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Transcript

Session 1 - Introduction to AHCS

HLTENN035 PRACTISE NURSING WITHIN THE AUSTRALIAN HEALTH CARE SYSTEM

Work in the context of professional nursing practice & Contribute to professional work team

Identify and discuss funding sources for health care in Australia

Identify and respond to factors and issues affecting health in Australia

Identify what are the historical and current perspectives, service models and standards of care in AHCS

Apply principles and knowledge of nursing practice to work in a health care system

Introduction to the Australian health care system

Australian Health Care System

Australia’s health care system is large and complex, with many different components delivering health care services to the Australian populationThis unit describes the skills and knowledge required to practise as a nursing professional within the Australian health care system, providing health care across the lifespan of people in a range of health and community care services or environments

If restaurants behaved like healthcare...

Lets discuss...

Australia's health-care system is a multi-faceted web of public and private providers, settings, participants and supporting mechanisms. Health providers include medical practitioners, nurses, allied and other health professionals, hospitals, clinics and government and non-government agencies. These providers deliver a plethora of services across many levels, from public health and preventive services in the community, to primary health care, emergency health services, hospital-based treatment, and rehabilitation and palliative care. Public sector health services are provided by all levels of government: local, state, territory and the Australian Government. Private sector health service providers include private hospitals, medical practices and pharmacies.Australian Government Department of Health, 2014

Australian Health Care System

In 2021 Australia celebrate the 100 year anniversary of the Department of Health. The department was formed out of a pandemic in 1921, and is now dealing with the COVID-19 pandemic in 2021.The Spanish flu and COVID-19 are the 2 largest pandemics in recorded history. Last century Spanish influenza killed millions worldwide. Up to 40% of Australians fell ill and 15,000 died of Spanish flu. What will be the outcome of this pandemic is to be seen...

AHCS Fun Fact

History of AHCS

Last 50 years

First 50 years

The start of health care system in Australia

Medical training moved outside capital cities to bring more doctors to rural areas. Also in the 1990s telehealth was an exciting new way to bring health advice to remote communities.

At first Health looked after quarantine, reporting infectious diseases, public health research laboratories, and occupational health. The 1944 Pharmaceutical Benefits Act allowed the Australian Government to subsidise medications. This led to the creation of Medibank, Medicare and the Pharmaceutical Benefits Scheme we still have today

A health care system became a national issue after state controls on movement of infection were not able to stop the spread of the Spanish flu. Prime Minister Billy Hughes officially created the Department of Health on 7 March 1921.

Australia’s health system is one of the best in the world. It provides quality, safe and affordable health care for you and your family. It’s a key reason why we enjoy one of the longest life expectancies in the world.The AHCS is jointly run by all levels of Australian government - federal, state and territory, and local. There are many providers of health care in Australia, including:

  • primary care services delivered by general practitioners (GPs)
  • medical specialists
  • allied health workers
  • nurses.

What is the Australian Health Care system?

Watch the following video and answer the following questions:

  • What is Australias national public health system called?
  • How is medicare paid for?
  • Why have private insurance?
  • What are the majority of long term care systems?
  • How can the government keep the PBS low?
  • the life expectancy of Australia - How does it compare with the rest of the world?

The Australian Health Care System

Medicare

The Medicare Benefits Schedule

Medicare has been Australia’s universal health care scheme since 1984. Its 3 major parts are:

  • medical services
  • public hospitals
  • medicines
Medicare is available to Australian and New Zealand citizens, permanent residents in Australia, and people from countries with reciprocal agreements. Medicare covers all of the cost of public hospital services. It also covers some or all of the costs of other health services. These can include services provided by GPs and medical specialists. They can also include physiotherapy, community nurses and basic dental services for children. The other important part of Medicare is the Pharmaceutical Benefits Scheme (PBS). The PBS makes some prescription medicines cheaper.

The Pharmaceutical Benefits Scheme

Medicare – the foundation of our health system

The PBS helps make medicines cheaper. Without the PBS, medicines would be more expensive. In some cases, they would cost tens of thousands of dollars more. The PBS lists brand name, generic, biologic and biosimilar medicines. There are over 5,200 products on the PBS. All products are shown to be safe and effective before being sold in Australia. Independent medical experts advise on what is added to the PBS. You only pay some of the cost of most PBS medicines if you are enrolled in Medicare. The Australian Government pays the rest. You pay even less if you have a concession card.If you spend lots on medicine, the PBS Safety Net helps keep costs down. When you reach the Safety Net Threshold amount, prescriptions will cost even less for the rest of the year

PBS

MBS

The Medicare Benefits Schedule (MBS) is a list of all health services that the Government subsidises. A team of medical experts keeps the list up to date, safe and best practice. The MBS has a safety net. It can help by making sure you pay less for services once you reach a certain amount of out of pocket costs. This might be the case if you have a year where you pay a lot for medical care.

** NOTE Local governments play an important role in the health system. They provide a range of environmental and public health services, community-based health and home care services.

Government responsibilities

The Commonwealth also shares responsibility with the states and territories for other activities under national agreements such as the Council of Australian Governments (COAG). These other activities include:

  • funding public hospital services
  • preventive services, such as free cancer screening programs including those under the National Bowel Cancer Screening Program
  • registering and accrediting health professionals
  • funding palliative care
  • national mental health reform
  • responding to national health emergencies

  • managing and administering public hospitals
  • delivering preventive services such as breast cancer screening and immunisation programs
  • funding and managing community and mental health services
  • public dental clinics
  • ambulance and emergency services
  • patient transport and subsidy schemes
  • food safety and handling regulation
  • regulating, inspecting, licensing and monitoring health premises

Shared responsibilities

State, territory and local government responsibilities

Austalian Governement responsibilities

  • MBS & PBS
  • supporting & regulating private health insurance
  • supporting and monitoring the quality, effectiveness and efficiency of primary health care services
  • subsidising aged care services,
  • funding for medical research
  • funding veterans’ health care
  • funding community controlled Aboriginal and Torres Strait Islander primary healthcare organisations
  • maintaining the number of doctors in and ensuring they are distributed equitably across the country
  • buying vaccines
  • regulating medicines and medical devices
  • coordinating access to organ and tissue transplants
  • ensuring a secure supply of safe and affordable blood products
  • coordinating national responses to health emergencies, including pandemics

Many Australians have private health insurance cover. There are 2 kinds of cover:

  • hospital cover for some (or all) of the costs of hospital treatment as a private patient
  • general treatment (‘ancillary’ or ‘extras’) cover for some non-medical health services not covered by Medicare — such as dental, physiotherapy and optical services.
Some people with private health insurance have either hospital cover or extras cover, and some people have both. The Government provides a means-tested rebate to help you with the cost of your private health insurance.

Private Health Insurance

Who spends the money in the pggybank??

Cost of Health care in Australia

Australia’s health system is complex — and so are its funding arrangements. It is funded by:

  • all levels of government
  • non-government organisations
  • private health insurers
  • individuals when they pay out-of-pocket costs for products and services that aren’t fully subsidised or reimbursed

In 2016–17, Australia spent nearly $181 billion on health

  • Primary
  • Secondary
  • Teriary

3 Tiers

Public health, primary health, hospitals, specialised health services and aged and disability care services are key concepts in health care. They are described as structural – how they are administered or funded – and sequential – where the individual journey services are located. Public health comprises a wide range of activities including safer environments, occupational health, disease prevention Primary care is ‘first-level care’ such as screening, episodic services, services for the chronically ill, and involves a multidisciplinary team of healthcare professionals Hospitals provide emergency and acute care services Specialised health services include mental health, sub-acute, transition care, palliative care, and alcohol and other drug services Aged care services and disability services comprise community care, specialist services for people with impairments, and residential aged care

Service delvery systems in health care models

  • Australia’s health care system is grounded in a biomedical model of care.
  • The biomedical model of health care provision focuses on illness and disease – specifically, ‘curing’ illness and disease once this has occurred. It relies heavily on the use of technology to diagnose and treat disease. The main advantage of the biomedical model is that it focuses on ‘fixing’ disease. However, it is expensive and even though it may improve life expectancy, it does not focus on preventing illness or necessarily improve quality of life.

Model of Care in Australia

  • Ageing population
  • Chronic diseases
  • Health and medical research
  • New technology
  • Better use of health data
  • Rural & remote health
  • Funding
  • Increases in waiting lists for elective surgery affect the ability of less privileged individuals without private health insurance to access services

Australia's health system challenges

  • According to the World Health Organization (WHO 2010), a good health system ‘delivers quality services to all people when and where they need them’.
  • Health systems are subject to political forces that often override rational evidence-based policy making.
  • Political actions shape the health and wellbeing of populations.
  • Political decisions regarding the design of healthcare and welfare systems affect population groups differently.
  • Structures and processes underpinning healthcare reforms change with political opportunity
  • Healthcare systems are funded with overlapping governance responsibilities, which creates political disputes
  • Elective surgery waiting times are a key political driver of hospital policy
  • Nurses are important stakeholders able to exert political pressure to influence healthcare reforms

Why are healthcare decisions political decisions?

Central to healthcare reform is the 5-year review of the National Health Agreement. The Council of Australian Governments (COAG) has become increasingly important in shaping the reform agenda. Key reforms include: The establishment of clear accountability structures to end political argument over funding Aged and disability care changes in the availability of community support packages Consumer involvement in health decision making Electronic health (e-health) systems to improve patient safety Health promotion and preventative care strategies development targeting obesity, diabetes, infectious disease prevention, mental health, and cancer screening Integrated care policies to manage the increase in chronic disease And reforms to public health policy to create specialised health services and transition care programs to reduce readmissions into acute services for: Stroke recovery Alcohol and drug programs De-institutionalisation of mental health services into inpatient and community settings Palliative care

Key health policy reforms in Australia

Anyone's brain hurt from all that information?

Thats the Australian Health Care system in a nut shell!

https://www.health.gov.au/about-us/the-australian-health-system

No?? Well, If you want more information about the Australian Health Care System visit