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The following essay discusses personal observations of the United States of America’s health care system and breaks it down in terms of equity efficiency and access. These observations are then compared with knowledge of the Australian health system and produce detailed evidence of the positive and negative aspects of both. Through this comparison the Australian use of the mixed market of operating healthcare is seen to be superior due to its greater development in both equity and access as apposed to the Americans use with only major benefits found within the systems efficiency.
The health care system in operation in the United States of America is one oriented towards self provision (Hsiao and Yip 2000). It is designed in a way in which its people are largely responsible for their own health care costs at their own choice. This is the result of the extensive push towards the private sector of health. Personal funding for American health care is usually achieved through employment (Hsiao and Yip 2000). That is, when a person seeks to purchase health insurance they can do so through their employer. This means that people who are unemployed do not experience the same luxury of opportunity. The production of a government funded scheme to support these people was implemented in 1965. The scheme allows for the elderly to attain health care, as well as the poor financed by the federal and the state governments (Nelson, 2007). As this system of health care seems to cover the two ends of society it would seem one of success, although there are still between 45-47 million uninsured people within America that have to pay entirely for any medical expenses they incur, which of course can be quite expensive (Hsiao and Yip 2000; Nelson, 2007).
The Australian health care system is designed to incorporate two major contributors to funding, the public sector (as a result of the nation’s revenue and taxation) and the private sector (private organisations that insure people’s health at an incurred cost). The Australian system provides necessary public funding to areas of what Hsiao and Yip (2000p.2), refer to as “adequate need” at both a federal and state level. These adequate need services surround the use of general practitioners and hospital visits. As these are not necessarily the extents in which people use the health care system, privately purchased insurance is then available to provide funding for a greater number of health care needs (Hsiao and Yip 2000).
The Australian health care system has a similar mixed market structure to health care as the American. This similarity is evident due to the presence of both public and private sectors providing funds to deliver health care. Although there is a similarity in the design of the market associated with health care there are vast differences within the orientation of the health care system itself (Hsiao and Yip, 2000). As opposed to the American system, the Ideology behind the Australian system is that all people should have equal rights to health care. This describes the equity present within the systems
Equity within health care is the subject of much debate. Even the definition of the term ‘equity’ itself is subject to various views and opinion. Mooney and Scotton, describe equity in health care as “equal access for equal need’ (p.13 1999). The reason for this debate resides within the context of values within the society in which it is being attributed to. This leads to the concept of equity within the American model.
The American model produces the lack of want and or need by the majority of people to create equity. Equity is seen to be non existent within the American health care model and as noted by Leeder (2003), is admitted to by American health care service managers. The explanation for this lack of equity is due to the ideology of American people. This ideology resides in relation to independence, associated with monetary success. As the association between health insurance and employment is evident throughout the American system, Americans themselves feel it is the responsibility for each individual to look after them selves when it comes to health care (Leeder, 2003). By attaining well paid jobs and thereby access to quality insurance the American system achieves and promotes the self resilience valued by its society at large. The downside of this ideology is that there are in excess of 45 million Americans without any insurance whatsoever. All of these have a reduced access to health care services and in most cases a greater need, creating a definitive example of inequity (Mooney, 2003).
Equity within the Australian context of health care is of greater ideological value. The policies of “adequate care” as previously mentioned allow for all Australians no matter there level of income, social status or ethnicity to have a basic level of funding allocated to there health (Hsiao and Yip, 2000).The concept of equity is seen in Australian society to be of higher value as apposed to American society, with the societal desire for ‘a fair go’. Many of the developed nations, such as the United Kingdom, value equity in a similar approach to Australia with a greater support for the public sector of health rather than the private (Nelson, 2007).
In recent years though, the Australian government has altered its support of the public sector and pushed for the privatisation of health care to cope with problems regarding the current systems efficiency (Hall and Maynard, 2005). This change provoked much debate amongst Australians in conjunction with their values surrounding equity of health care.
Efficiency within health care has been described by Bolnick in four main interrelated sectors, these include; “Delivering services”, “creating resources”, “financing” and “stewardship” (2003 p.5). Delivering Services is an aspect of efficiency that is most evident within a health care system. The term refers to the ability for a system to provide services to its population, for example a health care system that delivers services efficiently would be one with low waiting lists that delivers a quality of resources. For services to be efficient they need a variety of resources to be allocated to them, which develops the need for appropriate financial allocations to these resources. For all of these factors to be successful the need to appreciate the views of the society they impact is necessary, this relates to the concept of stewardship (Bolnick, 2003).
Within the American system’s service delivery and resources are of high quality, waiting lists for services are low and their variants vast (Hsiao and Yip 2000; Oberlander, 2002; Leeder, 2003). This is one major benefit of the strongly privatised system in place. These aspects of efficiency are strongly recognised by the American people as previously noted by Leeder, creating quite an efficient model of care. The large downside evident in the efficiency of the American model is its allocation of finances. The United States as described by Oberlander, is the highest spender of money on services related to health (2002). This level of spending is greater than all of the other countries that in fact according to WHO are seen to achieve better health (Bolnick, 2003). This excess spending shows inefficiency through Mooney’s analysis, in the system through the out weight of costs in association to benefits achieved (1999).
Within the Australian system, service delivery, resources and finance are not so efficient. Waiting lists within the system are long making ability to provide resources difficult.
As mentioned the recent government has promoted the privatisation of health to encourage Australia’s efficiency to improve (Hall and Maynard, 2005). Due to the need to accept public values and incorporate stewardship the use of both the pubic and private avenues of funding are still evident within the countries health care system.
The last of the areas of health care to be covered is that of accessibility. As alluded to within discussions on equity, access to health care plays a major role in the systems effectiveness. The public model of care is the one that greatly promotes equality and in turn access. The socioeconomic status of individuals plays a major role in their access to health care therefore the application of a publically funded system is necessary to adhere to this populations needs (Hsiao and Yip, 2000). Countries that place a large amount of weight on the private sector of health tend to reduce the amount of access available to their people.
The private sector does contribute to the greater ability of higher income earners to receive greater access to health care at their own cost. This may hold great advantage for some but does not deliver the same ability to those of lower socioeconomic status due to their inability to afford health insurance premiums (Hsiao and Yip, 2000).
The American access to health care is lacking enormously, as access and equity have strong ties it proves another area of inadequacies. Not only do the people without employment of which don’t fit government subsidy criteria have little ability to purchase insurance but many of those who are employed find it difficult to attain insurance due to employer implications. Without health care of any sort the individual themselves is made to pay the complete fund of any of their medical bills without subsidy. Due to the expensive aspects of medical care this makes access near impossible for many Americans (Nelson, 2007).
The ethnic population are also at an accessible disadvantage, according to Nelson, (2007) creating a racially achieved gap in the access of the private system.
Under the Australian health care system access to health care is achievable for people of all socioeconomic background although this is limited. The greatest problems that occur under this system are the lack of access delivered to the indigenous population of the country (Leeder, 2003). The reasons for this are seen largely to be due to cultural factors as well as geographical restrictions, as white Australians in rural settings also but not to the same degree have less access to health than their metropolitan counterparts (Dwyer, 2005).
Through use of my observations and professional knowledge living in a society such as Australia is far more relevant due to my feelings in conjunction to the ethics and values considered within the health care system. A society that is content with trading efficiency for equity such as the United States of America is a society that has significant differences to my morals and beliefs hence the conclusion that the Australian variation of the mixed market, while in short supply of efficiency produces much more access and equity to its people verifying my observations of its superiority.
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