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Power,politics, and healthcare
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- 4. Overview What isthe nature of Health Policy of Australia? What are the major health interest groups, and what influence do they have? What role does politics, power, and ideology play in shaping the health system?
- 5. This chapterprovides an analysis of the nature of Australia’s health policy. The financing and organisation of Australian health policy are products of a clash between the ideologies of compulsion and freedom of choice. Ideological differences between the major political parties remain the principle reason for the frequent changes in policy direction.
- 6. These arethe result of competing beliefs over the role of the state, the individual, the community, and the market. The major players are politicians and doctors, with hospitals and the insurance industry playing supporting roles. The chapter examines toe role of politicians and doctors with reference to the impact of ideology, politics, power, and structural interests on health insurance arrangements.
- 7. Australian Health CareSystem Australian Health Care system are its federal structure and a public/private division of responsibilities. These two characteristics provide a backdrop for the organisation of Australian health care system.
- 8. Federal Structure In1901 six Australian colonies accepted the need for a national and central authority. They agreed to the passing of an Act for the establishment of the Commonwealth of Australia known as the Commonwealth of Australia Constitution of Act As a consequence the people of New South Wales, Victoria, South Australia, Queensland, Tasmania, and Western Australia were united in a federal Commonwealth under the name of the Commonwealth of Australia
- 9. The Constitutionof Australia divided responsibilities between the Commonwealth government and the state governments The national parliament was given the power to legislate ‘for the pace, order, and good government of the Commonwealth’ in regard to the forty subjects named in Section 51 of the constitution. There were also concurrent powers on which both the national and the State governments had the authority to pass law, but in the event of a conflict between the two, the nation legislation would prevail.
- 10. The nationalgovernment was granted some powers exclusively, including customs and excise, defense, currency, external affairs and territories. Some areas of potential legislative activity were prohibited to both national and State governments… All other power remained with the states (Jeansch 1988,p.30).
- 11. Shared responsibilities Theresponsibility for the organisation and delivery of health services is shared between the three tries of government (Richardson, 1998, pp. 192-213) The federal government has a leadership role in policy making, particularly in national issues like public health, and national information management (McGuiness 1999) It funds most hospitals medical services expenditure (AIHW 2000, p.404).
- 12. The universal,public health scheme known as Medicare is a Commonwealth responsibility. It provides for: Access to free treatment in public hospitals, including Medical treatment—as ‘hospital’ in-patients or out- patients, through agreements between the federal and State or Territory governments, which compensate for loss of income as a result of the free, public hospitalization of those electing to be treated as ‘public hospital’ patients (Grant & Lapsley 1993)
- 13. Universal insuranceagainst the cost of private medical services. (Deeble 1991).
- 14. Public/private division of responsibilities There is a clear public/ private split in the organisation and financing of health care. In 1997-98 private sources accounted for 31.4% of total health expenditure In contrast to expenditure of 23.4% from the States and local governments
- 15. 42.5% fromthe federal government Expendetures State and local Private Commonwealth
- 16. Health Insurance Thepurpose of insurance is to provide protection against loss. This involves ;a contract whereby, for a stipulated consideration, called premium, one party to identify or guarantee another against loss by a certain specified contingency or peril, called a risk, the contract being set forth in a document called a policy’ ( Titmuss 1974, p.90).
- 17. The purposeof health insurance, be it private, is to provide protection against the financial loss of unpredictable health care costs. It does this by eliminating or reducing out of-pocket expenses through the pooling of costs. It generally incorporates a redistributive element in the form of cross subsidization of the sicker and poorer members of society by the healthier and wealthier members. This is known as ‘community rating’ (Scotton & Macdonald 1993)
- 18. There arevarious health insurance models, and those range across two continuums: selective–universal coverage and public private provision. Seletive coverage istargeted usually by means testing, so that only those considered unable to provide for themselves recieve benifits and/or services. Universal coverage seeks to provide benifits and or services for the whole population. Public provision is largely defined as provision of goods and services by the state.
- 19. Private provisiongenerally refers to good services that are provided in the market, and is dependent on the efforts of individuals, families, and communities for thier on need. Selective coverage assumes that thr majority of the population will be responsible for their own health care needs and hence favours private health insurance. Universal coverage assumes collective responsibility and is usually financed through taxtaion.
- 20. Public financingof health insurance is likely to be more equitable, as ability to pay is taken into consideration, with payments or contribution being calulated as a proportio of income for example, the medical levy is calculated on the basis of 1.5% taxable income. Private financing, however is likely to result in the sicker and poorer members of society bearing increased health cost. Threy are also likely to face increasing difficulty in meeting those costs because of their poor health status.
- 21. The adoptionof community rating seeks to address these problems.
- 22. International comparison TheAustralian health care system can be best described as ‘mixed’. The financing, organisation, and delivery to health services are drawn from combination of public an private sources. Services are largely delivered by private practioners in public institutions on a fee-for-service basis.
- 23. In theUnited States the Health care System is private The Federation insurance programme Medicare provide financial assitance to the disabled and elders while Medicade provide financial assitance to the poors.
- 24. Power,Politics, and HealthCare In Australia there are to major political parties ALP (Australian Labour Party) and then a collaition of the parties. With the ups and down in the political senario of Australia their is a variation in the healthcare policy of Australia Labours supports ALP While Doctors and Insurance, Pharmaceutical Companies the coilaton.
- 25. Healthcare System inPakistan In the article 38 subclose (d) of the constitution of 1973 it is written that, “to provide basic necessities of life, such as food, clothing, housing, education and medical relief, for all such citizens, irrespective of sex, caste, creed or race, as are permanently or temporarily unable to earn their livelihood on account of infirmity, sickness or unemployment is the responsibility of the state.
- 26. Healthcare System: Organization TERTIARY FACILITIES SECONDARYCARE: Tertiary health quarters, District health quarters PRIMARY CARE: first level healthcare facilities e.g. basic health units, rural health units, dispensaries
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- 28. Health insurance inPakistan The people in Pakistan are provided acidential death insurance of Rs 1,00,000/= for 2 years. Further the government provide free health facilities to its populace espacially poors on her expenses in public hospital Where as the private insurance companies also provide health insurance via policy the agreement that in case of accident or death they will provide a fix amount.
- 29. Power,Politics,and Healthcare Beforethe 18th ammendment the health was federal subject. After its passing from the NA and senate of Pakistan it became provincial subject. While federation and the Governement each decide the budget to be spended in the healthcare sector. They also recuit the mangerial staff and invest for research on diffrent diseases such as, dengue. The also licence the Pharmaceutical companies and ensure its quality. They also decide the price of a medicine to be launced in the market to be in the limit of populce
- 30. Conclusion Healthcare systemhas a great importance in the development of a country. If the populace will be healthu they can work day in day out to pave ways for the progress of the country. For this the goverment has to increase the allocation in the sector of health from 5% gradually to 25% Govt has to ensure the quality reserch facilities at terciary hospitals of Pakistan.