The key principle underlying Australian healthcare system is equity to universal access to most health care regardless of the situation or ability to pay. This is achieved since revenue for this healthcare comes from taxation. Health services are funded through Medicare and pharmaceuticals schemes which are highly subsidized by the government while public hospitals and public healthcare are partly funded by commonwealth and state funding agreements. The schemes are founded on the spirit to make public health accessible by all the citizens irrespective of their financial ability (Healy & Hilless, 2001). The purpose of this paper is to expound on the concepts of equity of access of healthcare in relation to effectiveness and efficiency and the relationships that exists among these concepts.
Equity of access
Equity is all about ensuring that all people have the support that they need to access, participate and achieve the same level. Access and equity are two concepts that go hand in hand they imply removing barriers and opening up opportunities. In the field of health these concepts mean that people with differing needs and abilities have the same opportunities to be attended to professionally by the medical practioners whether private or public at any time irrespective of their age, disability, color, race, gender, religion, sexuality, or location. It means addressing the healthcare need of everyone (Department of education and equity standards branch, 2003).
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The Australian government through its insurance schemes have tried to make healthcare accessible to all, however, it has been found that compressive insurance coverage is not always sufficient to ensure equitable access to health services since other factors such as shortages or mal-distribution of health services providers or constraints presented by language or cultural differences limit access to medically necessary care for apportion of the population (Docteur, 2004). In fact there is a wide agreement that rural and remote Australian communities are underserved by appropriately trained health professionals compared to those who live in the urban areas. Further, most remote Districts of Australia communities are unable to attract medical practioners and they are dependent upon rural remote area nurses to provide their healthcare. The shortage of rural registered nurses also impacts negatively on health care delivery. Despite these short comings, Australian population enjoys good health relative to other countries with an increasing life expectancy of an average of 78 years and low incidences of life threatening infectious diseases. Although the spirit of the government healthcare policy to provide equity and access to healthcare has not been fully achieved, this policy has contributed greatly to the health status of its citizens. For instance over 85% of the people consider themselves to have excellent health status. In order to achieve the equity of access to health care itââ‚¬â„¢s important that distribution of the health officers be checked and implements tele health services that will ensure that those Australians in remote areas have access to relevant healthcare (Jackson et al., 2009).
There is no unanimity on how the concept of effectiveness can be defined, as a result of this there is inconsistency among scholars in their definition of the concept for instance. Some scholars view effectiveness as the degree by which organization achieves their goals, while others view it as the survival of the organization (Sudan & Chand, 2004; Stephen, 2008). Other feels that effectiveness is present as long as an organization uses its resources efficiently and continues to contribute to the large system. Despite the inconsistencies, scholars have agreed on some points that may be applicable in measuring effectiveness. For instance how well has expectations of the society been met as per societal regulations and rules, the time dimension of how the system meets its goals in near future. Intermediate or in distant future and the decline or growth of the system can also be an indicator of effectiveness (Sudan & Chad, 2004).
Increasing the effectiveness of health care systems in Australia is growing priority for policy makers. The notion of effectiveness encompasses a broad and growing number of dimensions, reflecting increasing expectations in Australia in such away that health system must do more than just improve population health and reduce disability. The effectiveness of the access of health care by rural and remote communities in Australia has been enabled by the outreach models initiated; these are periodic supplies of the services from one location especially in towns to other location in this case remote areas. Other problems associated with heath care system especially in secondary and tertiary services such as surgery are not available to the people for instance Kimberley region has higher mortality rates than in the state level due to lack of access of specialist services like surgery which takes to long to be availed. The state rural community lacks enough medical personnel which mean that access to healthcare is also a problem. Compared to major towns like Melbourne, Kimberly the Australiaââ‚¬â„¢s most northern region with the highest proportion of aboriginal people always have a shortage of not lees than 20 medical doctors (OECD, 2002).
Measuring efficiency in healthcare is concerned with comparison of inputs with outputs or outcomes of the health care system to access the degree to which goals are achieved while minimizing resource usage. From economic perspective, efficiency put two elements into consideration that is allocative efficiency and dynamic efficiency.Allocative efficiency is aimed at allocation of resources so that the input invested in heath care system yield the best output. To achieve this technical efficiency, effectiveness and priority setting must be addressed. Effectiveness is aimed at maximizing outputs to a limited amount of inputs. Priority setting involves deciding amount of resources to be allocated in each and every disease while technical efficiency is achieved by ensuring that the staff serves to their full potential. Efficiency can also be measured in three levels i.e. the disease, subsector and system level. The disease level focuses on each disease on the gains in heath status brought by healthcare system, while the subsector level focuses on gains brought specifically by hospitals, outpatient care and pharmaceuticals and the system level relies on the holistic view of the system (OECD, 2010).
Large hospitals and multi general practioners practice and specialist medical centers are most common in urban Australia and rare in rural Australia and services that look similar are actually structured differently. These healthcares deliver different services and cater for different populations. Rural residents are not equal participants in the primary health system since there are few general practioners in rural areas, they also make few visits in healthcare centers and they spend much to seek health care than their urban counterparts this means that the Medicare scheme of the government is not efficient in providing equity of access of health care to all citizens. The cost of time, transport and greater competition for services in regional centers contributes to lower utilization rates of those in smaller isolated communities (Luck, 2011). In addition the experienced pre-exist nurses in rural area can be up-skilled to serve a broader range of primary health care hence reducing the burden of the general practitioners rather than trying to fill every vacancy of general practitioner. The nurses serve by complementing the work of medical practitioner.
A properly functioning health system can be evaluated in terms of equity of access, efficiency and effectiveness of all the components of the system. Although there are a number of challenges in these dimensions, Australian health care system has strengths which manifests that the government has made efforts to maintain the proper functioning of the system in recognition that all these aspects are necessary and inseparable in a good health system. Efficiency, effectiveness and equity of access concepts are thus interrelated and their matrix is important when formulating policies of a system.
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Healthcare has remained a focal point for discussion throughout the history. However with entitlement spending dramatically increasing, poised for further increases, healthcare has been placed at the fore front of public policy. Globally very few countries have achieved an efficient and equitable healthcare industry. Australia serves as an excellent example in their health care policy because its system balances for equity of access and efficiency through the adoption of the free market policies in health provision as well as the base safety net for individuals who cannot afford free market rates hence making sure that the biggest population can be able to access the health services.
According to Duckett (2008) efficiency compare outputs to inputs in this case, the number of health care staff to the number of people seeking health care services putting in to consideration the satisfaction the patients. Itââ‚¬â„¢s possible to estimate the number of health staff required to attend patients satisfactorily in every region if efficiency ratios are known. In the efforts to achieve efficiency and effectiveness of the medical staff the policies of the government ensures that the citizens can access adequate and qualified medical personnel equitably. For instance in rural Australia there is an average of one medical doctor in a population of one thousand people. This is in contrast with the urban settings where the number of medical doctors is higher in the same population. While doctors in rural area may be efficient due to high number of patients they attend to access to them by citizens is limited hence contributing to the in effectiveness of the system due to citizensââ‚¬â„¢ dissatisfaction.
Australia government and private sector has invested heavily in construction of health facilities in all regions so that citizens can access them easily and equitably. For instance it had 1051 acute care hospitals of which 734 were public hospitals providing 70% of the bed stock and 317 were private hospitals. Public hospitals are funded by the government or by charitable organizations while private hospitals are privately funded (Healy, 2001). Due to large number of public hospital with many facilities and resources they at times underutilized hence operating inefficiently. To ensure that efficiency is achieved public hospitals liaise with private hospitals to provide private services that are not available in private hospitals. This way efficiency is achieved and at the same time the satisfaction of the citizens by the kind of collaboration that exist between private and public hospitals indicates that the hospitals are effective in accordance with social rules and regulations. Efficiency of hospitals has also been achieved through the policy of regional hospitals constructed in regional centers especially to cater for rural population. The regional hospitals also help the citizens to access specialist health care with ease. All this efforts contributes to the success of the health system in the spirit on universal access to health care (Duckett, 2008).
For the societal satisfaction with the health care system the founding principles of the Australian health care system must work hand in hand. Effectiveness, efficiency and equity of access principles should be demonstrable in a perfect system. Although perfection cannot be achieved the governments through its insurance policies have tried to make accessibility a reality. In addition to accessibility the efficiency of the health workers has been tried to be achieved through encouraging the general practitioners to work in the remote areas where there is shortage of practitioners this is done through incentives, perks and allowances offered to those who practice in rural areas in addition to this tele health care services are adopted such that health care services are moved closer to the people from the urban areas where it concentrated these practices are done periodically.
The underlying principle in Australian healthcare system is equity to universal access to most health care regardless of the situation or ability to pay. This is achieved since most health care system get revenue from taxation thus promoting equity of access of the health system. The concept of equity of access in relation to effectiveness and efficiency is also explored in Australian heath care system (Healy, 2001). In this case efficiency is measured by degree to which goals are achieved in health care system while minimizing resource usage while effectiveness is measured by degree to which health care system achieve their goals. Large hospitals and multi general practitioners practice and specialist medical centers are most common in urban Australia and rare in rural Australia. This indicates that the Medicare scheme of the government is not efficient and effective in providing equity of access of health care to all citizens.
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