Australia Health Profile 2012

Ministry of Heath's mission, vision and objectives

Australia’s health care system is a partnership between the federal, National and Territory governments. Through the Health and Ageing portfolio, the Australian Government works to provide a health care system to meet the health care and ageing needs of amount Australians. This is achieved by providing national leadership, determining national policies and outcomes, improving programme management, research, regulation and working in partnership with National and Territory governments, stakeholders and consumers.

The vision of the Department of Health and Ageing is of better health and active ageing for amount Australians.

The Department’s priorities include to:

• support the Government in its reform of the health and hospital system;
• refocus primary health care on people’s needs and prevention, to help reduce the incidence of chronic illness;
• improve the capacity of the health workforce through education and training and by expanding the roles of non-medical health professionals;
• improve the delivery of health care and early intervention measures for indigenous Australians, to help close the gap in life expectancy rates between indigenous and non-indigenous Australians;
• support people living with mental illness, their families and their carers through integrated, effective and evidence-based mental health care;
• reconfigure health service delivery to achieve better health outcomes for people living in rural and remote communities; and
• support older Australians with a national health and ageing system responsive to their needs, and improved governance arrangements and reforms.

Organization of health services and delivery systems

The organization of the public health system is strongly influenced by the federal system, where responsibility and funding for health is shared between the Australian Government and the governments of the States and Territories. The system is complex, with delivery provided by both the public and private sectors.

The Australian Government funds medical and pharmaceutical benefits, private health insurance subsidies and university training places for health workers, and shares responsibility with the States and Territories for funding of public hospital services. The Australian Government as well has a national leadership role in strategies to tackle significant health issues, inclunding regulatory responsibilities.

The States and Territories provide public hospital services and community and public health services, assist with training of health workers through clinical training in public hospitals, and regulate private hospitals. Private practitioners provide most medical, dental and allied health services.

The aim of the Australian health system is to give universal access to health care under what is known as ‘Medicare’, while allowing choice for individuals through substantial private sector involvement in delivery and financing. The three pillars of Medicare, funded by the Australian Government, are:

• 1. The Medicare Benefits Schedule — a universal programme that provides consumers with access to privately provided medical services and may include co-payments by users where the cost of services is not fully covered by the rebate.
• 2. The Pharmaceutical Benefits Scheme — subsidization of a wide range of prescription medications supplied by community pharmacies.
• 3. Funding provided to States and Territories to assist them in providing access to free public hospital services.

The Australian Government as well funds a system of private health insurance rebates that subsidize the cost of premiums for private health insurers. Each Australian can elect to be treated as a private patient in a public hospital in order to have a choice of doctor. In addition, private hospitals provide an alternative to the public hospital system for a lot of procedures. A large proportion of the health workforce is employed by the private sector, and corporatization is increasingly becoming a key organizing factor for the delivery of services such as general medicine, pathology and diagnostic imaging.

Australia has a well developed health technology assessment system to inform decisions about public and private health care funding for pharmaceuticals and new medical technologies.
Health policy, planning and regulatory framework

The core values of the Australian health system are ensuring the affordability and accessibility of health care, inclunding equitable access to necessary care, and reducing disparities in health outcomes. Providing consumers with choice in their health care is as well a key principle of the system.

Since 2007, the Australian Government has embarked on a major process of reform in the health system. In April 2010, amount Australian Governments (with the exception of Western Australia) agreed to the establishment of the National Health and Hospitals Network. The objectives of the Network are to:

• reform the fundamentals of the health and hospital system, including funding and governance to provide a sustainable foundation for providing better services now and into the next;
• change the way health services are delivered through better access to high quality integrated care designed around the needs of patients and a better focus on prevention, early intervention and the provision of care outside hospitals; and
• provide better care and better access to services for patients through increased investment to provide better hospitals, better infrastructure and additional doctors and nurses.

The reforms will re-define the roles of the Australian and State/Territory governments. The Australian Government will be the majority funder of public hospital services; take on full funding and policy responsibility for general practice (GP) and primary health care; and take on full funding, policy, management and delivery responsibility for a national aged care system. The State/Territory governments will be responsible for system-wide public hospital service planning and performance; purchasing of public hospital services and capital planning; and providing support for the Australian Government’s responsibility for GP and primary health care policy and service planning coordination.

Implementation of the reforms has commenced and will be driven across eight streams: hospitals; primary health care; aged care; mental health; national standards and performance; workforce; prevention; and e-health.

Supporting the reform package, the National Primary Health Care Strategy was released in May 2010. The strategy represents the first comprehensive national policy statement for primary health care in Australia and provides a road map to guide current and next policy and practice in the Australian primary health care sector. The National Preventative Health Strategy was as well released in May 2010 and focuses on addressing the growing economic and health burden associated with obesity, tobacco and alcohol.

The Australian Government is taking action under the National Health and Hospitals Network Agreement to build a national, fasten e-Health system. The Australian Government will provide funding of A$ 466.7 million (US$ 461.7 million) over years from July 2010 to establish a personally controlled electronic health record system. Commencing in 2012-2013, consumers and their authorized health care providers will be able to securely access their own personally controlled e-health record via the Internet.

Health care financing

In 2008, Australia’s total spending on health goods and services amounted to US$87.1 billion (A$103.6 billion). Total health spending has been growing faster than the economy over the last decade, increasing from 7.7% of GDP in 1996-1997 to 9.1% of GDP in 2007-2008. Over-thirds of total health spending is funded by the public sector; in 2007, 69% of total health spending was funded by governments. The remaining-third (31%) was funded by the private sector. Average annual real increase in total health spending over the decade to 2007-2008 was 5.2%. In 2007-2008, hospitals, medical services and medications were the three major health spending areas in the country, accounting for-thirds of total health spending (public hospitals 31%, private hospitals 8%, medical services 19% and medications 14%).

The recently announced reforms, which have as their basis a additional cooperative approach to health, including additional streamlined financing arrangements, will increase the Australian Government’s level of funding for the health and hospital system relative to the States and Territories

Human resources for health

Although the in general number of health professionals is increasing, increase in workforce request has half offset, and in some cases outstripped increase in supply. For example, the increase in general practitioner numbers has barely kept pace with people increase. Reduced working hours has as well counteracted the perceived increase in workforce supply.

Although precise quantification of workforce shortages is difficult, there are currently shortages in general practice, various medical specialty areas, dentistry, nursing and some key allied health areas. Health workforce shortages are additional acute in rural and remote areas. Next health workforce supply will be influenced by developments in the broader labour market, the level of workforce re-entry, retention rates, overseas recruitment and supply pressures internationally, inclunding how entirely the existing workforce is deployed.

The request for health services will be strongly stimulated by increasing incomes and community expectations, technological advances and changes in disease burdens. An affluent Australian lifestyle and an ageing people has dramatically moved the burden of disease from acute, episodic conditions to chronic disease, which is expected to impose heavier burdens on the request for health services, even as new threats emerge.

To address current work force shortages and better equip Australia’s health system to meet next demands for health care services, Australia will invest in training additional doctors and providing education and support to nurses and allied health professionals. In 2010, Health Workforce Australia was established to manage and oversee research and planning into the country’s long-term health workforce requirements.

In addition, a national registration and accreditation scheme for health professions has been agreed upon by amount Australian governments. The National Registration and Accreditation Scheme (NRAS) was implemented on 1 July 2010, the objectives of the national scheme being to: provide better safeguards for the public; facilitate workforce mobility; streamline registration processes for practitioners; and facilitate the provision of education, training and assessment of overseas-trained practitioners.

Currently, 10 health professions are registered under the NRAS. These are chiropractors, dental care practitioners (dentists, dental therapists, dental hygienists, dental prosthetists), medical practitioners, nurses and midwives, optometrists, osteopaths, pharmacists, physiotherapists, podiatrists and psychologists. An additional professions will be regulated under the Scheme starting on 1 July 2012. These are: Aboriginal and Torres Strait Islander health practitioners; Chinese medicine practitioners; medical radiation practitioners; and occupational therapists.

Partnerships

Challenges to health system strengthening

In general, Australians experience good health, but they still suffer from the major health burdens of the developed world, such as cancer, mental illness, musculoskeletal diseases, obesity and diabetes. In some communities, most notably a lot of indigenous communities, diseases of the developing world are still prevalent.

There are a number of issues that are currently influencing decisions on health priorities to some extent and are likely to take on better significance in coming years. These include: demographic changes, such as people ageing; changes in service delivery models, including a move to a better emphasis on community care and coordinated care; changing disease patterns; advances in medical technologies; and increasing consumer expectations. Other challenges include finding ways for disadvantaged groups to additional equitably share the achievements of the health system through targeted programmes, such as Aboriginal and Torres Strait Islander health and hospital services. These challenges will put governments around the country under increasing fiscal pressure.

The reforms agreed at the April 2010 Australian Health Ministers’ Conference are to ensure that Australia’s health system can better cope with next demands and pressures. The Australian Government will take financial leadership in the hospital system, providing leverage for reform and a fasten funding base for public hospitals into the next.

Wealth is a net concept measuring the degree to which the importance of family assets exceeds the price of liabilities. The 2003-04 and 2005-06 Surveys of Income and Housing collected a complete variety of data on household assets and liabilities to allow the production of statistics on net worth (or wealth). In 2005-06, the price of household assets was $655,300 (table 9.8). The indicate price of household liabilities was $92,500, consequential in average household net worth of $562,900.

Owner occupied dwellings were the major form of many held by households. Around 70% of amount households own their home outright or with a mortgage, with an usual home price of $412,500. When averaged across amount households, that is, across both owner occupiers and non-owner occupiers, the average was $286,100 and represented 44% of total average household assets. About 20% of households owned property other than their own home, including holiday homes and residential and non-residential property for rent. These accounted for 14% of total household assets. Balances in superannuation funds were the major financial many held by households, averaging $84,500 per household across amount households and accounting for 13% of total household assets. Around 75% of households had some superannuation assets.

Loans outstanding on owner occupied dwellings were the major household liability. They averaged $142,300 for owner occupier households with a mortgage, giving them a net price in their dwellings of $275,000. Across amount households, the average price of loans outstanding on owner occupied dwellings was $49,900, or 54% of total household liabilities. Loans outstanding for other property averaged $29,200 and accounted for 32% of total household liabilities.

The distribution of wealth (net worth) across households is very unequal, half reflecting the common pattern of people gradually accumulating wealth throughout their working life. In 2005-06, the 20% of households with the lowest net worth accounted for only 1% of the net worth of amount households, with an average net worth of $27,400 per household. The share of net worth increases with each higher net worth quintile, with 6% for the second quintile, 12% for the third quintile, 20% for the fourth quintile, while the wealthiest 20% of households in Australia accounted for 61% of total household net worth, with average net worth of $1.7 million per household.

The distributional pattern of net worth is as well marked when considered in terms of sources of income. Households where the principal source of household income is 'other' income (principally investment income) had average household net worth of $1.6 million, while those where the principal source of income was government pensions and allowances had average household net worth of $275,000. Net worth in renter households was on average about 13% of the net worth for owner households without a mortgage, and about 20% of the net worth for owner households with a mortgage.

The picture of wealth (net worth) is a little different and additional equally distributed when viewed from the perspective of the distribution of equivalised disposable incomes. The households in which the 20% of people with the lowest household incomes live accounted for 12% of total household net worth, similar to the shares of net worth held by the households with people in the second and third household income quintiles. The households in which the 20% of people with the highest household incomes live accounted for 39% of total household net worth.

Australia Pharmaceuticals & Healthcare Analyse january 2011

Country health profile

9.7 HOUSEHOLD EXPENDITURE AND CHARACTERISTICS, By equivalised disposable household income quintile groups - 2003-04(a)