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7304MED Healthcare Systems And Policies

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  • Course Code: 7304MED
  • University: Griffith University
  • Country: Australia

Question:

1. Funding
a. Funding system (including health insurance)
b. b.% GDP spent on health
2. System governance arrangements in the country (i.e. who is responsible for what)
3. Population Health Indicators
a. Maternal Mortality Rate;
b. Infant Mortality Rate;
c. Life Expectancy at Birth
4. Health System Performance Indicators Incidence of:
a. Low birth weight infants
b. Obesity
c. Diabetes
d. Asthma
e. Hypertension
f. Cancer
5. The Management of Risk, Quality and Safety in the Health System.
 
 

Answer:

Introduction

Health care systems are elaborate system of organisational process and resources which makes them complicated whose core objective is to provide good health care facilities besides defined resources. Further there are numerous systems in health care depending on distinct demographic regions. As such realisation of an elementary system along with comprehensive and practical ways can help in filling the gap that is existent in health care systems in different nations thereby supporting in delivery of quality health outcomes (Schütte, Acevedo & Flahault, 2018). In this essay a comparative evaluation of data between healthcare systems of Australia and US are examined and presented. The Australia Government Department of Health (2019) has offered an exhaustive healthcare facility in varied sectors of heath along with administration and allocation of funds. The United States Healthcare also has same systems familiar with Australian Healthcare. Hence, comparison of healthcare systems between both is relevant (Schütte, Acevedo & Flahault, 2018). This comparative evaluation will be made on criterion of GDP spent on health, population heath index, funding, governance setup of health care systems of both the nations, heath system performance index and efficacious risk administration founded on quality and safety of health systems. The evaluation of data will thus help in problem interpretation and successive valuation.  

Funding system (including health insurance)

Primary financial backing for Australian public administered hospitals is retained together by both territory and state government of Australia. Australian government is liable even for Pharmaceutical aid and Medicare Benefits Schedule (MBS). Moreover they are also liable to cope with supervision, provision of subsidised age care facilities and are even responsible to oversee quality, funding and efficaciousness of elementary care centre (Australian Government Department of Health, 2019). Whereas HSS in US is responsible to cover primarily health insurance schemes through Medicare insurance which is mainly arranged for aged people. Also Government of US offers insurance cover for children, disabled people and low income group mothers which is called Medicaid applied for Children and US Government’s State Children Health Insurance Program. Hence as far as comparative evaluation is considered both healthcare systems of US and Australia maintain their individual health insurance schemes but configuration of healthcare system in US in context to insurance has many categories depending on socio-economic status and age of people like mothers and their kids. While in case of healthcare systems of Australia it can be said that they have exclusive subsidy for pharma products along with insurance cover for aged people. 

 During the year 2014-15 Healthcare system in Australia has spent nearly $161.6 bn of GDP in contrast to $ 4.4 bn during 2013-14 (Australian Institute of Health and Welfare 2016). Whereas, as per U.S National Library of Medicine (2019) health care system in US is shrinking in context to funding or direct payment to services which is a burdening issue. Thus it can be deduced that government of Australia has more exhaustive detailing of funding along with elaborate % of money spent on health care which is lacking in US healthcare system.

 

System governance arrangements in the country

The administration, collaboration and protocols in health care services of Australia is multifaceted and commissions across every stage of government. Moreover, arrangement and delivery of services are very similar across both public and private sectors, where facilities under public sector health care services are mainly distributed under territory, regional and state government while in case of private sector health care services consist of private medical professionals and hospitals. According to research valuation around $155 bn was consumed in healthcare services in Australia during 2013-14 of which about 2/3rd was contributed by government. Also public sector health services are very broad and consist of large number of medical practitioners, support employees and volunteers. Further government is engaged in distribution and funding of wide range of services including public heath arrangement, community heath aids, research in medical field and Aboriginal and  Torres Strait Islander health programs (AIHW, 2016). Moreover the territory, regional and state governments of Australia share liabilities that are related to regulation of health care manpower, providing education to professionals, governing of pharmacies, lending support to improve quality and safety development aspects as well as supporting arrangement for funding’s.   

In comparison, the health care system in US does not involve homogeneous systems except healthcare insurance covers arrangement. Currently an enactment has made it mandatory in US to provide all healthcare cover for citizens.  Also US healthcare systems operate under hybrid governance systems which has multiple payer health insurance schemes instead of single payer. Also in US, the healthcare system is primarily exposed to plenty of regulations at both federal and state level and it is the core liability of federal government to maintain highest level of care services for all their citizens (Department for Professional Employees, 2016). Nonetheless, in US Department of Health, the Human services are engaged to oversee federal authorities that are engaged and all the authorities are affiliated under Public heath service and FDA, where main responsibility of FDA is to govern efficiency, safety of drugs, food and medical items.

Population Health Indicators

Maternal mortality or maternal death means death of pregnant females during 42 days mainly post pregnancy that has been aborted other than on site or pregnancy period. A comparative evaluation of maternal mortality index between US and Australia indicates that more females died due to complication during 2016 in US (America’s Health Rankings, 2016). Whereas, approximately 8.5 death took place per 100,000 females while giving birth in Australia in comparison to US which has 19.9 deaths therefore reflecting that maternal death is higher in US (AIHW, 2018). High rate of maternal death were noted in Georgia (39.3%), New Jersey (37.3%) and Louisiana (35%). While low rate of maternal mortality was noted in Nevada (6.8%) and California (5.9%). Moreover, through evaluation of data it was also noted that there has been rise in mortality rate as compared to previous year in Australia along with rise in death rate due to ailments such as non-obstetric haemorrhage, cardiovascular complications, thromboembolism and sepsis which are found to be most prevalent reason that have resulted to death of females in Australia.

 

 

Infant mortality rates

Infant  mortality rate means demise of children under 1 yr and is termed IMR which is calculated as number of death per 1000 live births. The IMR also includes death in premature birth as contributing number in the index. From the comparative evaluation it has been observed that US has recorded more number of infant death during 2017 in contrast to Australia. In US, IMR reported in 2017 was 5.8 death per 1000 live births as against 5.9 recorded during 2016 (National Vital Statistics Reports, 2018). Also in US around 23,000 or more infants demised during 2016 because of sudden infant death syndrome, birth abnormalities, complication in pregnancy, pre-mature births and due to low birth weight. Largest rate of IMR was recorded in Alabama (7.4), Arkansas (8.2), Indiana (7.3) and Georgia (7.2). However, in case of Australia during 2017 around 1019 infant deaths (3.3%) was reported that included 457 girl child and 562 boy child (ABS, 2018). Thus from these data it is clearly evident that a better health care system is prevalent in Australia compared to US where index was 5.1 % higher compared to IMR during 2016 (970 cases/3.1%).  Thus it reflects that there is urgent need to implement better facility related to health care services of infants. IMR during 2017 was 3.3/ 1,000 live births as against 3.1 at 2016.

Life expectancy at birth

Life expectancy is basically an indicator that describes wellbeing of residents and reflects generic mortality rate in overall residents.  Life expectancy determines average length of survival for a person depending on contemporary sex and age related death rates. After comparing life expectancy at birth between both nations it could be noted that Australia has better life expectancy. In Australia a male born during 2014-16 normally survives till 80.4 years while female normal survival is 84.6 years (AIHW, 2018). While in 1881-1890 contrastingly the life expectancy respectively that existed was 47.2 and 50.8 years.   This shows that life expectancy at birth has largely extended over past years in Australia. However, in case of US this data is noticeably low with life expectancy at birth during 2016 to be expected around 78.6 years  (National Vital Statistics Reports, 2018). This represents a drop by 0.1 year in comparison to 78.7 which was the expectancy reported during 2015. Also life expectancy of female was 5.0 years more than men. The difference in life expectancy at birth between males and females in US has declined since 1979 which was around 7.8 years. 

 

Health System Performance Indicators

Low birth weight (LBW) represents prevalence of birth weight lower or proportionate to 2499 gms during birth of child, irrespective of gestational duration. Some reasons of LBW are being minor for gestational phase, environment impact and pre-mature birth. An examination of  figures reflects that amount of LBW in live born babies in Australia during 2015 was around 6.5%. The rate of LBW between 2006-15 for women who resided in remote and provincial areas fluctuated between 7.8-9.0%, however, LBW was also observed to be excessive in female (7.0%), native mothers/Aboriginals  (11.9%) and in individuals who belonged to lowest SES levels (7.6%) (AIHW, 2018). These data are largely distinct from those reported in US, where number of LBW during 2016 was reported to rise by 1%. The number during 2016 was 8.1% in comparison to 8.07% during 2015. Moreover the % of babies born with LBW was also reported to rise over 8.0% that was reported earlier (National Vital Statistics Reports, 2018). Further the level of LBW varied between 6.97% in non-Hispanic fair females and 13.68% in non-Hispanic black females.

Obesity can be described as a health disorder that is observable by rise of extra body fat to such a level that leads to unexpected health consequences and it is generally demonstrated through conditions noted by presence of (BMI) larger than 30 kg/m2. Announcement from government of Australia furnished that 2 out of 3 adults were overweight during 2014-15. Obesity was noted in around 28% people that reflects a large ratio in comparison to 19% that was found during 1995. Nonetheless, occurrence of obesity had also been declared in 1 out of 4 kids during 2015 within age of 2-17 years (AIHW, 2018). Larger ratio of obesity also turned out 22,700 cases of surgical weight minimisation which was only 9,300 during 2004-05. Contrastingly the rate of obesity was higher in US with around 39.8% adults and 18.5% of young adults being diagnosed during 2015.  The occurrence was larger amongst middle age people (42.8%), as against youth (35.7%). Also 20.6%  incidents were spotted in young, around 18.4% in 6-11 yr and 13.9% in under 5 yr age (CDC, 2017).

This metabolic syndrome indicates a medical condition that is noted by an unfamiliar rise in level of glucose in blood and it is noted to affect the body leading to renal failure, blindness, cardiovascular problems and non-traumatic limb amputations. Approximately about 30.3 mn people suffered from diabetes during 2015 in US which represents occurrence of diabetes in 1 out of 10 people. Also around 84.1 mn adults in US or 1 out of 3 are observed with pre-diabetes. The large scale presence of diabetes can be further explained with the fact that maximum lately diagnosed case was in middle age people not more than 45 years. Non-Hispanic and Hispanic blacks were found with more cases of diabetes when compared to the non-Hispanic white equivalents (CDC, 2017). While in case of Australia the data that was reported in case of diabetes was 1 mn events of hospitalisation and around 16,400 successive death due to diabetes during 2015. 55% of the cases reported were due to prevalence of Type 2 while similar spotted estimates hinted about 6% or 1.2 mn in adults of Australia in 18+ years to be affected with diabetes during 2015. Occurrence of condition was higher in males (7%) as compared to female (5%) and was (17%) in elderly (AIHW, 2018).

Asthma is long lasting provocative disease of lungs characterised through bronchospasm and rescindable difficulty of the airpipes. An evaluation of facts from US and Australia demonstrates that were an estimated 1 out of 9 people reported with asthma in Australia during 2015. 1 out of 5 people with age more than 15 years had developed asthma and abnormalities which resulted into estimated death of 421 during same year. Also it was noted that asthma led to negative health influences on 2.5 mn Australian people during 2015 that indicated to around 11% of overall population.  The disease was more prevalent in men between 0-14 years while women over age of 15 years were found to suffer more (AIHW, 2018). Moreover the nationwide generalised case of asthma in US was reported to  be 24,633 cases during 2015 (7.8%), with more cases noted in children (8.4%) as compared to adults (7.4%). The disease was found to mostly affect youths around 10.2 percent within age group of 15-19. Also asthma reported to outweigh in females (9.1%) as against men (6.5%) during 2015. Further likely 10.3% Black non-Hispanics were spotted with asthma during 2015, in contrast to fair non-Hispanics (7.8%) and Hispanics (6.6%) (CDC, 2018).

 

Hypertension

This medical condition is described as high blood pressure and is a sustained illness that occurs due to increase in level of blood pressure.  After evaluation of facts noted for high blood pressure in both US and Australia it was observed that hypertension was largely found in US reported to 29.0% between 2015-16 which on other hand presented a rise in cases of hypertension amongst 18-39 age (7.5%), amongst 40-59 (3.2%) and over 60 years (63.1%). Also hypertension was generally noted to be more common 40.3% amongst non-Hispanic black as against to (27.8%) amongst Hispanic white, (27.8%) amongst Hispanic and  (25%) amongst non- Hispanic Asians. Also hypertension cases in adults in US was reported to 48.3% (predominantly men) and was higher in non-Hispanic whites (50.8%) (CDC, 2017).

Contrastingly in Australia medium level of hypertension cases were found with occurrence in around 2.6 million people (11.3%) during 2015. Hypertension was more common in males than in females (12.0% and 10.7%, respectively) (ABS, 2015). Also cases of hypertension was also reported to increase with rise in age and around 45.5% people over 75 years were reported to be diagnosed with hypertension. Also high blood pressure was found in 23.0% Australian people with age over 18 years which on other hand is related to 4.1 mn people. This ratio was found to be commonly higher than 21.5% in adults who were found with hypertension cases during 2012.

Cancer describes a large number of diseases where exact parts of somatic cells begin abnormal reproduction at rapid rate. These abnormal cells attack and damage surrounding tissues thus widening to other places in body and slowing creating demise. During 2014 around 127,887 new incidents of cancer were spotted in Australians (57,942 women and 69,945 men) (Australian Government, 2018). Moreover this data reflects that during 2016 about 45,782 deaths in Australia occurred due to cancer (19,872 women and 25,910 men). Further age related death ratio was around 159 deaths per 100,000 individuals (128 for women and 198 for men). Contrastingly during 2016 around 15.5 mn cancer cases were reported (National Cancer Institute, 2018). Also during 2017, around 15,270 children and youths in 0-19 age were spotted with cancer which consequently led to demise of 1,790 people.

Management of risk quality and safety

A vision has been declared by Australian Commission on Safety and Quality for all people along with provision of activities that are mandatory to be attained so as to envision these objectives. The Australian framework is based on three core values i.e. high quality and safe care particularly consumer oriented that is guided by data and governed for security(Australian Commission on Safety and Quality in Health Care, 2018). Rigorous compliance to these visions form core of operations which are essential to deliver superior and safe plans as well as it will help to provide a framework that would examine and monitor security and quality in health care. Wellbeing quality of people also refer to a vital element of performance of healthcare systems in US other than protection that all kinds of health care facilities deliver through methods of harmless operations and patient focused care (OECD, 2016). Further it can be improved more through health indicator aspects that can involve elementary care, specifying acute care, mental health care, patient safety, cancer care, and patient encounters.

Conclusion

Hence it can be deduced that different nations are largely focusing on development and implementation of systematic measures so as to ensure effectiveness of their healthcare systems in contrast to other countries. Also it has been inferred that in lack of evaluation there can occur several issues related to interpretation of good or bad health care facilities, memorandums for health reforms, safeguard of patients or payers or related to funding in health care. Thus, even though both health care systems of US and Australia work to attain improvement for a common mission of development of heath systems but there exist certain dissimilarities in the way they undertake course of actions and set their goals . Nonetheless provision of health care systems, insurance cover and health care charges are completely different in both US and Australia.

 

References

America’s Health Rankings. (2016). Trend: Maternal Mortality, United States. Access date: 4 Feb 2019. Retrieved from https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/maternal_mortality/state/ALL?edition-year=2016

Australian Bureau of Statistics. (2015). 4364.0.55.001 - National Health Survey: First Results, 2014-15.  Access date: 4 Feb 2019.. Retrieved from https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001~2014-15~Main%20Features~Hypertension%20and%20measured%20high%20blood%20pressure~14 

Australian Bureau of Statistics. (2018). 3302.0 - Deaths, Australia, 2017. Access date: 4 Feb 2019.. Retrieved from https://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/3302.0Main%20Features52017?opendocument&tabname=Summary&prodno=3302.0&issue=2017&num=&view= https://www.cdc.gov/nchs/pressroom/sosmap/infant_mortality_rates/infant_mortality.htm

Australian Commission on Safety and Quality in Health Care. (2018). Australian Safety and Quality Framework for Health Care. Access date: 4 Feb 2019.. Retrieved from https://www.safetyandquality.gov.au/national-priorities/australian-safety-and-quality-framework-for-health-care/ 

Australian Government Department of Health. (2019). The Australian health system. Access date: 4 Feb 2019.. Retrieved from: https://beta.health.gov.au/about-us/the-australian-health-system

Australian Government. (2018). All cancers in Australia. Access date: 4 Feb 2019. Retrieved from https://canceraustralia.gov.au/affected-cancer/what-cancer/cancer-australia-statistics 

Australian Institute of Health and Welfare (2016). Health expenditure Australia 2014–15. Access date: 4 Feb 2019. Retrieved from: https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2014-15/data

Australian Institute of Health and Welfare. (2016). Australia's health 2016. Access date: 4 Feb 2019.. Retrieved from https://www.aihw.gov.au/reports/australias-health/australias-health-2016/contents/health-system 

Australian Institute of Health and Welfare. (2018). Asthma snapshot. Access date: 4 Feb 2019.. Retrieved from https://www.aihw.gov.au/reports/chronic-respiratory-conditions/asthma/contents/asthma 

Australian Institute of Health and Welfare. (2018). Children’s Headline Indicators. Access date: 4 Feb 2019.. Retrieved from https://www.aihw.gov.au/reports/children-youth/childrens-headline-indicators/contents/3-low-birthweight 

Australian Institute of Health and Welfare. (2018). Deaths in Australia. Access date: 4 Feb 2019.. Retrieved from https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/life-expectancy 

Australian Institute of Health and Welfare. (2018). Diabetes snapshot. Access date: 4 Feb 2019.. Retrieved from https://www.aihw.gov.au/reports/diabetes/diabetes-snapshot/contents/how-many-australians-have-diabetes

Australian Institute of Health and Welfare. (2018). Maternal deaths in Australia 2016. Access date: 4 Feb 2019.. Retrieved from https://www.aihw.gov.au/reports/mothers-babies/maternal-deaths-in-australia-2016/contents/report

Australian Institute of Health and Welfare. (2018). Overweight & Obesity. Access date: 4 Feb 2019.. Retrieved from https://www.aihw.gov.au/reports-data/behaviours-risk-factors/overweight-obesity/overview 

Centers for Disease Control and Prevention. (2017). Hypertension Prevalence and Control Among Adults: United States, 2015–2016. Access date: 4 Feb 2019.. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db289.htm 

Centers for Disease Control and Prevention. (2017). National Diabetes Statistic Report, 2017. Access date: 4 Feb 2019.. Retrieved from https://www.cdc.gov/features/diabetes-statistic-report/index.html 

Centers for Disease Control and Prevention. (2017). Prevalence of Obesity Among Adults and Youth: United States, 2015–2016. Access date: 4 Feb 2019.. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db288.htm 

Centers for Disease Control and Prevention. (2018). 2015 National Data Archive. Access date: 4 Feb 2019.. Retrieved from https://www.cdc.gov/asthma/archivedata/2015/2015_data.html 

Department for Professional Employees. (2016). The US. Health Care System: An International Perspective. Access date: 4 Feb 2019.. Retrieved from https://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/

National Cancer Institute. (2018). Cancer Statistics. Access date: 4 Feb 2019.. Retrieved from https://www.cancer.gov/about-cancer/understanding/statistics

National Vital Statistics Reports. (2018). Births: Final Data for 2016. Access date: 4 Feb 2019.. Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_01.pdf

National Vital Statistics Reports. (2018). Deaths: Final Data for 2016. Access date: 4 Feb 2019.. Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf 

OECD. (2016).Health Care Quality Framework. Access date: 4 Feb 2019. Retrieved from https://www.oecd.org/els/health-systems/health-care-quality-framework.htm

Schütte, S., Acevedo, P. N. M., & Flahault, A. (2018). Health systems around the world–a comparison of existing health system rankings. Journal of global health, 8(1).

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