As we all know, Australia's welfare system is among the best in the world, universal free health care system is enviable, so many people choose to emigrate to Australia, waiting to enjoy Australia's welfare. However, those who really lived in Australia must have had the kind of crashing experience of dragging a sick body, holding a cell phone and portable battery, sitting in the emergency room of a public hospital for four hours.
In January, there was a surge in medical complaints in public hospitals, and job rotation was the main cause. But is Australia's health care system itself perfect? In this paper, the advantages and disadvantages of Australian health care system, the shortcomings of public health care system and the solutions to health care system problems will be discussed in depth.
One, there is no free lunch in the world.
Of Australia's many welfare programs, the National Health system is its most proud.
All permanent residents and citizens of Australia can apply for a medical card (Medicare Card), cardholders have access to medical services free of charge in private clinics and public hospitals. (to thank the reader, add Medicare services and an analysis of the benefits of private health insurance at the end of the article.)
But free "medical lunches" are not free. In Australia, the health care model relies on government funding (known as Medicare) plus private health insurance. For Australian citizen and permanent resident (PR), the (Medicare) provides a range of health care services that are not cost-free, mainly composed of individual income taxes and health insurance taxes (Medicare Levy). The tax is 2% of the taxpayer's personal income.
In addition, an individual earning more than A $90,000 a year would have to pay an additional 1 percent to 1.5 percent surcharge without private health insurance. For a single family, the threshold is A $ one hundred and eighty thousand.
Recently, (Private Healthcare Australia), an Australian private health-care organization, proposed an additional 50 basis points surcharge, from 1.5% to 2%, because they believe the surcharge would encourage more people to enter private hospitals. This reduces the pressure on public hospitals.
Second, public and private, which is better or worse?
At present, about half of Australians have private health insurance. So if they go to hospitals, there will be more options for public and private hospitals. Most users of private health insurance are 60-79-year-olds. But about 1/4 people with private health insurance still choose to go to public hospitals.
As shown in the chart below, the number of Australian public hospitals is significantly higher than that of private hospitals.
By comparing the two medical systems, let's look at public and private hospitals, which is better or worse?
1, wait time
According to the data, half of patients in public hospitals are eligible for elective surgery within 36 days of being on the waiting list, compared with 90 percent within 262 days. That means 10% of people wait more than eight and a half months.
In Queensland, 50 percent of people are admitted to hospital within 28 days and wait longer in New South Wales, 49 days, depending on the region and the data.
Public hospitals are also seen by some as training camps for newcomers to medical students. Error rates show that public hospitals (6.7%) are slightly higher than private hospitals (4.1%), including infections or prescribing incorrect drugs. These differences exist mainly because treatment options in private hospitals are more likely to be discussed repeatedly by experts, so the risk of infection is lower.
2, cost comparison
Although it is difficult to compare costs depending on cases, the survey found that the average cost of private hospitals (A $2552) was higher than that of public hospitals (A $1953), including ward care, hospital supplies and full-time medical services.
In addition, medical and diagnostic costs in private hospitals, including X-rays and blood tests, stood at A $798, up from A $542 in public hospitals. Prosthetics are also expensive, with private hospitals costing about A $542 and public hospitals at A $131.
In the public health-care system, treatment costs little cash, and choosing private hospitals means expensive expenses. In addition to paying insurance premiums to insurers, the average self-payment to private hospitals is about A $293.32, or 20 percent of private medical costs. For surgeons, anesthesiologists, abnormal pathology and medical devices, patients will have to pay more.
3. Maternal care
Pregnant women with private health insurance choose to give birth in private hospitals. It turns out that private hospitals are more likely to have caesarean surgeries to help pregnant women give birth. In Australia, 30% of newborns are born in private hospitals.
Although many public hospitals provide continuous care during pregnancy. But research shows that in public hospitals, pregnant women see different nurses every time, resulting in a decline in maternal satisfaction. Many people still attach great importance to the facilities of private hospitals, such as private rooms and their own midwives and nurses.
Third, what are the reasons for the inefficiency of public hospitals?
1. Doctors are working part-time at the same time for public private gain.
A health-care expert said many Australian doctors now work in both public and private hospitals, which not only reduces efficiency and could delay patients. Doctors who spend half a week in both public and private hospitals are unlikely to have the energy to focus on improving the quality of health care or any improvement plans, and they may be late or early to leave in private hospitals for personal gain.
There is no clear indication of the minimum number of hours a doctor employed in a public hospital will work in a public hospital. A study of experts from eight different departments found that most of them worked at both public and private hospitals every week, but spent most of their time serving patients in private hospitals.
Eye surgeons spend 87% of their time in private hospitals, followed by plastic surgeons, otorhinolaryngologists and rheumatism specialists, who spend more than 70% of their weekly time in private hospitals. Gastroenterologists and cardiologists spend more than 60% of their time, while neurologists are close to 50%.
The only person who spends most of his time in public hospitals is a kidney specialist.
The main reason is that a doctor working in a private hospital earns about 30% more than a doctor working in a public hospital. For example, for a surgeon, it could cost an extra A $ one hundred thousand a year.
Professor Gary Freed, who has studied the Australian medical system for five years at (University of Melbourne) at the University of Melbourne, believes it is possible to better understand whether the Australian medical system meets the needs of patients by studying doctors' working schedules. He believes that public and private part-time doctors will lead to longer waiting times for patients in public hospitals, especially for the severe patients who seek medical treatment in public hospitals, each time facing different doctors, which will undoubtedly lead to inefficient work.
Efficiency comes from working together by experienced teams, and state governments should consider incentives to attract experts to public hospitals to reduce economic inefficiencies.
2. Rigorous examination of public hospitals
Michael Gannon, president of the Australian Medical Association, said many doctors decided to leave the public health system completely because of unnecessary management. In public hospitals, doctors are often required to receive re-education. For example, medical personnel have to pass various medical examinations every year. This is originally a good thing, the assessment to ensure the professional quality of medical personnel. But too cumbersome examination has reduced the popularity of public hospitals.
3. Shortage of funds in public hospitals
Although many doctors are willing to take various forms of assessment and participate in low-return research projects, funding shortages are still a major cause of brain drain. Out of all government spending in 2015 / 16, health-related spending was A $six billion eight hundred and thirty seven million nine hundred and ninety nine thousand nine hundred and ninety nine, of which only A $one billion six hundred and forty four million (23.7%) was spent on hospitals, as shown in the chart below.
Because of financial constraints, the frequency of use of certain medical equipment in public hospitals is limited. In private hospitals, the fee-as-a-service model (fee-for-service model) solves this problem. If there is surgery to be done and people are willing to pay, then it can be done.
There are, of course, some different voices that, on the plus side, waiting time due to the inefficiency of public hospitals is actually a manifestation of effectiveness and a clinical need.
4. Utility theory
Economists will tell you that with limited resources, waiting lists are an effective mechanism for improving effectiveness. This not only ensures that those who end up with medical services are really in need of services, but waiting lists also ensure that resources are maximized when medical resources are scarce, including medical professionals, beds, and medical equipment. This approach is particularly useful in areas where demand cannot be estimated, for example, a small town with a rapidly growing population as a result of migration.
5. Clinical needs
Utility theory may be just a reasonable economic explanation. In fact, hospitals are not based on the "first come first serve" principle, but on the severity of the patient according to the order of treatment. Clinicians consider the order of patients according to the urgency of treatment, so the most urgent patients can be considered the first to be treated. Of course, patients of the same degree are ranked in chronological order.
In the emergency department, there are five categories of people by degree of urgency:
With regard to elective surgery, there are three categories of people by degree of urgency:
Four, is there a solution?
Although many hospitals say they are in a poor financial position, will the availability of extra funds be an immediate solution to the problem of efficiency? International cases have shown that injecting more money into the health-care system has not shortened the waiting time. There are often more pressing needs in the health care system. For example, if resources are allocated to specific surgeries, demand may surge due to a lower threshold for treatment.
Some experts have called for a solution by encouraging people to buy private insurance. But those who can afford private health insurance are generally healthier and richer, and those who depend on public hospitals are often chronically ill or more difficult to treat.
Currently, patients with private insurance can reduce the waiting time in public hospitals and receive treatment twice as fast as ordinary patients, provided they pay at least A $100 extra annual premium to the health fund, (health fund premiums). The emergence of this group challenges the principle of equity in the health care system and, as shown in the figure below, public hospitals may no longer treat all patients equally according to the severity of the disease.
The number of people who pay extra premiums each year to "jump-in" treatment increases by nearly 10%. According to (AIHW) data from the Australian Institute of Health and Welfare, The number of public hospitals covered by private health insurance jumped from 382000 (8.2%) in 2006-07 to 872000 (13.9%) in 2015-16.
This has eased funding constraints for public hospitals, increasing their revenues by nearly A $1 billion a year, but that is not a good thing for the public health-care system. In the past, doctors were not only subject to professional ethics, but also monitored by the Ministry of Health to determine the order of treatment based on the degree of urgency of the patient. Now this "pay-in-line" approach is undoubtedly undermining the credibility of the entire health-care system.
END
As the saying goes, "you can't have both fish and bear paw". The basic idea of Australian medical care is whether you are rich or poor, whether you have a job or not. As long as you are an Australian citizen and hold an Australian green card, you can all enjoy good and free medical benefits. But now it's fair and free, but it doesn't solve the contradiction between the two and efficiency-in most cases, efficiency is more important to patients. Although the quality of medical care in Australia is among the highest in the world, the improvement of efficiency requires more institutional improvement and structural optimization. In Australia, it may take time for integrity to form a fair, efficient, free medical environment for the general public.
Comparison of Medicare's scope of Service and advantages of Private Medical Insurance
Medicare functions roughly meet the needs of people's daily medical care, hospital treatment and drug purchase. Although everyone has used Medicare, not everyone knows what service it really offers. The author made a simple summary.
Daily medical treatment
Medicare does not include glasses and contact lenses, hearing aids, cosmetic surgery, ambulance services, dental services, dietary advice, eye therapy, speech therapy, foot therapy, counseling, physiotherapy or spinal massage services. In general, all clinical treatment is not necessary.
When you see a doctor outside the hospital, Medicare provides reimbursement under the MBS (Medicare benefits Plan) for 100% GP and 85% specialist expenses.
If your doctor billing Medicare directly, you don't have to pay for anything. Medicare covers X-rays, hematuria, eye optometry, abnormal pathology, most general surgery, And some of the costs associated with the EPC (enhanced Primary Health Care) Program, the chronic Disease Management Program and the cleft Lip and palate Program.
Hospital expenses
Medicare covers the cost of treating patients in public hospitals. Free offer means you don't have a choice or say to a doctor, and the doctor's distribution is random.
Buy medicine
Under the PBS, most drugs are subsidized. This means that for most prescription drugs purchased at a drugstore, you will only have to pay a portion of the fee, and PBS will pay for the remaining portion of the cost, depending on the type of drug.
Medicare does not include medical expenses when you travel abroad. However, the Australian government has reciprocal medical agreements with a handful of designated countries that allow Australians to be given medical services and drug subsidies. Currently participating countries include New Zealand, the United Kingdom, the Netherlands, Finland, Norway, Slovenia, Italy, Malta, Belgium, Sweden and the Republic of Ireland. The agreement helps Australians visit these countries with access to basic health services. It must be stressed that, because of the limitations of the services under these agreements, travel insurance cannot be replaced.
Because of the limitations of the Medicare, it highlights the benefits of private health insurance, all of which is based on additional payments.
The attending physician has the option to better control when and where to receive medical care, and the waiting time for selective surgery is often much shorter.
Private health insurance is supplemented by services that are not covered by the Medicare, including dental, physiotherapy, spinal massage, optics and other specific healthcare services.
