Australian Health Care Systems Final Exam

Module Study Guides 1-4 Flashcards

What is health?

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Note: Health is hence not just a concept concerned with the absence of disease but rather focused on a positive state of well-being.

Health Determinants

Describe the factors that influence health but are not by themselves illnesses.

Illness or Injury

Usually refers to a pathological process that is abnormal and may lead to the detriment of health.

Health Treatments

Usually refer to some form of treatment or procedure intended to cure or ameliorate a disease process.

Disability

May result from illness, injury, genetic abnormalities, or complications during birth.

Main Determinants of Differences in Health

• Natural, biological variation.

• Health damaging behavioral choices.

• Health promoting behaviors.

• Exposure to unhealthy environments, stressful living and/or working conditions.

• Inadequate access to essential health and other public services.

• Health related social impacts.

The Social Determinants of Health Encompass 5 broad areas

1. Distribution of economic resources.

2. Education.

3. Living Standards.

4. Access to and conditions of work.

5. Social support.

How does Family Composition impact health status?

Being single or part of a single parent family is associated with higher standardized death rates, and higher self-reported poor health and a greater likelihood of experiencing other risk factors.

How does Ethnicity impact health status?

Certain ethnic group experience additional risk factors and a heightened vulnerability to poor health while others may be afforded certain protections.

How does Location impact health status?

Non metropolitan residents have higher standardized death rates but generally report better health status than their urban based counterparts.

How does Sex impact health status?

Males experience poorer health than females with higher death rates, risk behaviors and reduced life expectancy.

How does Indigenous Status impact health status?

Shared histories of colonization and dispossession and contemporary structural racism and experiences of disenfranchisement continue to impact indigenous populations globally.

How does Socioeconomic Status impact health status?

People of lower socioeconomic status often experience poorer health outcomes than wealthy populations.

What are some challenges to Australia’s health?

• Rising incidences and rate of chronic disease.

• Declining infectious diseases but a vulnerability to paramedics.

• Increasing obesity, hypertension and the diseases of aging.

• A vulnerability to injury and disasters.

The demand for health care continues to rise because of what factors?

1. Increasing population.

2. Aging population.

3. Chronic disease prevalence.

4. Management of risk factors.

5. Technological and professional advancements in health care.

6. Emerging or changing patterns of disease.

What are health systems?

A good health system delivers quality services to all people, when and where they need them.

What are the 6 building blocks of health systems?

1. Governance.

2. Information.

3. Financing.

4. Service delivery.

5. Human resources.

6. Medicines and technology.

Roemer’s Components of Health Care Systems

1. Resources.

2. Organization.

3. Management.

4. Economic support.

5. Delivery of services.

Lassey Components of Health Care Systems

1. Institutions.

2. Supporting resources.

3. Financing mechanisms.

4. Information systems.

5. Linking organizations.

6. Management structures.

What is macro consideration?

Describes the whole system approaches and understanding.

What is meso consideration?

Implies a focus on organizations and institutions.

What is micro consideration?

Level describes individual services or practitioners.

What does horizontal thinking consider?

• Self care.

• Primary care.

• Secondary care.

• Tertiary care.

What is the pragmatic approach?

• Population health.

• Medical, dental and allied health services.

• Home and community care.

• Institutional care.

• Complimentary health.

What is the breakdown of the health services funding and responsibility?

• Other services = 22%

• Primary health care = 38%

• Hospitals = 40%

What are the 3 tiers of the Australian Government?

1. The Australian (Federal/Commonwealth/National) government is led by the Prime Minister and is responsible for national issues including external affairs, defense and the coordination of national efforts involving more than one state.

2. The state (6 total) and Territories (2 total) governments are responsible for those matters not delegated to the Australian government under the Australian constitution and for representing the interests of people within their jurisdictions.

3. Local government includes shires, towns and cities, which are created by the States and Territories under specific legislation..

How are the health care services underpinned financially?

1. The national compulsory health insurance scheme Medicare.

2. The subsidized Pharmaceutical Benefits Scheme.

3. Publicly subsidized health insurance.

4. Individual payments.

Who is responsible for Medicare?

The Federal Government.

Who is responsible for Emergency Services?

The State and Territories.

Who is responsible for Environmental Health?

Local governments.

The Living Longer, Living Better reforms sought to accomplish what?

To reshape the Australian aged care sector to ensure greater self-determination.

In Queensland what are Local Hospital Networks referred to as?

Hospitals and Health Services.

What government made the original attempts to introduce a form of universal health care coverage in Australia?

The Chifley Labor Government in the 1940s.

What are formal policies?

May be articulated through legislation or regulation that provide legal force to the policy direction.

What are informal policies?

Are often recorded and therefore open to deliberate or accidental manipulation.

What did the agreements 2021 addendum suggest?

• Delivering safe, high quality care in the right place at the right time.

• Prioritizing prevention, and helping people manage their health across their lifetime.

• Driving best practice and performance using data and research.

• Improving efficiency and ensuring financial stability.

Who are stakeholders?

Players, organizations or people, who have an interest in the are being considered.

What is the role of the government in health?

• The government remains the majority of owner of public hospital services in Australia.

• The government acts on behalf of the people.

• The Federal and State Territory departments of health should be considered public agencies essentially owned by the people and managed through their elected representatives in their respective Federal and State Territory parliaments.

What does the Australian government provide?

• National leadership in regard to health standards and health policy.

• National service such as military health services and quarantine services.

• National coordination of health policy initiatives and health responses, particularly in regard to major incidents.

• Determine national standards regarding health through the National Health and Medical Research Council, non-government agencies, the National Health Performance Authority and the Australian Commission of safety and quality in health care.

• Ensure national reporting of health statistics and performance through the Australian Institute of Health and Welfare and the productivity commissions report on government services and through national clinical registers.

• Fund health services through the Medicare scheme, support for private health insurers and direct payments to the States.

• Support for education of the health workforce through funding of universities and the Higher Education Contribution Scheme gives the Australian government control over health workforce numbers.

• Support health research through the National Health and Medical Research Council and other research funding bodies.

• National coordination in the registration of health professionals through national boards supported by Ahpra.

The Australian Institute of Health and Welfare

Produces a range of publications about Australia’s health and use of health services.

The National Health Survey

A population based survey conducted by the Australian Bureau of Statistics and designed to obtain national information on a range of health related issues and to enable the monitoring of trends in health over time.

What are the State and Territory Governments responsible for?

• Population and health services.

• Health care services.

What does the Local Governments provide?

Environmental health, food and safety, and other disease prevention activities including waste disposal and water quality control.

What are semi-government agencies?

Those that are publicly owned but are operated as semi-independent often commercial organizations.

Not for profit

Agencies that do not seek to earn a profit for owners/shareholders.

For profit

Agencies that seek to provide health services for a profit which is returned to the owners/shareholders of the organization as fdividends or direct profits.

Statutory Laws

Those that are developed by parliaments.

Common Laws

Developed through the precedence of case judgements over time by the courts.

Health and Health Service Legislation

1. Health specific legislation by which government empower the articulation of government policy or provides for the organization of health services.

2. Legislation for which government health agencies are responsible (Public Health Act 2005 (QLD)).

3. Legislation relevant to the management of organizations (Work Health and Safety Act 2011 (QLD)).

4. Legislation which applies to all organizations and individuals (Traffic Act 1949 (QLD)).

What are some legal issues?

1. The relative legislative authorities of the Australian and State Territory governments.

2. Law, morality and ethical dilemmas.

3. Negligence.

4. Consent to treatment.

Who are responsible for running public hospitals?

State Territory Governments.

Who funds private hospitals?

Federal government, private insurance companies and out of pocket companies.

What does health funding imply?

The sources of funds for health services. It seeks to identify who pays for health goods and services.

What does health expenditure imply?

The application of the funds and addresses the issues of who spends the money, on whom and for what.

What does health economics address?

The allocation of resources within health and the production of healthcare.

What is the macro funding method?

Whole of community level where decisions are made by government, individuals or corporations about the relative allocation of funding to health rather than other services such as transport infrastructure or education.

What is the meso funding method?

Organizational level describes the allocation funding to organizations and units and considers how decisions are made to allocate funding amongst services.

What is the micro funding method?

Individual level considers how decisions are made at the individual level to allocate funds to a particular patient or for the person to decide whether to allocate funds to health expenditures over other possible options.

Historical Funding

Is defined as the allocation of resources on the basis of previous years modified in accordance with changes in scope of outputs and cost of inputs.

Population Based Funding

Involved the allocation of funds to a population group proportionate to their expected health needs rather than the current use of health services by the group.

What are the key drivers of the population based models?

• Population size.

• Health size.

• Supply factors.

Activity Based Funding

Describes the allocation of funding on the basis of the activity a health services undertakes, giving consideration to the complexity of care a patient requires.

What is data?

Information without context.

What is information?

Data that has been made meaningful.

What is knowledge?

Information becomes knowledge once it has been interpreted and synthesized.

What are the dimensions of health reform?

• The patient- information gained from the patient and the interactions of health care providers.

• The professional- information that supports evidence based treatment and informs clinical knowledge.

• The management- the information that meets administrative, financial, and evaluative needs of health services.

Key components of pharmacy and pharmaceutical’s regulation

1. The PBS- only drugs approved by the Minister are allowed onto the list of subsidized medicines.

2. The Australian Community Pharmacy Authority- considers and makes recommendations regarding an application to supply pharmaceuticals at particular premises.

3. The Therapeutic Goods Administration- must approve any product which has conventional therapeutic claims, and it must be registered in the Australian Register of Therapeutic Goods before it can be supplied in Australia.

4. The relevant State Health Acts make provision for Drugs and Poisons Regulation, hence providing authority for the carriage and administration of certain substances.

The Pharmaceutical Benefits Scheme

The PBS is a government subsidized scheme that is part of the broader National Medicines Policy. Designed to reduce financial barriers which might prevent access to medications.

What is the breakdown of the health expenditure in Australia?

• 1/3 of expenditure is by individuals who collectively make many decisions about healthcare spending.

• 2/3 of expenditure is made by the government.

What are the three E’s?

1. Effectiveness refers to the ability of interventions to achieve health outcomes and additionally to their quality and safety.

2. Equity refers to the fairness in access and outcomes.

3. Efficiency means using resources in such a way that you get the maximum benefits possible for the resources used.

Allocative efficiency

Occurs when the inputs are allocated in the health system to achieve the best possible outcomes.

Productive efficiency

The production of the maximum quantity of output with a fixed cost set of inputs.

Cost Analysis

To understand the cost of the health good that is being used.

What are the 3 steps for Analysis?

1. To identify all the resources that are used to produce the health service.

2. Resources must be measured, either under staff time, consumables, and capital costs.

3. Costs have to be valued in monetary terms.

Cost Minimization Analysis

Based on least cost alternative.

Cost Benefit Analysis

Aims to assess whether costs outweigh the benefits of a particular intervention, where the benefits are also valued in monetary terms.

Cost Effectiveness Analysis

The most common form of economic evaluation used in healthcare.

Cost Utility Analysis

A subset of cost effectiveness analysis. It allows for comparisons of the relative value for money of interventions across different areas of health care by measuring change in health outcomes in a generic unit capable of capturing changes in mortality and morbidity in a single metric.

What are the principles of health reform?

1. A focus on prevention.

2. A health system that is focused on the needs of people and not the interests of providers.

3. An equitable system that provides access to health care for those in need regardless of their capacity to pay.

4. Shared responsibility between health care providers and individuals.

5. Comprehensive and smoothly articulated health care in which the process of navigating the health system is transparent and efficient.

6. Value for money.

7. Improved efficiency achieved through the use of new technology.

8. A focus on primary case as the coordinator of care and the gatekeeper to highly expensive advanced care.

9. Managing expectations in the future through greater engagement of people in their own care and in determinants of their desires.

10. To take a long term view of system redevelopment.