Activity 1.

1 Where does Australia stand in comparison with other OECD countries in regard to infant mortality, life expectancy, subjective health status and access to health services? Construct a table which compares Australia with three other nations. Australia Japan Italy In Australia, the infant In Japan, the infant In Italy, the infant mortality rate is 4.3 mortality rate is 2.4 mortality rate is 3.7 infant deaths per infant deaths per infant deaths per thousand births thousand births thousand births according to 2009 according to 2009 according to 2009 statistics statistics statistics Japan has the lowest mortality rate of 2.4 per 1000 births, almost half of Australias mortality rate, which is the highest. Italys mortality is 3.7 deaths per 1000 births, which is significantly higher than Japans mortality rate but still slightly lower than Australias mortality rate. According to 2009 According to 2009 According to 2008 statistics, life statistics, life statistics, life expectancy for both expectancy for both expectancy for both sexes is 81.6. For sexes is 83.0. For sexes is 81.8. For males, life expectancy males, life expectancy males, life expectancy is at 79.3 and females, is at 79.6 and females, is at 79.1 and females, 83.9 years 86.4 years 84.5 years Japan has the highest overall life expectancy and has the highest life expectancies for both sexes. Its male life expectancy rate is only slightly higher than Australias, who also has a slightly higher male life expectancy than Italy. Australia however has the lowest female life expectancy, where Italys rate is marginally higher and yet again, Japan has the highest female life expectancy. Australians are The Japanese have the Italians have reported generally pleased with lowest reported their health status to their health status, subjective health be good, with a 63.6% claiming it to be very status in the world and satisfaction rate. good, reporting 84.9% have a 32.7% satisfaction rate. satisfaction rate. Although Australia has the highest mortality rate and lowest overall life expectancy, it has the best subjective health status percentile of the three. The opposite has been reported for Japan, whose percentile rate was the lowest with bad ratings. Italys percentile was double that of Japans and significantly lower than Australias percentile. http://www.conferenceboard.ca/hcp/details/health/self-reported-healthstatus.aspx

Infant Mortality Sources statistics taken from OECD.org

Comparison of Infant mortality among these three OECD countries Life Expectancy

Comparison of life expectancy among these three OECD countries

Subjective Health Status

Comparison of subjective health status among these three OECD countries Source Access to Health Services Comparison of access to health services among these three OECD countries

Activity 1.2:
Develop for yourself a working definition of health and of health systems and draw a diagram which demonstrates how in your view health status relates to health determinants and health services. Health: Health is the term encompassing a sound complete state of wellbeing, social, mental and physical wellness and not just the mere absence of illness. Health systems: Health systems is an umbrella term which comprises of multifunctional and multilateral public and private organisations governed in accordance to legislative regulations. Health systems are dedicated to improving health status, accessibility and wellbeing in populations in professional, traditional or informal settings.

Health Status

Specialised Public

Health Services

Integrated

Private

NonTraditional

Health Services Physical Environmen t

Social and economic environment

Income

Health Determinants

Personal Characteristic

Genetics Education

Gender

Activity1.3:
Write a one page description of the Australian Healthcare system such as you may use to describe the system to a new immigrant. Explain briefly why the system is structured as it is. The Australian Healthcare system is a complex mixture of private and public services underpinned by three core pillars: the nations compulsory insurance Medicare, privately subsidised health insurance and the subsidised Pharmaceutical Benefits Scheme (PBS). The places where you can receive treatment include private and public hospitals, private medical practitioners, clinics, government and non-government run institutions. I will explain to you in much detail as possible, the structure of the healthcare system. The system is structured as it is to give you a choice of service. Australias healthcare system is based off the UK model and its traditions and cultural links have been ingrained in our system. The system is a balanced outcome of competing influences. The difference between structures is in health insurance. If you want extremely quick, personalised care, you might prefer the private healthcare system, which is covered by private health insurance. The private health care system is special in that you can go to both private and public hospitals and request your own doctor. You can be admitted to hospital when you want to, those without private health care cannot control when they are admitted to hospital. The public health care system is known as Medicare. The federal government pays 100% in-hospital costs, 75% GP services and 85% specialist services. In this system

Activity 2.1Examine the health policy statements for the 2012 Qld state election published by the major parties and produce a table which highlights the differences. ALP
Access to Emergency Care $1.5 billion in funding to upgrade emergency departments, faster access

LNP
Access to emergency care should be on time, with patients treated as fast as possible Free consultations and home visits to monitor infant growth

Greens
Improved preparation for pandemics

Natal Care

Education for women regarding pregnancy and natal care

More birthing services, pregnancy termination services

Workforce numbers

Doubling GP places and funding for 1000 nurses Attractive incentives and retention bonuses for doctors to work in rural and regional Australia Australians should know where their tax monies are being spent and MyHospitals website allows for Australians to choose the best care for them

More doctors and nurses should be employed Proposes that Queensland Health Staff should be paid the correct amount at the right time Queenslanders should have a clearer picture of what the Australian Healthcare system is like

GP numbers should increase GPs should have increased pay

Workforce pay

System Transparency

Queenslanders have the right to know exactly what is going in in the health care system and should actively take part in it

Facilities

Infrastructure to be improved for easier autonomy and transport access LHN devolved to local level, clinicians in control of community services Increased funding for public hospitals (13 billion)

Queenslanders having access to world class healthcare and hospitals

Increase of multifunctional community health care centres People have the right over their own health care Increased funding for preventative measures to reduce smoking, drinking and obesity Private health insurance rebate to be abolished in favour of Medicare Ban on junk food advertising on childrens television

Control of Health Services

Local clinicians should regain control of delivering health services Increased funding for improved accessibility for health services Support for Medicare and medicines

Funding

Medicare

The public health system will continue to be under Medicare Preventative health programs in schools workplaces and community. $103 million binge drinking strategy

Promoting well being

Ban on junk food advertising on childrens television

Examine the following and identify the role, responsibility of each tier of government: Food quality Patient safety and quality Reporting to WHO on health system effectiveness Pandemic preparedness

Education of health professionals

Or Federal Responsible for foreign affairs, defence, trade and communication services EDUCATION OF HEALTH PROFESSIONALS State Responsible for education, health, police, railways, main roads and public housing FOOD QUALITY PANDEMIC PREPAREDNESS Local Responsible for garbage collection, local roads, buildings, parks, libraries, child care, youth services, social planning and local environment. Patient safety and quality

Activity 2.3
Read 'Health Service Management and the Law and explain how Bates is offering caution to readers by indicating the legal consequences of decisions taken by health services managers. Bates is offering caution to readers as legislation is not equally authoritative, noting that ignorance of the law is no excuse for a valid defence brought against the persecuted. Bates is telling readers to think perceptively and evaluate their thoughts. Malpractice of clinicians has resulted in large ramifications for the workforce, where clinicians are more afraid of being sued than before. A preventative guideline has been suggested wherein clinicians are to act in accordance to patients wishes and to avoid imposing of views unduly onto patients, whose values must be respected. Confidentiality and professionalism are valued. Conundrums take place in situations regarding life-or-death scenarios and health professionals are faced with dilemmas which are ethically contentious or morally unacceptable such as euthanasia usage. Bates is telling the readers to be weary and emphasises this point by providing examples. He observes that patients are being used as guinea pigs for new and unevaluated treatments and without their knowledge and consent, warning readers to inquire more about their healthcare and treatments. Usually, the relationship between a doctor and patient is confidential. However, courts are able to demand access to patient records. In court, Medical practitioners must provide medical reports and oral evidence as expert witnesses.

Activity 2.4
Name 5 different types of health service organisations you are familiar with and create a table which describes the services provided and the ownership arrangements. For example: Organisation Services Provided/ownership

Private charitable hospital Acute medical care, food services, laundry, physiotherapy, outpatient department.

Organisation Mater Hospital Not for profit organisation which operates 7 hospitals

Services Provided/ Ownership Includes a range of hospitals Education Services Affiliated with universities Training for general practitioners Food, beauty, childcare services, acute medical care, allied health, occupational therapy, pathology, social work, speech therapy services Founded by Sisters of Mercy and run by the Mater Foundation. Owned by Mater
Misericordiae Health Services Brisbane Limited

Invisalign Private company specialising in orthodontic services Luxottica Profitable business which runs eye care chain stores

QML Pathology Private pathology services.

Owned by Invisalign Australia Pty Ltd, marketed, designed by Align Technology, Inc Provides oral health , orthodontic and paediatric services, overbite correction Runs OPSM, Sunglasses Hut, Laubman and Park, Budget Eyewear and Bright Eyes. Provides information regarding Eye care health standards, franchising opportunities, provides warranties for eye products, employment services, frame dispensing services. Runs a profitable foundation called Onesight, which provides accessible and free eye care and eye wear around the globe. In partnership with Salvation Army. Owned by Bruce Gutteridge and Robert and James Duhig , the sons of the original founders. Drug and alcohol, workplace and safety, preemployment, employee health screening. Veterinarian vaccination and pathology services. Diabetes care clinic.

Activity 2.5
Consider a public hospital. Mater Hospital 1. Who owns the hospital? The hospital is owned by the Sisters of Mercy 2. Who operates the hospital? The hospital is operated by Mater Misericordiae Health Services Brisbane Limited 3. What is the role of the CEO? The role of the CEO is to manage and regulate the management of the Mater Hospital. The CEO of Mater is Dr John ODonnell, who leads Maters executive team and has led Mater through a rapid growth. He ensures that Maters Mission of delivering compassionate care to the ill and needy are alive and well. Under his guidance, the Maters Mothers hospital was opened, and he oversaw the transition of Queensland Paediatric Cardiac Service from the Prince Charles hospital and lastly, he has led a course of innovative evidence based health care. The CEO is part of the board of directors, and he advises those under the board of directors and motivates his employees and drives change within the Mater Health Services. Who are the key stakeholders? The key stakeholders are people who have an interest in Mater, largely the patients, employees, board of directors, the government, administration, suppliers and the community. The patients are invested in having the best healthcare provided to them, the employees are interested in providing services following their job descriptions. The board of directors are interested in making the decisions behind the running of the hospital and how features can be improved. The government is invested in providing funding for the hospital and the administration is involved with running the hospital. The suppliers are interested in providing the hospital with medical devices, functional contraptions, bedding, computing technologies and essentials such as paper. The community is interested in participating actively in voicing their opinions regarding the care that Mater provides.

Activity 3.1
Australia spends an estimated 9.4% of GDP on health while the US spends 17%. 1. Identify and discuss at least five factors that may contribute to this variance. Discuss five ways in which the Australian Health care system could constrain the growth in costs. There are a lot of factors which contribute to this variance between estimated percentages of GDP spent on health. These factors include chronic disease, obesity, heart disease, smoking, alcohol and so on. There are many ways in which the Australian Health care system could constrain the growth in costs. There should be education and preventative methods in place. This strategy would not only educate the public in improving lifestyle, but it would also be effective in reducing treatment costs. Through TV advertising, advertisements could be shown to the general public regarding the outcomes of unhealthy habits could make people feel averse to continuing or taking up these unhealthy habits and promote improvement in lifestyles. Operations should only be undertaken as a last resort though many people are taking up this option due to wanting a faster and immediate improvement to their lives. An instance of this would be gastric bypass surgery, which is not only costly, but is sometimes unneeded. To rectify this problem, medications should be used instead. Medications are not only cheaper than operations, but they are also much safer to use. Also, many people are visiting doctors and taking up hospital beds for unnecessary reasons. This is not only costly, but potentially dangerous as some people need those facilities and health services more than others. It could be suggested that people seek other professional alternatives first before going to the doctors or hospitals. Medical equipment has been overused and inappropriately used, increasing the growth of costs in the health system. To control this variable, medical technicians and professions should receive more training regarding device usage and medical practitioners should not refer their patients for services which are unnecessary for them.

Activity 3.2
1. Increased specialisation and the creation of new professions have been features of the workforce over the last 20 years. Suggest possible impacts on the delivery of health care from this trend. Increased specialisation has led to more specialised equipment and techniques. In all, the training gone into educating new professions and monies used to develop machinery has been extremely costly. Healthcare has become more complex with a network between clinicians and specialists. In order to accommodate specialisations, more facilities and infrastructure had to be built. Since health services are not delivered at the local GP as they used to, more travelling and postal services have been evident though time consuming. Healthcare has become more focused. 2. Discuss factors you believe contribute to the geographical misdistribution of health professionals in Australia. Rural areas are remote where smaller populations of people reside in, thus some specialised health professionals may not be needed. In urban areas, health professionals are more accessible in comparison and the populations are much greater than in rural areas. 3. Discuss why market forces fail to remedy the misdistribution of medical practitioners in Australia (that is, why does the oversupply of GPs in metropolitan areas and the undersupply in rural and remote areas persist?). The rural areas are thought to be remote, with little supplies or facilities for medical practitioners to carry out their jobs. Market forces fail to understand that GPs need larger scale support systems. There may be a smaller distribution of pharmaceutical drugs in rural areas, less transport options. 4. Discuss the challenges that would limit expanding the scope of health practitioners into areas that are traditionally those of another profession. E.g. Enrolled nurses, Nurse practitioners, radiographers diagnosing Xrays. There would be discrepancies if expanding of scope occurred, such like retraining of health practitioners which is time consuming and costly. New facilities and equipment may need to be built into already existing clinics, which calls for the need for refurbishment costs. People already in the existing professions would be displeased to see the amalgamation of health practitioners into another fields profession as their job security may be threatened. Protests and strikes may occur as a result. Some professions may end up becoming defunct, pushing people into retirement or redundancy. There will be a lot of pressure to take on more jobs that they didnt need to do before.

Activity 3.3
Identify and discuss the key strategies you consider could reduce the growth of cost of pharmaceuticals. To reduce the growth of cost of pharmaceuticals, we should understand that many diseases can be prevented before there is a need for pharmaceuticals. For diabetes, more advertising and education could help prevent this by encouraging people to improve their lifestyles to a healthier one. Poor diets can be treated by visiting dieticians and nutritionists, whose advice should be taken before taking pharmaceuticals. There should be more focus on advertising vegetables, which Australia has plenty of so there is no excuse for consumers not to buy any, as they are also very cheap. For lung disease and lung cancer, smoking habits need to be circumvented so that incidences decrease. Measures have already taken place where the costs of tobacco are rising very quickly. This deters consumers from buying these products as they have become extremely expensive. Graphical ads have also been placed on cigarette boxes as a means to disgust smokers and turn them off the product. Drinking problems have also been a large source of concern and preventative strategies have already been put in place by the Australian Government via use of television advertising. Increasing education in schools has also warned of the impacts of drinking and the problems that entails e.g. Cirrhosis. More strategies could be put into place by furthermore increasing prices of alcohol, which would prevent people from acquiring diseases, therefore lowering the amount of people taking drugs to curb their addiction. Growths in pharmaceutical costs can also be decreased through the workplace. In workplaces, especially offices, people work for long hours on ends with little breaks, which could lead to issues developing such as haemorrhoids, carpal tunnel syndrome, strained eyes etc. These conditions are treated by pharmaceuticals and can be reduced by increasing break times in offices, which would encourage employees to move around more and exercise. An exercise regime can also be incorporated into the workplace, promoting wellbeing. In schools, bad hygiene practices can lead to the circulation of viruses, illnesses and events like head lice, which are treated which pharmaceutical products. To reduce these incidences, hand washing must be thoroughly practiced. Teachers could supervise students when they go to toilets in order to enforce these practices. Also, canteens should place a ban on junk food and instead place fruit and vegetables on the menu. Teeth brushing should also be a MUST in schools as the costs of pharmaceuticals such as cold sores medicines, toothache drops and antibiotics are increasing. The usage of these pharmaceuticals can be reduced if dental health is kept up to standard.

Overuse of pharmaceuticals is a large issue, wherein drugs are used excessively, and increasing pharmaceutical costs. To control this issue, clinicians should be consulted.

Activity 3.4
Consider some recent technologies and discuss the factors that should be taken into consideration in their implementation.. Some recent technologies have been numerous, comprising of technologies from the area of biotechnology, medical devices and pharmaceutical developments from the life sciences, e-health from information technology and many others. In the area of the life sciences, technologies have been largely therapeutic and diagnostic, including areas of stem cell research, gene therapy, organ farming and transplant technologies, genetic engineering and other technologies. These technologies, though extremely promising, are also a source of concern as to whether they should be implemented or not. These technologies may be ethically contentious and controversial. They are also extremely costly and are research based, which could be time consuming. Organ farming in particular, is a source of conflict. Medical devices include a large range of devices, ranging from angioplasty, cochlear implants, medical laser technologies; diagnostic imaging machines and lithotripsy machines have greatly advanced how diagnoses are made for the last 30 years. However, there are many factors which should be taken into consideration. Firstly, cost is a large factor and all of these technologies are extremely costly to manufacture and they are costly to set up. These are much specialised technologies, which may not be suitable for some populations. For example, it would not be reasonable to have MRIs in rural areas as populations are comparatively smaller to urban areas and the variable costs involved in setting up and running these technologies may never be covered. This is an instance where a slow rate of diffusion technologies is involved as demand serves as the impetus for the usage of these services. Information technologies have also advanced greatly in modern times though its application tends to lag. New information systems are continuously being developed to overcome efficiencies. Faster processors, a range of intelligent devices, reliable communication services and internet access will continue to develop and improve. However, software is not developing up to the same standard as these above technologies, which is an issue. Specialised computing such as wearable computing and wireless computing have already been developed. What is to be taken into consideration regarding the implementation of these technologies is that of the

Activity 3.5
Discuss five factors that will impact on the cost of consumables and identify how those costs may be minised. Administration Those necessary expenses borne by the lab or other hospital service which includes reagents, disposables, and other supplies, as well as maintenance and lease contracts.

Activity 4.1 Medicare: Universal Access or Safety Net?

In The current distribution of expenditure across the Australian health system, is sometimes described as hospital centric with less than 2% of total health expenditure occurring in public health activities (AIHW: 2006). As the population ages and chronic diseases like diabetes place increasing pressure on the hospital system, there will be a need to ensure investment is more appropriately balanced across the health continuum. 1. What are the barriers professional/institutional/political/financial to moving investment between care types?

2. Give an example of a health policy that seeks to redistribute health inputs between the private and public health sectors. 3. What is the basis for how this policy would achieve greater allocative efficiency?

Activity 4.2
Identify and discuss five issues that are challenging the future design and functioning of the Australian Healthcare System.

Activity 5.1
Identify and briefly discuss the drivers and principal barriers to health reform in Australia.