Executive Summary
Health care systems differ from one country to another due to existence of differences between the countries’ traditions, beliefs, political influence and socio-economic conditions. The three basic goals of the Australian health care system include: equity, efficiency and quality. Equity entails fair payment, access and availability of effective services to all. On the other hand, efficiency involves receiving value for money while quality relates to attainment of high standard and good health outcomes. The efficiency and sustainability of Saudi health care system depends on a number of elements. Some of these include effective policy making and implementing, health status of the population, efficient financing and effective public-private mix.
Australian health care system is different from that of Saudi Arabia in a number of ways. For example, in Saudi Arabia, there is no sufficient data to aid in the decision-making and policy formulation process. In addition, these processes are not coordinated among the various public agencies which finance and deliver health care. On the other hand, in Australian health care system there is absolute transparency in relation to health care information.
Considering the current socio-economic trends in Saudi Arabia, the government which accounts for approximately 80% of the total spending in health care has a challenge in sustaining the system. However, there are other mechanisms through which this can be attained. These include formulating and implementing effective budget and tax policy.
List of acronyms
- AU Australia
- GDP Gross Domestic Product
- MOH Ministry Of Health (in Saudi Arabia)
- NHHRC National Health and Hospitals Reform Commission
- KSA Kingdom Of Saudi Arabia
- WHO World Health Organisation
Introduction
There is a general perception that the health care system model is complicated. This arises from the fact that there is a wide range of drivers involved (Goodman, 1999, p. 1; Anderson, Frogner & Reinhardt, 2007, p. 1488). Social ethics, economics and political drivers are considered to be important characteristics of each health care system (Bolnick, 2003, p. 3; Wolper, 2004, p. 56). According to Bolnick (2003, p. 1), there is no ideal health care system to model on due to a number of factors. The aim of this report is to discuss the economics, ethics and political drivers in relation to two selected health care systems. These include the Australian and Saudi Arabian health care systems. An analysis on similarities and differences with regard to the two health care systems will be conducted. The report will also conduct an analysis on Bolnick’s views with regard to shared goals in relation to the two selected health care systems. The conclusions will be illustrated according to the discussion to address originality and comprehensiveness of health economics and comparative health systems.
Discussion on economic, ethic and political drivers
Personal importance is considered as one of the fundamental non-medical issues driving health care systems (Cassens, 2004, p.115; Bolnick, 2003, p.2; Enrado, 2009, p. 6). Political structure and government involvement are significant factors which differentiate health care systems among various countries (Cassens, 2004, p. 116). The degree of government involvement in supporting health care varies from nationalised approaches to decentralised private or non-profit making institutions. On the other hand, ethical issues have an inevitable effect on the allocation of health care system (Rice & Smith, 2001, p. 256).
Australian Health care systems
Cultural diversity
Australia is a multicultural country which is composed of individuals from diverse cultural backgrounds. The immigrants generally enjoy better health care services compared to Australian-born individuals. This is largely explained by the “healthy migrant effect”, resulting from stringent eligibility criteria which ensure that only those in good health migrate to Australia (Australian Institute of Health & Welfare, 2001, p.2).Overall, immigrants enjoy a number of advantages due to various conditions. However, this presents a disadvantage to others. Their health status can vary according to factors such as birthplace, age, socioeconomic status, fluency in English, dietary and genetic factors, living conditions and their satisfaction with life in Australia (Australian Institute of Health & Welfare, 2001, p. 22).
Economic
Australia is a prosperous country with a well-established capitalist mixed economy. The country’s economic well-being and growth depends on a competitive domestic economy, access to foreign markets and investment. The Australian health care system is considered to be a publicly funded universal system. Funding of the system is undertaken by the Australian government as well as the state and territory governments (Australian Government, 2009, p. 3). The decisions and policies applicable within the country’s health care system are made by the political parties in power. Health equity in accordance with ethical foundation in Australia is quite reflective with professional guidelines (Breen, 1997, p. 23). In 2008, the country spent approximately 8.8% of its GDP on health care which is relatively high (OECD, 2010, p. 8).
Politics
Australia has a federal system of government. This government has three political and administrative tiers which include: the commonwealth, states and territories and the local government. However, Australia has a complex health care system with both public and private financiers (Blanchette & Tolley, 2001, para. 1-7). Given the division of powers within the federal form of government and the many stakeholders, the ability of any one actor to plan or regulate is limited. Governments have considerable leverage, in that they provide the largest share of funds. The Australian government has a national role in health care policy-making process. In addition, it possesses the “power of the purse”. In 2009, NHHRC released its annual report. One of the key recommendations is that “The commonwealth government would assume full responsibility for the policy and public funding of primary health care services” (NHHRC, 2009, p. 27).
Health status
Findings of a study conducted by the World Health Organisation revealed that the life expectancy of the Australian population has increased from 77 years in 1990 to 82 years in 2006 (World Health Organization, 2009, p. 8). The increase in life expectancy of amongst the Australian population depicts an improvement in health care system. The main chronic diseases which are common causes of death include rheumatic heart disease, cancers and stroke (Australian Institute of Health and Welfare, 2008, p. 12).
Saudi health care system
“Maintaining health in both quantity and quality for different parts of the kingdom” (MOH).
Cultural diversity
Geographically, Saudi Arabia is divided into four main regions. These include the Central, Western, Southern and Eastern regions. However, health services are given priority in Saudi Arabia’s development agenda ( Funnell, Koutoukidis &Lawrence, 2008, p. 93).Saudi Arabia’s culture with regard to its devotion to Islam, extended-family values, the segregated status of females and the Al Saud monarchic hegemony is being formulated. This is being done in an increasingly deliberate fashion, constituting a new ‘political culture. In its effort towards provision of healthcare services, the government is commitment at ensuring that it minimizes cultural sensitivity in relation to male physicians attending female patients. This will be attained through training sufficient number Saudi Arabian female physicians to attend to female patients. This will improve the effectiveness with which the cultural diversity is addressed in the society. Currently, most health care services in the Kingdom are offered by male expatriate physicians. Through this plan, Saudi Arabian government will be able to replace a significant proportion of Saudi Arabian health care system with Saudi physicians. Increased dependency on expatriates is considered to threaten Saudi Arabian culture. However, this is expected to continue for a decade or more. Currently, health care systems are considered to be a form of transformation which is in line with cultural compatibility (Funnell, Koutoukidis & Lawrence, 2008, p. 93).
Economic
Saudi Arabia is an oil-based economy. The government has a strong control over major economic activities (Cavendish, 2006, p. 104). The Saudi Arabian government plays a significant role in the provision of finances to health care services to its citizens. The budgetary provision for the MOH increased from 2.8% of the national budget in 1970 to 6.4% in 2004(Li, 2006, p. 5). Of the total health care spending, public health accounts for approximately eighty percent of the total amount money allocated.
In addition to revenue received from sale of gas and oil, health care financing also comes from revenue received from trade of other natural resources. This accounts for approximately 75% of the total financing. Budget transfer is the most common method through which the government uses when making payment to public providers via the Ministry of Finance. Most of the cost items relate to salaries to civil servants, cost of maintaining and undertaking various projects. Managers are generally prohibited from switching funds across line items. Upon allocation of funds, it must be ensured that all the funds are utilized. This arises from the fact that all unspent funds are generally not retained by the government agency.
The ‘other government’ sector also receives annual allocations to meet their health care needs.The proportion of total health to Gross Domestic Product ratio in Saudi Arabia is relatively below other countries with the same income countries ratio. However, the proportion of the country’s public health to Gross Domestic Product ratio is higher than the global average when compared with other comparable income countries. This magnitude of spending on health care is relatively higher tan the regional average.
Politics
Saudi Arabia is governed by a traditional monarchy. A Ministerial committee for administrative organization was established in 2000 and is headed by the Seconded Deputy Prime Minster HRH Prince Sultan bin Abdel-Aziz Al-Saud. Its function is to revise and recommend changes in the administrative and structures of the different ministries and corporations (Marty & Appleby, n.d, p. 114).Saudi Arabian health care system that was initiated in 2002 through a royal decree ensure that health care offered is effective, affordable and available to all Saudi Arabians. This is necessitated by the presence of a Council of Health Services headed by the Minster of Health. The council is composed of representatives of governmental and private health sectors (Marty & Appleby, n.d, p. 114). The government’s has formulated a strategy aimed at encouraging growth within the private sector. This will minimize increased dependence of the oil as the main source of revenue. In addition, there will be creation of more job opportunities. Government priorities for spending additional funds include health and education (Marty & Appleby, n.d, p. 114).
Health status
There is a decline in the incidences of infectious diseases. In addition, there is a program for T.B control which succeeded in increasing case detection rate and decreasing the incidence rate. There are also anti malaria and anti bilharzias programs which are aimed at controlling these diseases (National Library of Australia 2001, p. 206). In addition, non-communicable diseases are of priority concern in Saudi Arabia. As a result, initiative control programs are being applied on a nationwide scale. The first initiative is with regard to application of the WHO step wise surveillance system. Deaths recorded in MOH hospitals are coded according to ICD10. One of the leading causes of death in the kingdom is cardiovascular diseases (National Library of Australia, 2001, p. 206).
Discussion on Bolnick’s views on shared goals
According to Bolnick’s, the three key goals in health care system relate to cost, quality and access. However, it is challenging for an actual health care system to fulfil those goals (Asthana & Ahmadi, 1999, p. 29; Bolnick, 2003, p. 23). The quality of health care system in Australia has been improved in terms of performance of health care services. Accessibility to the health care system has also been taken into account with the intention of providing all health needs (NHHRC, 2009, p. 6). However, cost has become one of the key challenges in the country’s health care system. It is worth noting that Saudi Arabian health care system is ranked below that of Australia. Saudi Arabia health care system is faced with a number of problems especially in relation to cost and access (Asthana & Ahmadi, 1999, p 45). The health care system in KSA is considered to consume a significant proportion of the country’s GDP compared to other Gulf countries. This trend tends to be increasing continually. Rejection of access to health care is minimal amongst Saudis (Asthana &Ahmadi, 1999, p. 20). Nonetheless, the quality of health system is considerably high in terms of diagnosis, treatment and follows ups.
Table (1) Economic Political mapping.
Conclusion
The study has entails a discussion of health care system with regard to Bolnick’s views. It has also conducted an analysis of the Australian and Saudi Arabian health care systems. It can be concluded that the model of health care system varies widely depending on a number of factors. The drivers of heath care system include personal importance, political structure and government involvement as well as ethical concerns. The key differences between the Australian and Saudi Arabian healthcare system is with regard to government involvement.
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