1.Medicare can be described as a publicly funded universal health care system, operated in Australia by the collaborative management of Department of the health services and public funding. According to recent statistics, Medicare is undoubtedly the primary funder for heath care both in Australia and all across the globe, and hence Medicare has had a significant role in the improvements of health care and enhanced availability of it throughout all sectors of the society (Marmor, 2017). However, there certainly are some challenges to successful financial management provided to all the socioeconomic sectors of the society and there is room for many improvements in the Medicare sector.
For instance, considering the seniority coverage, the benefits for Medicare starts only after the age of 65; whereas, in the current age, the health care complexities do not always start past 65, most of the common health concerns arrive with the onset of middle age, around 50 and above. Hence in order to improve the relevance and benefits of the Medicare covers, the seniority cover age bar should rather start from the age of 50, so that the unnecessary burden on the taxpayers does not escalate (Munyisia, Reid & Yu, 2017).
According to emerging research the most of the common health priorities and concerns can be prevented with adequate precautionary and promotional program linked to the Medicare coverage, so that the public health services provided can improve its efficiency and effectiveness, enhancing life expectancy and health across all age groups. Along with that improvising and promoting the bundled payment method to facilitate direct payment to packaged or organized systems of care could positively extend the incentives to the health care providers and improving the quality of care provided, at the same time minimizing the amount of extra money paid by the citizens for different sectors of care needed (Raghu et al., 2014).
2.In simple terms revenue can be defined as the total income by an organization in an annual basis, and expenditure can be defined as the annual amount of spending in the organizations. The difference between revenue and expenditure can be described as total opposites of one another; however, the clear lines of demarcation between both terms can become a little blurred when applied to the context of health care. In case of the health care industry, the entire revenue generation depends on the funding, whether it comes from government subsidization, insurance companies or privately from the public availing the health care (Marmor, 2017). However, with the bundled payment format and pay for package system in place in the healthcare sector, the annual profits of the health care sector has taken severe blows;
Now, considering the expenditure in health care, the entire costing for the advanced health care services has increased at an alarming rate. The drug prices continue to increase and legislative guidelines like the Affordable Care Act on the other hand is not helping the privatized health care units as well (Reeves et al., 2015). Moreover, the growing consumerism, the insurance companies continue to pressurize the health care facilities to improve the quality benchmark of the care provided, and in order to meet the benchmark, the expenditure increases further. Hence, there is a great imbalance between the revenue and expenditure in health care at the moment and there is need for standardizing the differences between both areas so that a state of equilibrium can be facilitated (Cleverley & Cleverley, 2017).
3.One of the greatest challenges in health care at the moment is the optimal and justifiable utilization of public funding in order to make the best use of the hard earned tax money paid by the citizen, to provide optimal care quality to the people of Australia (Gillett, Houlihan & Williams, 2015). Activity based funding is considered to be one method of funding and managing public health care in a manner that payment is circulated efficiently between different sectors of health care, so that the patients pay for every health care activity they avail depending on the severity of their medical condition into account.
In case of NSW, the funding and budget allocation is carried out critically and succinctly to ensure optimal yet justified utilization of the funds. The national funding framework in place for the NSW is NHRA or National Health Reform Agreement; the health budget for the NSW is allocated from the consolidated funds by the authority of the ministry, LHDs, and specialty networks. The outside funding and budget allocation is influenced by the direct recommendation of the director general as well. The expenditure is managed and monitored quarterly by the expenditure review committee (Hjermstad et al., 2016).
4.Case mix can be defined as the assessment or measurement system for assessing the performance of the health care facilities or hospitals; along with the assessment this auditing framework also aims to reward the initiatives that attempt to increase the efficiency of health care workforce and facility along with improving the quality of care. Its also serves as a information tool, classifying different health care facilities into different categories. The case mix classification system involves activity based costing as a parameter to the profession of health. It swiftly and effectively links billable activities directly to the international standards like ICD-10. It will eventually help the billing process to align the classification system with the concept of electronic patient records (Jackson et al., 2015).
Another very popular classification system in place in Australia is diagnosis related group classification. This classification system has 7 key groups and the hospital cases are grouped under these categories based on the type of heath care facility that the patient is availing. The Australian version of DRG is a bit more complicated and detailed and is known as the Australian refined DRG classification system, have ICD10-AM groups. The Australian DRG system has had different versions being utilized and the recent version under use is the version 8.
The Australian DRG classification system is monitored and refined by the DRG technical groups established for the sole purpose of monitoring the effectiveness and efficiency of the classification system (Polyzos et al., 2013).
References:
Cleverley, W. O., & Cleverley, J. O. (2017). Essentials of health care finance. Jones & Bartlett Learning.
Gillett, S., Houlihan, K., & Williams, W. (2015). Investigating the predictors of chronic care annual funding requirements under activity-based funding. BMC health services research, 15(8).
Hjermstad, M. J., Aass, N., Aielli, F., Bennett, M., Brunelli, C., Caraceni, A., ... & Jakobsen, G. (2016). Characteristics of the case mix, organisation and delivery in cancer palliative care: a challenge for good-quality research. BMJ supportive & palliative care, bmjspcare-2015.
Jackson, T., Dimitropoulos, V., Madden, R., & Gillett, S. (2015). Australian diagnosis related groups: Drivers of complexity adjustment. Health Policy, 119(11), 1433-1441.
Marmor, T. R. (2017). The politics of Medicare. Routledge.
Munyisia, E. N., Reid, D., & Yu, P. (2017). Accuracy of outpatient service data for activity-based funding in New South Wales, Australia. Health Information Management Journal, 46(2), 78-86.
Polyzos, N., Karanikas, H., Thireos, E., Kastanioti, C., & Kontodimopoulos, N. (2013). Reforming reimbursement of public hospitals in Greece during the economic crisis: implementation of a DRG system. Health policy, 109(1), 14-22.
Raghu, G., Chen, S. Y., Yeh, W. S., Maroni, B., Li, Q., Lee, Y. C., & Collard, H. R. (2014). Idiopathic pulmonary fibrosis in US Medicare beneficiaries aged 65 years and older: incidence, prevalence, and survival, 2001–11. The lancet Respiratory medicine, 2(7), 566-572.
Reeves, A., Gourtsoyannis, Y., Basu, S., McCoy, D., McKee, M., & Stuckler, D. (2015). Financing universal health coverage—effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries. The Lancet, 386(9990), 274-280.
