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L4 Looking after Aus' health: Aus Health Care System (Healthcare…
L4 Looking after Aus' health: Aus Health Care System
Healthcare system
Health syst: all the activities whose primary purpose is to promote, restore &/or maintain health
~ medicare (medical benefit syst
Good h syst: 'delivers quality services to all ppl, when & where they need them'
~ robust financing mech
~ well-trained & adequately paid workforce
~ reliable info on which to base decisions & policies
~ well-maintained facilities & logistics to deliver quality meds & techologies
Main issue:
delivering services to rural remote regions (where they need them)
the gap ppl @ times have to pay
workforce where they need them
Main aim
To give all Australian- regardless of their personal circumstances- access to adequate health care at an affordable cost or no cost
Main roles of gov in Aus' h syst
Aus Gov
sets national policies
regulates private health insurance
State & territory gov
manage public hospitals
license private hospitals
Local govs
provide environmental health-related services (eg. waste disposal)
deliver some public health & health promotion activities
Shared
reg of health workforce
ed & training of h professionals
Medicare
maj elements:
~ free treatment for public patients in public hospitals,
~ the payment of benefits or
~ rebates for profess health services listed on the Medicare Benefits Schedule
~ subsidisation of cost of wide range of prescription meds under the PBS
PBS
equitable access to medications for all Aus residents
not all drugs listed
drugs of proven efficacy, cost-effective & necessary in treatment of disease
Money
4 broad areas of health spending
Hospitals
Primary health care
Recurrent expenditure
Capital expenditure
Diseases attracting the most expenditure
Cardiovascular disease
Oral health
Aus & state Gov : biggest funders
Issues:
out-of-pocket health spending for individuals
goes against "universal access health care syst"
Ethics & Resource allocation
Efficient & Equitable?
Low-value health care practices/services
ineffective or unsafe, flagged for consideration to constrain resource use
redirecting funding away from these services
Examples: Chlamydia screening & liver function tests
Efficient & equitable allocation of health money
Fundamental concepts
resource scarcity →
Choice →
Opportunity cost →
Efficiency & equity
Basis of health econs
demand for h.care is infinite
resources are scarce
choices are necessary
prioritisation is reqd
costs & benefits must be compared
H.syst main Goals
Efficiency
~ Getting max h. benefit for scarce h. dollars
Equity
~ notion of fairness or justice
~ efficacy= max possible reduction in disease due to use of intervention
~ efficiency= benefit from an intervention tht is applied in day-to-day practise to population
Lvls of Decision making- Resource Allocation
Macro lvl
~ funding across all sectors [fed & state gov lvls- h competes w/ these other sectors]
Meso-lvl
~ Reg areas of gov, administrator & commitees [hospital managers - allocating resources to competing services & specialities- across the h sector]
Micro-lvl
~ Daily clinical work decisions [time spent w/patient, triage, resources used to diagnose & treat patient]
Criteria for evaluating h care [&∴ prioritising h resources)
Equity (Justice)
Effectiveness
Efficiency
Consumer preferences
Burden of disease
Efficiency
Maximise benefits (h) @ min cost
notion of cost-benefit analysis & avoiding wasteful practices
Allocated Eff
best allocation of resources; to yield best possible outcomes
choosing the right thing to do
pursuing h.care programs tht are worthwhile
types f services provided
Technical eff/ priority setting
after choosing to do smth: choosing the right way of doing it
selective between alternatives to achieve the same outcome
quantity & quality of services provided
Opportunity Cost
Choice is just as much abt what we leave undone
benefits forgone when a decision is made to use a resource one way, instead of next best alternative way
costs linked w/ benefits: must get best value of money
economic evaluations are how we operationalise the oppo. cost principle
~ benefits vs. benefit forgone