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Funding and governance systems in Australia and Canada

Question:

Research and analyze healthcare performance data in two countries. The two countries which are selected for the comparison are Australia and Canada. 

This study aims to research and analyze healthcare performance data in two countries. The two countries which are selected for the comparison are Australia and Canada. A comprehensive comparison will be made in the areas such as funding system (including health insurance systems), governance system, selected population health indicators, health system performance and  % GDP spent on Health. This study will also define each of the measures and will provide the results and commentary for the comparison has been utilized to demonstrate healthcare.

In Australia, Healthcare is provided by the private as well as the government institutions. The Australian healthcare system offers worldwide access to an inclusive range of services that are mostly funded through universal taxation. In the year 1984, Medicare was introduced which covers worldwide access to the treatment which is free in public hospitals and financial assistances for medical services (Oderkirk et al., 2013).  This country possesses a federal system of government, through a Commonwealth (national government) along with two territories and six states. Health remained the liability of the states, at Federation. Though, the Commonwealth Government holds the maximum authority to raise revenue, so the states rely on fiscal transfers so that their systems of health can be supported by the Commonwealth (Morgan et al., 2013).  This makes the system of Australian health care a versatile division of roles and responsibilities of the different states of Australia. It is also noticeable by a complex interaction of the public as well as the private sectors. It is also essential to note the number of insured individuals aged over 65 is 1.86 million which represents that around 53% of the populations of Australia are aged over 65 (Eijkenaar et al., 2013).  Rising levels of insurance across the elderly Australians is a necessary factor in making sure that this country possesses the ability to deliver outstanding healthcare as its populations get older (Janssen, 2013).

On the other hand, in Canada, Healthcare is publicly funded which is mostly cost-free, and most of its services are provided by the private entities.  Through federal standards, the government of this country endeavors to guarantee the quality of care (Oderkirk et al., 2013).   There is no participation by the government in everyday care or collection of information regarding the health of individuals. The provincially based Medicare systems are partly cost-effective because of the simplicity in administration.  In the provinces, the doctors handle the claim of insurance against the provincial insurer (Mossialos et al., 2015).  The expenditure of private health accounts for around 30% of finances associated with healthcare. In this country, Single-payer healthcare system is followed in which the costs of healthcare are paid by the private insurers and not by the state itself. The actual financial support of the single-payer system comes from all or a part of a population (Foroughi et al., 2016).

The governance system of Canada is based on a federal democratic system which denotes that there is an existence of two systems in this country. One is a provincial government which is involved in the setting of laws along with regulations intended for the region they represent, and other is a federal system which is involved in the governance of the entire country (Walls et al., 2012). On the other hand, Australia is no different than Canada regarding the governance system. It is compulsory for the individuals residing in the country of Australia to cast their vote in the elections and if in case, if they do not cast their vote they possess a risk of getting behind the bars (Schäfer et al., 2015).

Selected population health indicators: maternal and mortality rate, infant mortality rate, life expectancy at birth, Health status, low birth weight, diabetes, asthma, hypertension, and cancer

The governance of these two countries closely resembles each other, and both of them follow the British parliamentary system. Their resemblance can be characterized principally by the fact that both of these countries are the members of the British Commonwealth (Schoen et al., 2012).

Considering the selected population health indicators such as maternal and mortality rate, infant mortality rate, life expectancy at birth, Health status, low birth weight, diabetes, asthma, hypertension and cancer, the comparison of these two countries can illustrate a clear picture with respect to all these parameters. The first population health indicators which will be compared involves maternal mortality, the ratio of maternal mortality is the number of women who die from the causes that are associated with pregnancy while undergoing through the period of pregnancy or within the termination of pregnancy within 42 days per 1000,000 live births (Bourke et al., 2012). This data is estimated with a model of regression utilizing information on the ratio of maternal deaths (Papanicolas et al., 2013).

Maternal mortality rate in Australia is a rare incident in the context of global maternal deaths. From 2008-2012, there had been 106 maternal deaths that took place within 42 days of the end of the pregnancy and represented a ratio of maternal mortality of 7.2 deaths per 1000,000 women who delivered babies (Oderkirk et al., 2013).  These deaths ought to be observed as distressing the family and community of the woman’s. On the other hand, in Canada from 2009-2010, the rate of maternal deaths was 6.1 per 100,000 deliveries. In the year 2010-2011, the most widespread diagnoses that were associated with these deaths was due to the diseases involved with the circulatory, digestive and nervous systems along with some mental disorders (Eijkenaar et al., 2013).

Another health indicator which can be compared with respect to both of the countries involves infant mortality rate, which is the number of deaths of infants before reaching one year of age, per 1,000 live births in a year. In the year 2012, there were about 1,032 deaths registered in Australia of the infants who died before reaching the age of one. This ratio was a 9.7% decrease compared with the number registered in the year 2011. Over the last decade, there has been a reduction in the number of deaths of the infants, with a few fluctuations, from 1,265 deaths in the year 2002 to 1, 032 in the year 2012. On the other hand in Canada, in the year 2007, the number of deaths of an infant less than one year of age per 1,000 lives was 5.2. It is the second country with the highest rate of infant mortality (Walls et al., 2012).

Life Expectancy at Birth, this is the most frequently, utilized measure to describe the health of the population and it reveals the overall level of mortality of a population. It measures on an average how long individuals are expected to survive based on their present age and sex-specific rate of deaths (Kassebaum et al., 2014). In Australia, life expectancy has improved noticeably for the male and the females in the most recent century. In this country, a male who took birth in the 2011-2013 is expected to live to the age of 80 years and a female is expected to survive to 84 years compared to 46.2 and 51.1 years, respectively, in 1882-1890. On the other hand in Canada, the average life expectancy for males who took birth in the year 2013 is 81 and for the females 84. For both the sexes, life expectancy at birth augmented on an average from 76 in 1990 to 82 in 2012 (Janssen, 2013).

Health system performance in Australia and Canada

Health Status is a comprehensive concept that is established the presence or absence of any type of disease. It mainly comprises of functioning, mental well-being, and physical illness. Australians possess a good health, and this country is one of the healthiest countries in the world. The individuals residing in this country have a relatively high expectancy of life, and it could easily remove its burden of diseases from its communities (Mossialos et al., 2015). The rate of mortality is also comparatively low as compared to Canada. In Australia, a decrease in the rates of mortality has resulted in augmented rates of morbidity for several conditions. On the other hand, the health status of Canada achieves a ‘B' with respect to the overall performance of health (Marchildon, 2013).  It has third highest rates of mortality because of diabetes, and this disease is continuing to increase. It is raising concerns, not only for the policy-makers of Canada but also to the public. This country achieves ‘A' regarding the three indicators: premature mortality, mortality as a result of circulatory diseases and self-reported health (Lecours & Béland, 2013). It scores a ‘B’ for life expectancy, mortality as a result of respiratory diseases, mortality as a result of mental disorders and mortality as a reason of medical accidents (Turner et al., 2013). 

In Australia, around 6% births result in the infants having low weight when they are born. There were 17,565 babies having low weighed during birth which represented 6.10% of all births. From 2001-2003, there were 3,404 lively births of babies having low weight at birth to the Australian Indigenous mothers (Eijkenaar et al., 2013).

On the other hand, in Canada, in the year the percentage of babies having low weight at birth was 6.3%. The low weight birth rate remained comparatively steady between 1979 and 2011, ranging from 5.6% to 6.3% (Deber, 2014). In the year 2010, the percentage of low birth weight was lesser than as compared to girls. In the year, 2010, the percentage of rates of low birth weight was above the national average for mothers between 35 to 49 years (Osborn & Squires, 2012).  

In Australia, the occurrence of obesity and overweight has been progressively rising for the past thirty years. Around 65% of Australians adults, in the year 2011-2012, were categorized as obese or overweight and more than 30% of them fell into the category of obese (ABS 2013). In the year 2007, approximately 26% of children aged 3-16 were obese or overweight, with 7% (Mossialos et al., 2015). A report by the Organization for Economic Co-operation and Development (OECD) 2009, predicted that there will be a constant augmentation in the rate of obesity and overweight across all the groups of age in the next decade, to approximately 68% of the population. On the other hand, in Canada, one in four adults and one in 10 children possess obesity, which means that 6 million Canadians suffering from obesity may require instant support in controlling as well as managing their weight. According to Forbes, it ranks 33 on a 2007 list of fattest countries, having 61.2% of its citizens possessing a body mass index of at least 25 (Eijkenaar et al., 2013) It has considerably increased in the case of children between the years 1989 and 2005, with rates in males increasing from 3% to 14% and rates among females increasing from 3% to 13% (Foroughi et al., 2016).

% GDP spent on Health in Australia and Canada

Talking about diabetes, in 2011-12, an estimated 921,000 Australian adults aged 20 years and above had diabetes, based on measured and self-reported data, from the ABS 2011–12 Australian Health Survey. It included individuals with type 1 diabetes and type 2diabetes. Around 2% of the adult population did not report that they suffered from diabetes, which indicated that they were ignorant that they had this condition, contrasted with 5% who were aware of it and reported their condition of diabetes. On the other hand, Fifty-eight percent of Canadians suffering from diabetes reported they cannot stick to prescribed treatment due to the high cost of required medications, supplies, and devices. Because of fear of stigma, 38% of Canadian individuals with type 2 diabetes surveyed by the Canadian Diabetes Association reported they do not feel comfortable revealing their diabetes (Lecours & Béland, 2013).

In Australia, 1 in 10 individuals has asthma. This disease is more widespread in males aged 1–14, but among those aged 15 and above, it is more widespread in females (Marchildon, 2013). The rate of asthma among the Indigenous Australians, the rate of asthma is almost two times as high as compared to the non-Indigenous Australians. It is even more noticeable in the elderly age group. It is more prevalent in the individuals residing in the areas that are socioeconomically deprived. The occurrence of this disease is considerably higher in the individuals dwelling in inner remote areas compared with the individuals residing in main cities or outer regional areas (Kassebaum et al., 2014).

In Canada, rates of asthma have augmented four-fold over the most recent 20 years. Though asthma-related deaths have reduced to some extent, it still causes around seven deaths every week, in spite of advances in what we know regarding the condition and the accessibility of effectual medications. More than 2 million people of this country suffer from asthma and every year it adds to around 360 deaths (Mossialos et al., 2015).

In 2012-13, approximately one-third of all adult Australians suffered from hypertension, comprising 22.5% of the individuals having high blood pressure and 10.2% having normal blood (Papanicolas et al., 2013). Males were more probable to have hypertension in comparison to females. Hypertension was extensively more common at older ages, with approximately 9 in 10 individuals aged 80 years and above having hypertension.  On the other hand, in Canada, in 2007/08, almost 6.5 million Canadians aged 25 years or more had diagnosed hypertension (around 6.10 million adults; 4.2 million females and 3.8 million males, crude frequency) (Fineberg, 2012). 


The rate of occurrence of hypertension among the individuals aged 21 years and above was 23.8% in 2007/08 (25.0% for females and 22.4% for males, crude frequency) (Sussman et al., 2012). This frequency is constant but fairly elevated as compared to the self-reported value reported as of the 2008/09 survey of Canadian Community Health (Turner et al., 2013). The values of Self-reported hypertension might be lesser because around 6% of individuals who report treatment meant for hypertension do not report having hypertension in Canadian self-report surveys, probably for the reason that they believe that they do not suffer from hypertension or else their hypertension has been cured when their blood pressure is controlled by means of medication or alteration in lifestyle (Tchouaket et al., 2012).

Medicare and single-payer healthcare system in Australia and Canada

Talking about the prevalence of cancer in Australia, in the year 2013, there were 123,934 new cancer cases were diagnosed (68,289 males and 54,806 females).  In the year 2013, the age-standardized occurrence rate was 486 cases for every 100,000 individuals (573 for males and 413 for females). In the future years, it is expected the incidence of cancer will generally increase with age (Nicholson et al., 2012).

The proportions of widespread cases of cancer in the population of Canada increased considerably more than the time periods considered.  The three-year occurrence ratio for all types of cancers combined at a yearly rate of 3.0% from 1998 to 2009, following steady from 1995 to 1998.  Likewise, the five-year occurrence ratio rose by 3.1% per year from 1998 to 2009, and the ten-year ratio, by 3.4% per year from 2003 to 2009 (Brown et al., 2014).

Performance measurement and reporting of health in Australia, utilizing performance indicators, is undertaken by the Australian Government and the state and territory governments, as well as a number of private health-care providers (Lecours & Béland, 2013). The measurement of Health system Performance is essential to improve the services that provided by governments as well as other contributors. What is precise reveals the significance to governments, to service providers, to the services (counting taxpayers), in addition to customers along with additional stakeholders. In Australia, national public reporting of measured performance of diverse components of the system of health is carried out by several organizations under nationally approved measures (Marchildon, 2013).

Canada achieves a ‘B' with respect to the overall performance of health. It has third highest rates of mortality because of diabetes, and this disease is continuing to increase (Deber, 2014). It is raising concerns, not only for the policy-makers of Canada but also to the public. This country achieves ‘A' regarding the three indicators: premature mortality, mortality as a result of circulatory diseases and self-reported health. It scores a ‘B' for life expectancy, mortality as a result of respiratory diseases, mortality as a result of mental disorders and mortality as a reason of medical accidents (Sussman et al., 2012).

Diabetes remains a rising concern. This country has the third highest rate of mortality due to the prevalence of diabetes among the peer countries, and its prevalence goes on to augment (Nicholson et al., 2012). It is raising concerns, not only for the policy-makers of Canada but also to the public. This country achieves ‘A' regarding the three indicators: premature mortality, mortality as a result of circulatory diseases and self-reported health. It scores a ‘B’ for life expectancy, mortality as a result of respiratory diseases, mortality as a result of mental disorders and mortality as a reason of medical accidents (Smith et al., 2012).

As a percentage of GDP, Australia’s expenditure on health in the year 2009 was much less in comparison to Canada (11.4%) (Tchouaket et al., 2012). In 2010–11, hospitals were undoubtedly the leading area of health expenditure. They consumed 50% of usual health expenditure (which consecutively made up almost 98% of total health expenditure, the rest being for major equipment and new buildings). The next largest constituent was medical services (19%), including primary services provided by specialists and GPs as private practitioners. Drugs made up another 15%, followed by dental services (8%). On the other hand in Canada, Health expenditure accounted for 11.9% of GDP in Canada in 2013, 1.5 % higher than the OECD average of 9.4%. Though, health expenditure as a share of GDP is much lesser in Canada.  The public sector is the major source of funding for health in all OECD countries, except Chile and the United States. In Canada, 75% of health expenditure was financed by public sources in 2013, somewhat less than the OECD average of 73% (Deber, 2014).

Federal system in Australia and Canada

Source: ((Tchouaket et al., 2012).

To conclude, the healthcare performance data in these two countries has provided a clear picture regarding the funding system, governance system, different indicators of population health such as maternal and infant mortality rate, life expectancy at birth, and health status along with the prevalence of diseases like obesity, diabetes, asthma, hypertension and cancer. The obtained data have also revealed the health system performance and percentage of GDP spent on health. The results of the obtained data are more or less similar, and these two still lacks behind in comparison to the other countries regarding healthcare. Though, the healthcare of both the countries is almost acceptable, appropriate, effective, efficient and safe. However, both the countries need to improve their healthcare performance because a good performance in healthcare will lead to the successful existence of the individuals in and efficient manner. 

References

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