Health Care Essay

Question:

Write an essay on "performance in healthcare sector".

Answer:

Health improvement greatly depends on primary health care services. It is vital to have an adequate medical care services to enhance the overall health of the population. The comparison of health care management in two different countries might help identify the factors needed to boost up the role of the health care systems in these and other countries that are burdened with high mortality rate, low health status and other related issues.

The essay welcomes an opportunity to perform a comparative study on Australia and Canada, in reference to its performance in health care sector. The reason to choose these provinces is that these countries have played a key role in developing a new model in health care organisation. The author will perform a thorough literature search, to analyze several areas of health care such as the governance system, funding system, health indicators, and the performance in health system and the percentage of GDP spent on health. The essay will demonstrate the health care system of the two countries by discussing each of these parameters. The essay will end in conclusion based on the research findings of the study.

The leadership and management is the core of the governance in health sector. The rich mix of practitioners, clinicians, policy makers and politicians in health system deals with “life and death issues” with changing technology and elevating costs. These are the heart of the system which when put together raises governance problems which are sensitive than any other sector.

In Australia, both the government and the private based health organisations exist, which provide wide range of services worldwide (Eijkenaar et al., 2013). This province has six states and two territories. The country provides free medical treatment and financial assistance, since the introduction of “Medicare”, in 1984 (Walls et al., 2012). The universal taxation system funds most of these services (Bourke et al., 2012). Australia is a federated system with equal division of power between the state and central government in health care related matters (Mossialos et al., 2015). Australia is having a commonwealth government, to support the revenue for fiscal transfers and the heath care system, with the main authority being the government in raising the revenue (Papanicolas et al., 2013). The “five year health agreements” have consolidated improved the commonwealth powers.

The health care system in Australia is versatile with its equal distribution of its role and responsibilities in different states of the country (Oderkirk et al., 2013). There is a complex interplay of services in private and public organisation. In Australia, 52 % of the elderly population (above 65 years) possess health insurances, which are estimated to be 1.84 million. It also reflects the total number of population above 65 years old (Kassebaum et al., 2014). Therefore, it indicates the fact that Australia is prepared with effective health care services for older patients, increasing their health insurances (Schoen et al., 2012).

The early governance system in Australia is quite different. Then the local governments played a little role in health care provision. Postcolonial settlements changed the scenario when only subscription fees were the finance. Doctors worked in Canada and other states as entrepreneurs.

In Canada, there exist a public funded and a cost free health care system. Private institutions provide most of the medical services (Sch?fer et al., 2015). The quality assurance of the care delivered comes from the government through its federal standards (Sch?fer et al., 2015). There is no data collection on a daily basis pertaining to the individual’s health. The health administration maintains its simplicity by maintaining the provision of cost effective services based on the Medicare system (Nicholson et al., 2012). Out of the total health care associated finances, 30% accounts for the private health expenditure. Canada follows a “Single-payer healthcare system” (Janssen, 2013). In this system, the state does not pay the cost of the healthcare rather it is taken care by the private insurers. Public as a whole or in part financially supports the single-payer system (Walls et al., 2012). Overall provinces continue to dominate in Canada with new emerging model for taking national initiatives.

In Canada, there exists a federal based governance system (Sch?fer et al., 2015). Although one can expect the governance to have centralised characteristics, the actual scenario is somewhat opposite. The country’s provincial government system deals with formulating laws and regulations specifically for a region. On the other hand, the federal system governs the whole province (Foroughi et al., 2016). The governance system of Australia and Canada has evolved to be similar. The government rule in Australia mandates every individual to caste his or her vote in election, failure of which is punishable (Mossialos et al., 2015). There is a close resemblance in the government system of Australia and Canada pertaining to their “British parliamentary system” (Turner et al., 2013). The fact that reflects this resemblance is that both the provinces are under the membership of “British commonwealth” (Schoen et al., 2012).

The two countries are further compared to assess any differences present in the health indicators such as low birth weight, asthma, obesity, infant mortality rate, hypertension, maternal mortality rate, life expectancy at birth and cancer. The maternal mortality rate refers to number of deaths of pregnant women due to associated complications and termination of pregnancy per 1000,000, live births. It occurs within the period of 42 days (Sch?fer et al., 2015).

While studying the “global maternal death” it was found that in Australia, maternal mortality is found to occur rarely. The reports of (Papanicolas et al., 2013) showed that there were 102 maternal deaths in the time span of 2008-2012. This represents the ratio of 7.1 per 100,000 women who had successfully delivered babies (Oderkirk et al., 2013). These deaths lead to mental distress among other women. The maternal mortality rate in Canada was found to be 6.0 per 10,000 deliveries, taken into study the time span of 2008-2010 (Eijkenaar et al., 2013). Later, in the year 2010-2011 it was observed that majority of the deaths were due to cardiovascular diseases, mental disorders, neurological ad digestive problems (Walls et al., 2012).

Infant mortality rate was the next health indictor used to compare both the countries. It refers to number of deaths per 1000 live births occurring before an infant completes one year (Janssen, 2013). According to the reports of (Kassebaum et al., 2014) in 2012, around 1034 infant death cases were registered in Australia. It was decrease by the percentage of 8.8 found in year 2010. There is a significant improvement in the infant death rate. There was a mild fluctuation observed since the year 2002, that reported 1270 deaths, which is reduced to 1044 in the year 2012 (Mossialos et al., 2015). In Canada, in 2008 the number of infant deaths, before the age of one was recorded to be 4.9 per 1000 live births. Canada ranks second in the world in terms of “infant mortality rate” (Eijkenaar et al., 2013).

(Source: The other indicator for describing the health condition of the population is Life Expectancy at Birth. It indicates the mortality rate of the population (Marchildon, 2013). It determines the life span of the individual as per their age and specific rate of death. This parameter has improved for the public in Australia. According to this method, a man born in 2011-2013 would survive for 82 years, whereas a female would survive for 86 years. These number changes to 45.6 and 49.1 years if they are born in 1882-1890 (Janssen, 2013). On contrary, a male born in Canada in 2013, would survive for 83 years and females for 86 years. For both the genders, the life expectancy at birth seems to be augmented from 74 to 80 in the year 1990 to 2012 (Kassebaum et al., 2014). In Australia, the life expectancy decreases with increasing remoteness. Therefore, in indigenous population, the Torres Strait Islanders experienced worse health than any other communities did (Walls et al., 2012). The aboriginals in Canada are in much better position than aboriginals in Australian.
Figure: Life Expectancy at Birth in Austarlia

Health status refers to the state of physical and mental well being. As per (Marchildon, 2013) Australia is recognised to be “one of the healthiest countries” in the world. The rate of diseases and associated death occurs rarely in this country (Lecours & B?land, 2013). In comparison to Canada, it has low mortality rate. It further augmented the rate of morbidity. Canada receives a “B grade”, with respect to its overall health performance (Turner et al., 2013). As per the reports of (Marchildon, 2013) Canada stands third in terms of mortality rate. The number of deaths is mainly associated with diabetes and its incidence rate is found to increase (Eijkenaar et al., 2013). Therefore, it has turn out to be a major health concern for the administrators, stakeholders and policy makers. Canada receives “A grade” in the category of “premature mortality, mortality due to circulatory diseases and self-reported health” (Kassebaum et al., 2014). It receives “B grade” in the category of “mortality due to respiratory diseases, life expectancy, mortality due to medical accidents and mortality due to mental disorders” (Janssen, 2013).Australia has 5% births resulting in “infants with low weight” at birth. There were, 17,654 infants born with low weight, which is a percentage of 6.12 (Osborn & Squires, 2012). As a result of indigenous population, in Australia, there were 3950 babies born with low weight during the period of 2000-2002. However, in Canada the babies born with low weight constitutes 5.3%. This data was constant during the period of 1980-2010 (Deber, 2014).Since last three decades, there is a growing incidence of “obesity and associated complications” in Australia (Foroughi et al., 2016). During the time of 2010-2011, 64% of the adult population in Australia were recognised with obesity. In the year 2009, 24% of the children in the age range 3-15 were identified to be obese and overweight (Lecours & B?land, 2013). As per the data records of “Organization for Economic Co-operation and Development” (OECD), in the year 2010, the rate of obesity might increase by 67% in coming years for all the age groups (Mossialos et al., 2015). Whereas, in Canada, the study by Deber, (2014) show that “one in four adults and one in 10 children” suffer from obesity. This accounts for total population of six million. Therefore, it implies for serious health management programs for combating weight gain issues. Canada is in 33rd position in terms of having overweight citizens (Smith et al., 2012). The percentage of the citizens having body mass of 25 in Canada comprises of 60.2% (Nicholson et al., 2012). This percentage has increased since 2006 in children, where the frequency in males was found to be 4-15% and the percentage increase in females showed 3-14% (Smith et al., 2012).As per the statistical data collected by “Australian Health Survey”, in the year 2010-2011, the Australian adults diagnosed with diabetes were reported to be 9,22,000 (Kassebaum et al., 2014). These individuals were mainly comprised of age above 20 years. Both type I and type II diabetes is prevalent in this population group. Only 3% of the total population in Australia showed no diabetes and some were unaware of the prevailing condition. 6% of the population reported of their diabetes (Osborn & Squires, 2012). The condition in Canada is slightly different. Majority of the patients with diabetes has difficulty in adhering to their medication due to high cost of treatment (Tchouaket et al., 2012). According to the survey conducted by “Canadian Diabetes Association”, 36% of the patients suffering from diabetes resist from revealing their condition due to social stigma and inferiority complex (Marchildon, 2013).

Asthma is the common health issues in Australia with one tenth of individual effect by it. It is commonly found in males and females of age 15 and above (Sussman et al., 2012). The incidence rate of asthma is high in indigenous group in comparison to non-indigenous Australians (Tchouaket et al., 2012). It mainly effects and prominent in the elderly people in remote areas and those with low socioeconomic status and poor living conditions (Turner et al., 2013). A thorough literature research shows that the prevalence of diabetes has increased in Canada since the last two decades (Smith et al., 2012). Although there is a serious effort to ameliorate this issue, one death per two days is observed. The report of hypertension may not be accurate as it was observed in the case of diabetes; Canadians do not self-report about their health issues, although simple remedies can easily cure hypertension. These categories of people constitute around 5% of the total Canadians (Nicholson et al., 2012).There is a growing concern in Australia, due to increase in cancer cases. In the year 2012, the total number of cancer cases registered was found to be 124,153. The male patients (69,030) were more in number than females (55,123). In 2013, there were 467 cases reported out of every one-lakh individuals for “age- standardized occurrence rate”. It is estimated that the incidences of cancer will be rising by next decade (Lecours & B?land, 2013). The situation is almost same in Canada. The rate of cancer is increasing at an alarming rate. In Canada, there is an increase in “three-year occurrence ratio” with yearly rate of 3.2% from 1998-2009 and 3.4% that of the “five year occurrence ratio”, whereas the ten year occurrence ratio was found to be 3.8% ((Nicholson et al., 2012).
Figure: Global cancer rates
Australian Government along with the state and territory government has taken initiative for “performance measurement” (Walls et al., 2012). It requires assessing through the health indicators. This step enables that the quality and safety of the health services are improved (Lecours & B?land, 2013). Thus, it will help identify any changes that need to be implemented in filling the gap. It requires significant contribution from administrators, taxpayers, stakeholders, health care providers and other contributors. In Australia, some nationally acclaimed bodies function to measure the diverse components of the organisation (Smith et al., 2012).The major concern in Canada remains to be diabetes, which is leading towards the “third highest rate of mortality” (Tchouaket et al., 2012). Canada is graded B for its health performance. Canada stands third in the terms of mortality rate. The number of deaths is mainly associated with diabetes and its incidence rate is found to increase (Eijkenaar et al., 2013). Therefore, it has turn out to be a major health concern for the administrators, stakeholders and policy makers. Canada receives “A grade” in the category of “premature mortality, mortality due to circulatory diseases and self-reported health” (Kassebaum et al., 2014). It receives “B grade” in the category of “mortality due to respiratory diseases, life expectancy, mortality due to medical accidents and mortality due to mental disorders” (Janssen, 2013). Australia’s health expenditure measured as the percentage of GDP in 2010 was observed to be lesser than Canada (Smith et al., 2012). In the year 2011-2012, hospitals were the leading cause of the health expenditure. Hospitals comprise to be 97% of the total area in health expenditure with other being miscellaneous purposes such as new buildings. 20% of the health expenditure constitutes of the medical services. This includes services in acute care facilities, primary health facilities and that provided by general practitioners (Lecours & B?land, 2013). Drugs and other chemicals comprises of 14%, dental services constitutes to be of 7% (Sussman et al., 2012). On the contrary, the health expenditure in Canada, in 2013 was calculated to be 11.8% of the total gross domestic product (Brown et al., 2014). It is observed to be 1.6% above than the average set by the OECD, which is 9.5% (Foroughi et al., 2016). Compared to Australia, Canada has a lesser health expenditure. In all most all of the OECD countries, public institutions mainly provide the funding (Deber, 2014). Two countries that are exceptional to these funding includes United States and Chile (Fineberg et al., 2012). In Canada the public source, financing contributes to 75% of the health expenditure as reported in 2012. Here it is less than the average of 74% set by the OECD (Eijkenaar et al., 2013).

In conclusion, it can be said that the comparative study related to the health care system in Australia and Canada, has clearly highlighted the governance system, funding system and the overall performance in health system. The essay has clearly discussed the health indicators such as mortality rate, health status, and life expectancy at birth, the prevalence of obesity, asthma, hypertension, diabetes, and cancer. The essay also provides the percentage of GDP expended on health. There is a high similarity between both the chosen countries. Both Australia and Canada were found to have efficient, safe and effective health care services. In both the countries the main objective of regionalisation was to accomplish greater accuracy and efficiency in consumption of health care resources and decrease the cost of escalation. The issue of governance involving the public participation in decision system is paid less attention in Australia. The public opinion is different from the decision of more state involvement in health operations. It can be said based on the literature review that Compared to Canadians the Australians are more apathetic in regards to reformation of public institutions and structures.

However, they both lack behind when compared with other countries in terms of their advancement in health sector. Both these provinces must enhance their medical care services, as health is the foundation of healthy nation. Australia ranks higher than Canada in all of the indicators but is lower than Germany and U.S. In Australia, the life expectancy decreases with increasing remoteness. Therefore, in indigenous population, the Torres Strait Islanders experienced worse health than any other communities did (Walls et al., 2012). The aboriginals in Canada were in much better position than aboriginals in Australian. Australia must overcome its health service discrimination between the Indigenous and non-indigenous Australians.

In Canada, the “patient first approach” should be more focused on rather than on different governing structures. Both the above countries have underwent several health reforms since last two days, there still remains a challenge in rising costs and workforce related to health care. These issues need to be paid more attention.

Overall, it was an interesting area to work on. This comparative study has given a clear concept on the healthcare management of Australia and Canada and there scenarios in past and present. The literature review was interesting as it gave a deep insight of the subject.

References

Bourke, L., Humphreys, J. S., Wakerman, J., & Taylor, J. (2012). Understanding rural and remote health: a framework for analysis in Australia.Health & Place, 18(3), 496-503.

Brown, S., Castelli, M., Hunter, D. J., Erskine, J., Vedsted, P., Foot, C., & Rubin, G. (2014). How might healthcare systems influence speed of cancer diagnosis: A narrative review. Social Science & Medicine, 116, 56-63.

Deber, R. B. (2014). Thinking about accountability. Healthcare policy= Politiques de sante, 10(Spec issue), 12-24.

Eijkenaar, F., Emmert, M., Scheppach, M., & Sch?ffski, O. (2013). Effects of pay for performance in health care: a systematic review of systematic reviews. Health.

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