Professional Documents
Culture Documents
chapter
In this chapter you will evaluate health care in Australia by investigating issues in relation to social
justice principles. You will examine the advantages and disadvantages of Medicare and private health
insurance as well as critically analyse complementary and alternative health care approaches.
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Chapter 3 | WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? 53
Health services are categorised into public health services, primary care and community
health services, hospitals and specialised health services, as illustrated in Figure 3.2.
Cancer screening
Screening programs for breast, cervical and bowel cancers aim to reduce morbidity and
mortality as early as possible. BreastScreen Australia uses mammography for screening, the
National Cervical Screening Program uses Pap tests and the National Bowel Cancer Screening
Program uses faecal occult blood tests. Breast cancer screening services are free to females in
the target age group. Bowel cancer screening is free to those males and females who have been
invited to participate in the screening. Screening for cervical cancer is covered by a Medicare
rebate.
Immunisations
PDHPE Application and Inquiry
Vaccinations covered by funding for children include diphtheria, tetanus, pertussis (whooping
cough), polio, measles, mumps, rubella, Haemophilus influenzae type b (Hib), meningococcal
type C disease, varicella (chickenpox), pneumococcal disease, hepatitis B, rotavirus and, for
females aged 12 years and over, human papillomavirus (HPV). Aboriginal and Torres Strait
Islander children living in high-risk areas are covered for hepatitis A. For adults, influenza
and pneumococcal vaccines are available free to all Australians aged 65 years and over, to
Indigenous Australians aged 50 years and over, and to those younger Indigenous Australians
who are deemed to be medically at risk.
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Indigenous Australians tend to use mainstream services Abdominal pain 1.2 1.8
differently from the rest of the Australian population. Administrative procedure 1.1 1.6
For geographic, social and cultural reasons, mainstream
Headache 1.0 1.6
services are not always accessible to, or the most
appropriate provider of health care for, Indigenous Skin complaint 0.9 1.4
Australians. Australian governments recognise this and,
Ear pain 0.9 1.4
given the relatively poor health status of Aboriginal and
Torres Strait Islander peoples, provide specific health care Weakness/tiredness 0.9 1.4
services to meet their needs. Indigenous-specific health Diarrhoea 0.9 1.3
services are important providers of comprehensive primary
Knee complaint 0.8 1.3
health care. The state and territory governments provide
community-based Indigenous primary health care services. AIHW, Australias Health, 2008
These include management of acute and chronic health
conditions, preventative health measures (such as immunisation and screening), health promotion
activities, transport services and assistance in accessing other appropriate community and health
services. A small number provide specific programs only, such as health promotion and counselling.
Chapter 3 | WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? 55
Ambulance services
The role of ambulance services generally includes providing Figure 3.3 Public dental services are provided to primary
emergency pre-hospital patient care and transport in and secondary school children
response to sudden illness and injury. It also involves
retrieving emergency patients, transporting patients between hospitals,
conducting road accident rescues and coordinating patient services in multi-
casualty events.
Figure 3.4 The Royal Flying Doctor Service provides health Figure 3.5 Acupuncture is classed as an
services for remote communities alternative health service
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Psychiatric hospitals
Psychiatric hospitals are devoted mainly to the treatment and care of admitted patients with
psychiatric, mental or behavioural disorders. Reforms under the National Mental Health Strategy
introduced in 1992 meant that their role declined in the early to mid-1990s. This change reflects the
moves made to take mental health services out of institutions, and to integrate hospital services with
care in the community setting. There is still a small need for some people with mental illnesses to have
access to full-time care, and there are also short-stay specialised psychiatric units available.
Emergency departments
Public and private hospitals also provide emergency
department services. The types of services provided
in each hospital may reflect a number of factors,
including the availability of other health care services,
patterns of disease and injury, and the generally
poorer health of Aboriginal and Torres Strait Islander
peoples, who have higher population concentrations
in remote areas.
Chapter 3 | WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? 57
Hearing services
PDHPE Application and Inquiry
Most hearing services are provided by private practitioners. The Australian Government also provides
free hearing services to:
anyone under 21 years of age
Aboriginal and Torres Strait Islander peoples aged 50 years and over
adults with special needs
those living in remote locations.
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Public sector
Under the Australian Constitution the Commonwealth Government has very little
direct responsibility for the delivery of health services; this responsibility is
#
Medicare was introduced in 1984
limited to repatriation hospitals. The main role of the Commonwealth Government
and the PBS has been in place
is to provide funding to the state and territory governments for them to deliver
appropriate health services to their populations. In recent years, however, the for more than 60 years.
Commonwealth has expanded its role, introducing and controlling schemes
such as Medicare and the Pharmaceutical Benefits Scheme, as well as health
promotion initiatives that focus on issues such as mental health, alcohol and HIV/
AIDS. The Commonwealth Government shares with the states the responsibility
for occupational health policy and standards. Managing Worksafe Australia is
another Commonwealth role.
Responsibility for delivering the majority of health services lies mainly with
state and territory governments. These governments administer public acute-
care hospitals and public psychiatric hospitals. They also develop the legislation
and regulations under which private hospitals, nursing homes and health
professionals operate. State and territory governments manage mental health
programs, dental health services, home and community care, family health
services and rehabilitation programs.
The health care responsibilities of local government are more related to
personal preventative areas; for example, immunisation programs. They are
also largely responsible for the enforcement of environmental health and
hygiene regulations. The states draw up the regulations, and local government
enforces most of them. Local government is also responsible for some home-care
operations and community health centres.
Chapter 3 | WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? 59
sp
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Funding source
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Private
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State/territory and local governments
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Private
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Public sectorstate/territory governments
Private sector
Combined private sector/state/territory/
local government/Australian Government
The range and types of health facilities and services in Private sector
Australia are illustrated in Figure 3.7. The outer ring in the
All the preceding governmental roles are carried out in
diagram illustrates the different funding sources for each
association with a health system that is largely private in
service. The next ring shows the major groups of services that
nature. Private hospitals, private specialist doctors and
comprise the health system. The health system is made up of:
private GPs make up the majority of the services provided
public hospitals by the health care system. The private sector also provides
private hospitals a range of other health services, such as physiotherapy,
dental services dentistry, pharmacy, chiropractic services, optometry and
medications radiology. Larger organisations within the private sector
community and public health also deliver a broad range of health services. Examples
community nursing of private sector, non-profit health organisations are the
public health education campaigns Spastic Centre of NSW, Cancer Council, Royal Blind Society,
medical services National Heart Foundation, Diabetes Australia, Royal Life
general practice Saving Society, Salvation Army and Red Cross.
specialist care
pathology and medical imaging Equity of access to health facilities
patient transport and aids
other health professionals, such as physiotherapists
and services
and psychologists Access to health services and facilities is essential to health
administration and research and well-being. The cornerstone of Australias health care
state departments of health system is Medicare. Medicare is designed to allow simple
hospital or community health administration research and equitable access to all Australian citizens regardless of
PDHPE Application and Inquiry
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Chapter 3 | WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? 61
increase in funding during the 1990s. Despite this increase, more than 90 per cent of government health
expenditure is still allocated to curative services. With Australias leading causes of death and illness
being lifestyle-related, the argument that prevention will be more cost-effective than cure has gained
considerable support.
Prevention programs that have been implemented include school medical and dental services,
immunisation programs, the fluoridation of water supplies, anti-smoking campaigns, the National
Campaign Against Drug Abuse, the National Mental Health Strategy and the National HIV/AIDS Program.
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Critical inquiry
1 a Governments are reluctant to divert money from curative to
preventative measures because it might not win them votes at the
ballot box. (For example, closing a hospital or decreasing hospital bed
numbers could be politically costly.) What is your opinion of this?
b Are there other reasons for so much health expenditure being devoted
to cure and so little to prevention?
Chapter 3 | WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? 63
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Medicare
Medicare was introduced in Australia in 1984 as a national system of health care funding.
It is designed to protect people from the huge costs of sickness and injury by providing free or
subsidised medical care, and free hospital treatment in public hospitals. All Australian residents
are eligible for Medicare benefits. Short-term overseas visitors are not eligible unless they are from
a country with which agreements have been made between governments.
The three principles upon which Medicare is based are:
universality
#Through the Medicare system
equity
every Australian resident is
simplicity.
Medicare is funded from general taxation revenue plus an additional contribution guaranteed adequate health
known as the Medicare Levy. The Medicare Levy is 1.5 per cent of each taxpayers income, care at minimum cost.
and people pay it in addition to their ordinary income tax. Individuals and families on
higher incomes may have to pay a 1 per cent surcharge in addition to the Medicare Levy
if they do not have private health insurance. The government introduced this change in the hope
of encouraging more financially able people to take out private health cover, and thus ease the
pressure on the public health system. It seems that this strategy had little effect and a further
incentive to take out private health insurance was introduced in 1999. This strategy was a 30 per
cent rebate on health fund premiums, regardless of income.
Chapter 3 | WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? 65
Non-referred medical 4.83 4.91 4.93 1.0 103 433 90.6 4029.6
attendances
PDHPE Application and Inquiry
Other allied health 0.01 0.03 0.07 144.8 1 554 1.4 97.5
Total non-specialist 5.22 5.35 5.43 2.0 114 124 100.0 4405.8
items
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Chapter 3 | WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? 67
amount is increasing. For many years alternative health care approaches were dismissed
as unscientificeven radical and weird. The popularity of alternative therapies is growing,
however, and there is a new sense of acceptance building in the community, and in the
medical field, regarding what are also called complementary therapies. Complementary
therapies are so-called because they are not necessarily designed to replace orthodox
medicine, but are an additional approach that can be used alongside traditional
treatments. Treatments such as acupuncture and osteopathy, and the use of herbal
medicines, are now far more common than they once were.
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Acupuncture
Acupuncture is based on ancient Chinese beliefs that propose that energy (chi) flows through the body via meridians.
Meridians cross the surface of the body and are said to be linked to the major body organs. Through the painless insertion
of very fine needles into the skin at certain points along the meridians it is believed that health benefits can result.
Acupuncture is widely used for pain relief and also to manage conditions such as asthma.
Chiropractic treatment
The aim of chiropractic treatment is to relieve pain and improve health through the manipulation of the spine. The basis of
this treatment is the theory that many ailments are the result of poorly aligned vertebrae. Chiropractors believe that because
the nervous system controls the body, adjusting the spine can deliver health benefits to other body parts.
Osteopathy
Osteopathy involves manual deep-tissue massage and the manipulation of the spine, joints and surrounding tissue
to alleviate back pain, joint problems and muscular disorders. Osteopathy is based on the principle that the well-
being of an individual depends on the skeleton, muscles, ligaments and connective tissues functioning together
smoothly.
Naturopathy
Naturopathy involves treating the whole person by harnessing the bodys natural ability to heal itself.
Naturopaths will often adopt a variety of therapies tailored to meet individual needs. These can
include massage, relaxation techniques, herbal medicine and nutrition.
Chapter 3 | WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? 69
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Chapter 3 | WHAT ROLES DO HEALTH CARE FACILITIES AND SERVICES PLAY IN ACHIEVING BETTER HEALTH FOR ALL AUSTRALIANS? 71