Health Systems

Answer

Weekly Discussions

Module 1: Discussion Topic 1: Health Systems

             Some of the current problems with Australian health system encompass ineffectiveness, lack of equity of access, and ineffectiveness. Equity entails ensuring that everyone gets the support they require to access, participate and attain the similar level. The government of Australia through its insurance schemes have tried making healthcare accessible to everyone but it has been detected that comprehensive insurance cover is inadequate to ensure equitable access to healthcare because other issues including shortages of healthcare practitioners, as well as, barriers brought by the cultural and language differences limit access to required healthcare for a particular population of the society. Reports have indicated that remote and rural Australian societies are underserved by well-trained healthcare practitioners as compared to the communities staying in urban areas. In addition, remote areas within the country are incapable of attracting competent healthcare professionals and have relied on local nurses to offer their healthcare.

            Improving the effectiveness of health care systems has remained a major challenge for Australian health system. The concept of effectiveness entails myriad of dimensions, increasing reducing disability and improving population health. Reports have shown that other challenges linked with healthcare system, particularly in tertiary and secondary services such as surgery are unavailable to people in certain regions such as Kimberly and this has led to increased mortality rates as compared to other states because of lack of access to quality services including surgery that takes longer time to be provided. Moreover, these regions also lack adequate well trained medical practitioners, implying that there healthcare cannot be accessed with ease.

            In healthcare, efficiency is concerned with comparing inputs with outcomes of the healthcare systems to evaluate the level to which objectives are being realized while reducing the utilization of resources.  A survey conducted by Willis, Best, Riley, Herbert, Millar and Howland (2014) has revealed that large healthcare facilities and general, specialist medical centres and general practitioners practice are often common in Australian towns and few in rural areas of the country and that services that appear similar are indeed structured differently. Intuitively, the stated healthcare facilities provide services to different population. Moreover, individuals staying in remote and rural areas do not participate equally in the primary health system since few general healthcare providers are available in those areas. Moreover, the local residents hardly visit healthcare facilities and spend few coins to healthcare as compared to their counterparts in towns. Essentially, this implies that the Medicare scheme that the Australian government provides is not efficient in offering equitable access to healthcare for all residents of the country. Moreover, the cost of transport, time and stiff competition for services experienced in regional healthcare facilities contribute to reduced utilization rates of persons staying in isolated communities.

            In conclusion, the problems of inefficiencies, ineffectiveness, and lack of equity access experienced in the Australian health system have many relationships to the reading concepts such as building blocks of a health system. The building blocks of a healthcare system encompasses healthcare providers, financiers, government among others. These individuals must ensure that the underlying principles of healthcare particularly efficiency, effectiveness, and equitable access are attained. The concept of equity of access in connection to efficiency and effectiveness is also explored in the class readings.

Discussion Topic 2: Challenges to a Systems Thinking Approach

Systems thinking entails using different approaches examine systems of different kinds. It is the process of understanding ways in which factors that are considered systems affect each other within a larger system. Just like other developed countries, Australia maintains a tax based universal health system that is administered by regional, provincial, and local health care providers and organizations. Most of these health services are delivered through the country’s regional health authorities. Despite these efforts, the country is currently, the country’s health system is grappling with the issue of issue of increased chronic diseases, ageing population, competition for competent health practitioners, inadequate access to services, growing costs, as well as, costly treatments and technologies. Using the system thinking approach, the Australian government should use the three principles of transforming its health system that include putting patients and their families at the core of the health system, designing a cohesive instead of disjointed system, and motivating frontline providers (Peters, 2014). To pursue this mission, the government through the ministry of health, as well as other partnering agencies should formulate a coordinated approach to design and implement various initiatives aimed at enhancing radically the culture, structure, and quality of provincial health services. The government should formulate a plan on how it seeks to offer better value, quality care, and better teams to its citizens. This plan should be designed collaboratively among health system partners through strategic planning that stresses on the need to engage the whole system, thinking and acting as a unit in formulating key targets, strategies, and actions. Some of the critical initiatives that should form the country’s transformation should include changing the surgical patient experience, improving patient cantered primary health care, and implementing a provincial quality improvement approach.

Collaboration between people (families, patients, and providers) is a key to surgical transformation initiative. Intuitively, the government should create various initiatives that is founded on the joint efforts of providers, patients, as well as families working together, particularly codevelopment of patient care surgical pathways. Moreover, the government should promote and use tool for shared decision making to ensure that patients together with their families are brought on board and informed partners to their care. Moreover, in changing the surgical care, the government should understand that the system is indeed an interrelated web of intricate systems that are influenced by one another. Integration across these systems is essential in case additional efficient service delivery is attained. Therefore, although significant investment can be made to provide room for more surgeries, there is need to implement more initiatives to enhance the quality of interactions between system elements, eradicate possible bottlenecks and enhance patient experience. These initiatives encompass increasing the number of laboratory and diagnostic services, introducing third party providers for out of hospital surgeries and MRI, pooled referral systems, collaborative electronic health and medical records and wide retention and hiring of nurses.

Module 2: Discussion Topic 1: Core Competencies in Public Health

             Core competencies are critical skills, knowledge, and attitude required for the practice of public health. As a public health practitioner, I will am well equipped with analytical and communication skills that are core competencies of public health professionals. With these skills, I am able to pay attention to identifying and synthesizing data, converting data into information for necessary actions, assessing and dealing with population literacy among others. As a public health professional, I am well versed with policy development or planning skills that public health practitioners require to determine the required programs and policies foster for programs and policies, as well as, formulating and adopting community health improvement plans to address various public health issues. As equally alive to the fact that public health professional must understand and respond to diverse needs, evaluating cultural and organizational diversity, as well as, competence. Having cultural competence skills allow me to evaluate the impacts of programs and policies on various populations and taking various public health workforces.  I normally use public health science skills, financial management and planning skills, as well as, systems thinking and leadership skills to address public health problems that diverse populations across Australia continue to grapple with.

            Although I am well conversant with core competencies of public health professionals, I feel that additional improvements in education are required to enable me become one of the greatest public health professionals of all times. Some of the critical areas that require education improvement include genomics, informatics, cultural competence, communication, global health; community based participatory research, law and policy, as well as, public health ethics.

Discussion Topic 2: The Brain Drain

            Migration of healthcare professionals from low income countries has become a major problem since brain drain degrades the already exhausted healthcare resources in developing countries and enlarges the gap in health inequalities across the world. Street et al. (2014) noted that some of the major reasons that cause healthcare professionals to emigrate include unfavourable working conditions, poor remuneration, repressive political condition, as well as, discrimination and persecution of intellectuals. Studies have also cited poor facilities, lack of funding, inadequate career structures, as well as, poor intellectual motivation as critical factors for the dissatisfaction. To deal with the problems of brain drain of healthcare professionals, Australian government have started demanding compensation from departing healthcare professionals, adjourning their emigration through compulsory service, raising salaries in the public health industry,  allowing healthcare practitioners in public sector to undertake private practice, offering educational benefits for their dependants, and training paramedics who are able to perform most of the roles that doctors can do but whose qualification are not well explained in the international market. Currently, the Australian government currently offers an inspiring environment for professional growth with sufficient facilities, funding, as well as, vibrant intellectual community (Willis et al., 2014).

            The Australian government has allocated more resources to improve the conditions and training for healthcare practitioners and researchers. Reportedly, when such training are offered overseas, it would be pertinent and applicable to challenges of the original country so that the frustrations and challenges witnessed by those moving to a poorer environment are reduced.  More importantly, the Australian government has kicked off the process of understanding the effects of brain drain in healthcare, especially in low income countries and has started reimbursing these states for the costs involved in training healthcare practitioners they import.

            Personally, formulating regulations to initiate the return and flows of competent healthcare professionals can be an effective way of addressing brain drain. Intuitively, most low income countries have experienced significant losses due to brain drain. As such formulating regulations that will get back manpower rich in experience, knowledge, and skills will ensure that these countries fully utilize job opportunities that often exist in technologically and economically developed nations.

Module 3: Discussion Topic 1: Maintaining Universal Health Coverage

             Universal health coverage is multidimensional since its political, legal and health system, as well as, socioeconomic agenda emanated almost at the same time across the world. In most developed countries such as Australian and United Kingdom, there is the barrier of how to increase health insurance coverage to inform sectors, properly designing benefit packages to contemporary health problems and quality health services. Willis et al. (2014) posited that high cost coupled with poor access to healthcare is the key barriers to maintaining UHC. Insufficient political dedication and decision making power are the major barriers towards maintaining universal health coverage.  For instance, the UK has not put any priority in controlling the quality and prices of drugs for all citizens despite the fact that adequate supply of drugs is a critical component of attaining universal health coverage. Similarly, high costs of drugs, low quality and counterfeit medicines, as well as, irrational use of drugs are key barriers that limit many countries from achieving and maintaining universal health coverage.

            Social stratification is another barrier that hinders several states across the world from achieving universal health coverage. Developed states such as Australia and United Kingdom have already attaining universal health coverage some years back. However, social inequality in those countries is a critical factor that has hindered them from maintaining quality care. Precisely, high out of pocket expenses, insufficient insurance coverage, increasing medical cost, poor utilization of scarce resources and unequal delivery of subsidy to the various regions have remained some of the major barriers.

            Intuitively, waiting durations for elective processes in public health facilities are too long in various states across Australia and United Kingdom. For instance, a survey conducted by Walsh et al. (2012) revealed that in the year 2016, about 2% of 712,000 patients who were taken in for elective processes in Australia waited for more than one year and in the United Kingdom, the figure rose to 10%. Findings of this survey further revealed that 4% of orthopaedic patients across the two countries waited more than one year with 50% of the patients waiting for kore than three months. Similarly, just like most developed countries, UK and Australia are facing the problem of growing pervasiveness of chronic diseases. Limited ways of dealing with chronic disorders have been included in the list of things subsidised by the government. Nonetheless, the payment system for general practice continue to be fee for service in which the global best practice indicate that a more incorporated payment model would eradicate the financial incentives to achieve quality and affordable care.

            In conclusion, although countries such as United Kingdom and Australia faced numerous barriers in the maintenance of universal health coverage, these barriers are unlikely to bar them from maintaining UHC.

Discussion Topic 2: Universal Health Coverage: Limitations

             Reports have indicated that several countries across the world are progressively moving towards universal health coverage (UHC). To move faster towards the achievement of this goal, developing countries need to strengthen their health systems. To achieve this, they must robustly finance their structures. Normally, when citizens have to dig deep in their pockets to meet healthcare costs, the poor are unlikely to access essential services they require. At the same time, the rich are likely to be exposed to financial hardship in case of severe or terminal illness. Therefore, developing countries should pool funds from compulsory funding sources to spread the financial risks of diseases among a population.

            Empirical studies have indicated that fostering health service coverage and health outcomes relies on the accessibility, availability and the ability of healthcare practitioners to offer quality patient focused care. As such, to achieve UHC, developing countries should invest in their primary healthcare. In particular, to ensure that there is equitable access to essential healthcare services, the countries should invest in their healthcare workforce. Secondly, they should increase accessibility, as well as, coverage outcomes in the primary care. Some of the key factors hindering access to healthcare encompass geography, especially how to ensure access for individuals staying in remote, rural and fragile states (Peters, (2014). Willis et al., (2014) posited that a critical strategy to improve the coverage and accessibility of primary care is to ensure the sustainable training, availability, as well as, retention of healthcare workers. To ensure quality coverage, organizations must have a workforce with required combination, composition and distribution that include nurses, community health workers, specialists, pharmacists, and doctors. Therefore, developing countries must establish the future health care employees from the society and then provide them with a vocational and educational training.

            To achieve universal health coverage, developing countries must remain innovate in their primary care management, financing, and delivery. To achieve this, they should establish innovative funding options such as social impact bonds. Moreover, they should identify their urgent health priorities informed by equity and data analysis, as well as, evidence based approach by bringing on board all stakeholders.

Module 4: Discussion Topic 1: Estimating Expenditures

 In Australia, the level of spending required for public health organizations to maintain critical activities and to expand to other population health problems are estimated using bottom up or top down approach. The top down approach estimates the healthcare costs based on the existing number or benchmark that the government considers sufficient. Similarly, bottom up figures are founded on estimating the costs of key elements of the system and adding them to get the total (Pimpin, Sassi, Corbould, Friebel, & Webber, 2018). Some of the factors that might cause the actual costs to be lower or higher than the estimated costs include growing and aging population, prevalence of chronic diseases, growing health insurance premiums, increase in the rate at which people use healthcare services, as well as, increases in the intensity and price of services.

Discussion Topic 2: Economic Levers and Health Promotion

             When the government offers price subsidy to healthcare, the expenditures on health programs and initiatives are likely to increase. The reasoning is that consumers will purchase more commercial health coverages through these health programs and initiatives. Given the manner in which subsidy amounts are determined, health insurance agencies are likely to charge higher premiums to low income persons as these persons are likely to qualify for increased tax credits. As result, the expenditures on healthcare programs and initiatives are likely to increase. Knaul and Nugent (2006) contended that to raise its revenues, most government across the world often find it vital to tax certain commodities. At times, these taxes are often imposed on consumers or producers thereby raising the prices of products. Through commodity taxation, the government is likely to collect many funds to support health care initiatives and programs. Therefore, commodity taxation enables government to collect much revenue to support healthcare programs and initiatives. Therefore, price subsidisation and commodity tax imply that the Australian government should continue allocating many funds to support the increasing health initiatives and programs.

 Module 5: Discussion Topic 1: Demand and Supply

             Some of the challenges that public health professionals may experience in managing demand for public health programs and services include inadequate time with patients. Essentially, electronic documentation, as well as, other administrative challenges continues to consume the time physicians often dedicate to patients. This makes it difficult to fully address the demands of each patient. Some other challenges experienced by public health professionals include staffing, regulatory requirements, physical burnout, and ethical dilemmas. Managing demand is not the most appropriate solution to these challenges because every patient has different demand and thus it is difficult for public health officials to address all the needs of the patients.

            The public health professionals can use economic principles and concepts such as demand and supply, scarcity, opportunity cost, differences between demand and need, time horizons, discounting, margins, equity and efficiency to establish specific health services and programs urgently needed by customers.

Discussion Topic 2: Access, Equity and Citizen’s Juries

            Citizen’s jury is regarded as a critical tool for bringing citizen to health policy decision making (Street, Duszynski, Krawczyk & Braunack-Mayer, 2014). To consider priorities and healthcare funding, citizen’s jury offer a room for proper deliberation so that the citizens can be exposed to myriad of perspectives and experiences. The relationship between health literacy and use of health service is that low health literacy often has several detrimental effects on health and is linked to decline in the adherence to treatment and use of preventive services. Other impacts include rise in the cases of hospitalization, poor health, and increased mortality risk.

Module 6: Discussion Topic 1: Impact of Economic Analysis on Public Health Research

             Public health professionals can conduct either partial or full economic analysis to deal with the needs of present health care issue within the community. Using partial economic analysis, the professionals can measure disease or program costs to determine necessary actions to take to address the public health issue that communities grapple with. Through partial economic analysis, the professionals hardly compare alternative options and hardly relate costs to outcomes but still gather critical information for addressing key public health concerns. Secondly, to address public health issue, health care professionals can use full economic analysis in which they conduct either cost of disease or program analysis. These individuals often compare two or more public health solutions and evaluate costs of inputs and outcomes to come up with viable actions for addressing the identified public health concern.

            Intuitively, the data gathered from partial or full economic analysis can health public health professionals and other healthcare stakeholders to formulate a model char of accounts that can be use by public health organizations across various levels to allow for easy tracking of finances related to research outcomes and outputs across agencies. Secondly, data collected from the economic analyses help in developing a proper research infrastructure for designing the value and effectiveness of public health, as well as, prevention approaches. More importantly, data from these analyses can help design data systems and actions to attract research quality information on critical components of public health delivery and policies such as program implementation costs. Data gathered from these economic analyses can influence policy, research and public health practice by establishing and validating techniques for comparing costs and benefits of alternative approaches to enhancing public health.