accord would mean.

We shall also examine other implications that the accord presents in its recommendation and
how it relates with other policies contained in the report. In order to understand the
recommendations as outlined within the Healthy Australian Accord let us briefly examine the
Australian government structure: particularly the commonwealth government and the state.
While keeping in mind that the accord mainly seeks to transfer control and implementation of
healthcare reform to the federal government. We shall also identify the traditional roles that
each level of government namely, commonwealth government and the state has always
undertaken.

Australian government structure is made up of three levels, the federal government also
commonly referred as the commonwealth government, the state and the local government
(Our Government, 2009). There is usually a fourth level referred as the territory government
which is regarded as special form of state. Basically Australia is governed from two levels the
federal governments and at the state levels, between these two governments the Australian
constitution accord them equal powers.

Commonwealth government is the central level of the Australian government and is

considered the level where the most power are vested (Quartly, 2002). It is the level that
controls the three vital arms of any government i.e the legislature, executive and judiciary.
The federal government is responsible for implementing national policies and in passing
directives for the entire nation. The authority of the federal government is not limited by the
state boundaries but applies to every citizen. However state government powers are defined
by the states boundaries. It is a form of power devolution from the central federal government
to the state level.

There are a total of six states within Australia each run by the presiding state authorities. In
many instances states are allowed to enforce laws within their jurisdictions that are different
from those of the federal government, on condition that the laws to do not in any way
contradict the federal laws (Quartly, 2002). The state level three arms of governance,
judiciary executive and legislature must draft laws that are in line with federal laws. Between
the three levels the federal government has more funds and more clout in all matters that
pertains to governance and policies. Needless to say the commonwealth government would
be more effective in implementing policies that are of national importance such as the
Australian health care reforms plan, for many good reasons.

According to recommendation written on the Healthy Australian Accord the federal

government is to pay full cost towards outpatient in all public hospitals up to a certain figure
that is preset for each hospital facility. It should also meet 40% of the cost for all hospital
admission that occurs at public hospitals (Bennet, 2009). With time the accord suggest that
the federal government should move towards acquiring and controlling all public hospitals
and thereby also meet the full costs of patient admissions in public hospitals as well (Bennet,
2009).

Indeed the accord has gone a long way towards putting the healthcare reforms
implementation and funding squarely in the door of the federal government and I believe for
good reasons. Health care financing is traditionally undertaken by both the commonwealth
government and the state. In this arrangement each partner has always contributed undefined
amounts that went towards healthcare financing that varied each time. Therefore long term
plans on healthcare services cannot be undertaken since future budget is impossible to be
accurately quantified or even relied upon.

The results are that healthcare services budget keeps shifting now and then so as to meet the
available funds each season. The accord addressed this challenge by having the federal
government commit to predefined regular funds which will allow long term healthcare plans
to be implemented since resources can be guaranteed in advance (Bennet, 2009). The main
advantage of having a central form of a healthcare reform policy is that national wide
healthcare reforms can be achieved rapidly through implementation of directives that cut
across the healthcare board.

More importantly it enables coordinated healthcare reforms that are in tandem with every
other state within the country. This way upgrading of let’s say, hospital facilities and training
institutions is done uniformly in every part of the country because each state or hospital
institution is given equal amount of funding. Besides the healthcare reform within the country
is systematic for all states in the manner that priority sectors are first addressed before next
sector of health care reform is agreed upon. Transferring health care reforms to Federal
government would also mean that healthcare programs would be implemented directly from
the central level.
This would require the government to invest in human resource to manage the broad array of
services that makes up healthcare system. Meaning the federal government would not pay a
casual interest to healthcare services as it has usually done when only funds were necessary
to disburse. Increased participation by the federal government would therefore translate to
quality healthcare programs and services. In shifting the health care funding, the Healthy
Australian Accord would put to rest a dance in circles that has gone on for far too long
between the commonwealth government and the state, at the same time it will reduce the
bureaucracy within the health sector.

Essentially what happens is that commonwealth government disburses money to all states
that are earmarked to be used for various projects. The state government after receiving the
money goes on and funds its various projects with the funds including healthcare programs
(Bennet, 2009). If the federal government was to inject this fund directly to existing
healthcare projects, would mean reducing the time taken and the cost in terms of human
resource that goes towards funds distribution. The other point is that this funds that are given
to states as grants are usually surrounded by controversy.

The state government usually funds the priority projects using the money since it is never
enough, in doing so states generally omit covering patients care services which is left to the
federal government, in what the commonwealth governments claim to be covering through
the allocated state grants (Bennet, 2009). And this is not the only problem that arises out of
this arrangement federal government claims that the state’s healthcare services are not up to
the task and therefore the patients most of the times get referred to commonwealth funded
hospitals.

This ends up undermining the logic behind the whole arrangement where the idea is to
diversify and decongest federal healthcare institutions through strengthening the state health
facilities through grants.

If the current healthcare system seems ineffective and underfunded then it is equally confused
and uncoordinated. There are no clear guidelines that exist which can be referred to by the
partners which would outline the functions of each government in providing healthcare. The
health care structure itself is confusing as well and patient including other people in general
have no idea which government level is supposed to provide what services. Therefore it
becomes hard for the people to petition the state or the commonwealth government to provide
quality healthcare since both stakeholders would just shift keep shifting the healthcare
responsibilities.

This arrangement also means there is no sense of leadership within the sector due to the fact
that healthcare institutions are so much defragmented without any form of consolidation
(Evans and Gil-Soo, 2006). In the same way the healthcare sector management is not defined
in any way since healthcare services are not run from a central point. Lack of central
management of healthcare services also results to similar programs being implemented by
different actors in the sector that are waste of taxpayers’ money (Miller, Vandome, and
McBrewster, 2009).

Conclusion
However in the same way that centralizing healthcare reforms implementation has its
advantages, then the existing healthcare system has its advantages, but it benefits have been
far outstripped by its drawbacks.

Among its advantages is the fact that two sources of funding are important since one source
can step in for the other in case of shortfalls (Gee, 1994). However federal funding of
healthcare services would certainly provide enough finances to ensure the reforms are
implemented undisrupted. Besides federal funds are more stable than state sources since it
has the capacity to seek loans from international monetary institutions in case of any
shortfalls. Perhaps, the only advantage that the current healthcare system has is in the way
that it can be customized to meet the unique aspects of it residents. Nevertheless, the benefits
of seceding healthcare services to central government have many advantages and are the
practice in many countries worldwide.