The Australian Healthcare System

by Duckett, Stephen; Willcox, Sharon

• ISBN13: 9780195574647
• ISBN10: 0195574648
• Edition: 4th
• Format: Paperback
• Copyright: 2011-11-10
• Publisher: Oxford University Press

Summary

The Australian Health Care System 4e, provides students with a fully updated, comprehensive and forward looking overview of the structure and operation of health systems and services in Australia. It adopts a systems approach to analyse how the inputs of Australian health services, such as finances, the health workforce, and the roles of state and federal government - influence the outputs and outcomes, which range from consumer confidence to policy changes.Written with an emphasis on policy and economic issues, the book provides an extensive overview of the interactions between consumers and providers of health care in Australia. This fourth edition includes expanded coverage of Primary Care, Specialist Health Services, Aged Care and Disability Services and increased pedagogy, such as case studies of sections of the health care system.

Author Biography

Stephen Duckett is Professor of Health Policy at La Trobe University. Sharon Willcox is the Director of Health Policy Solutions and Adjunct Associate Professor in the Department of Epidemiology and Preventive Medicine at Monash University.

Table of Contents

List of figures	p. ix
List of tables	p. xi
Abbreviations	p. xii
Acknowledgments	p. xiv
Introduction	p. xv
Frameworks for Analysis	p. 1
A systems perspective on health	p. 2
Inputs	p. 2
Outputs and outcomes	p. 2
The socio-political environment	p. 4
Evaluating the Australian health system	p. 5
Equity	p. 5
Quality	p. 6
Efficiency	p. 6
Acceptability	p. 7
Choices in health system design	p. 7
'Need'	p. 8
The distribution of benefits	p. 9
Design parameters for health systems	p. 10
Purchasing versus providing	p. 12
The Australian Population and its Health	p. 17
Measuring health	p. 18
Health status in the Australian community	p. 19
Self-reported health status	p. 19
Mortality	p. 21
Causes of death	p. 214
Burden of disease	p. 27
Health expectancies	p. 29
Equity and ill health	p. 31
Health of Indigenous Australians	p. 33
Health care and health status	p. 35
Financing Health Care	p. 41
The role of governments and markets in health expenditure	p. 43
Policy debates on health expenditure	p. 45
Measuring health expenditure	p. 46
Funds flow	p. 47
Health expenditure trends	p. 52
Medicare	p. 54
Medicare arrangements for hospital services	p. 54
Medicare arrangements for medical services	p. 57
Medicare support for other health professions	p. 58
Constraining expenditure under the Medicare Benefits Schedule	p. 59
Health insurance	p. 61
Structure and regulation of the health insurance industry	p. 64
International comparisons of health expenditure	p. 66
International studies on ageing and health expenditure	p. 68
How should health expenditure be controlled?	p. 72
The Health Workforce	p. 76
Profiling the health workforce	p. 77
Registration and regulation	p. 80
Preparation of health professionals	p. 81
Models of provider payment	p. 83
Issues in health workforce supply and demand	p. 85
Balancing supply and demand	p. 86
Influencing workforce supply	p. 89
Options for addressing a workforce imbalance	p. 94
Emerging workforce challenges	p. 95
The challenge of improving productivity	p. 96
Full scope of practice	p. 97
Medical workforce issues	p. 100
The need for change	p. 102
Governance, Accountability and Reform	p. 106
Federalism in Australia	p. 107
The Australian Constitution and governments' responsibility for health services	p. 108
Financial power and intergovernmental relations	p. 109
Power, bargaining and coordination under federalism	p. 111
The scope and organisation of government departments	p. 114
Departmental scope	p. 115
Departmental structures	p. 116
Accountability through consumer participation	p. 118
Historical development of Australian consumer participation in health	p. 119
Consumer advocacy and representation	p. 121
Improving the experience of health service consumers	p. 121
Mechanisms for reforming the health system	p. 123
Reform through intergovernmental mechanisms	p. 123
Reform through public inquiries	p. 124
Models for implementing health reform	p. 125
Public Health	p. 129
History and concepts of public health	p. 130
Selected public health developments in Australia	p. 131
Frameworks for thinking about public health	p. 132
Governance, infrastructure and expenditure on public health	p. 135
Public health funding	p. 136
Creating a safer environment	p. 138
Air quality	p. 140
Water quality	p. 140
Food safety	p. 141
Occupational health and safety	p. 142
Reducing risks of transmission	p. 143
Identifying disease early	p. 146
Health promotion-healthy behaviour and healthier environments	p. 148
Health promotion: Individual versus environmental approaches	p. 148
Issues and future reform directions	p. 155
Primary Health Care Services	p. 158
Scope and profile of primary health care services	p. 160
Spending on primary health care services	p. 161
General practice	p. 162
Primary health care management in general practice	p. 163
General practice and the Medicare Benefits Schedule	p. 165
Reforming the funding of general practice	p. 166
Accessibility of GP services for patients	p. 168
Community health services	p. 169
Community nursing	p. 170
Health call centres	p. 172
Dental and allied health services	p. 173
Dental services	p. 174
Allied health services	p. 175
The role of primary health care services in tackling chronic disease	p. 177
The Chronic Care Model	p. 178
Australian efforts at improving care coordination	p. 178
Evaluation and contemporary policy issues	p. 180
Future reform directions	p. 182
Hospitals	p. 185
Overview of Australian hospital services	p. 187
Hospital capacity, utilisation and access	p. 188
Hospital capacity	p. 188
Hospital utilisation	p. 189
Access to public hospital services	p. 199
Hospital costs, efficiency and payment models	p. 203
Paying for hospital services	p. 203
Public hospital operating costs	p. 208
Comparison of efficiency of public and private hospitals	p. 210
Safety and quality of hospital care	p. 211
Measuring hospital safety and quality	p. 211
Strategies to improve hospital safety and quality	p. 213
Governance and operation of hospitals	p. 216
Hospital organisation and management structures	p. 220
Evaluation and contemporary policy issues	p. 221
Future reform directions	p. 222
Specialised Health Services	p. 225
Mental health services	p. 227
The unrecognised magnitude of mental health disorders	p. 227
Mental health service provision	p. 228
Reform directions for mental health services	p. 230
Sub-acute services	p. 232
Organisation and utilisation of sub-acute services	p. 233
Recent developments in sub-acute services	p. 238
Alcohol and drug services	p. 239
Prevalence, morbidity and mortality	p. 240
Service and policy response	p. 241
Palliative care services	p. 242
Provision of palliative care services	p. 242
Issues with palliative care services and end of Life care	p. 243
Evaluation and contemporary policy issues	p. 244
Pharmaceuticals	p. 247
NationaL Medicines Policy	p. 248
Assuring quality, safety, and efficacy: Regulatory control	p. 249
Timely and affordable access: The Pharmaceutical Benefits Scheme	p. 250
A viable medicines industry	p. 256
Quality use of medicines	p. 258
Trends in PBS utilisation and spending	p. 259
Supply arrangements and the pharmacy workforce	p. 260
Evaluation and contemporary policy issues	p. 264
Future reform directions	p. 265
Aged Care and Disability Services	p. 269
Evolution of aged care and disability services	p. 271
Role of government	p. 271
Relationship between aged care and disability services	p. 272
Organisation of aged care and disability services	p. 274
Community care for the aged and disabled	p. 275
Specialist services for people with a disability	p. 278
Specialist community care for older people	p. 284
Residential aged care	p. 285
Regulating the supply and quality of aged care services	p. 289
The role of informal care	p. 292
Evaluation and contemporary policy issues	p. 294
Future reform directions	p. 295
Policy Challenges for the Australian Health Care System	p. 299
Equity	p. 300
Equity of access	p. 300
Equity of outcomes	p. 302
Quality	p. 303
Efficiency	p. 304
Allocative efficiency	p. 304
Dynamic efficiency	p. 306
Acceptability	p. 307
Patient and community acceptability	p. 307
Provider acceptability	p. 308
The future of the health care system	p. 308
An ideal system?	p. 312
Emphases in the ideal health system	p. 314
Can we get there from here?	p. 315
Conclusion	p. 316
Appendices	p. 318
Funding flows for hospital and medical services, Australia	p. 318
Evolution of Medicare/Health insurance arrangements	p. 319
Bibliography	p. 323
Index	p. 379
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