Introduction
Health and wellbeing holds a very critical importance in each of us. This importance is only recognisable when we face threat of a potential loss of wellbeing, mobility, or life itself. The ‘rule of rescue’ that we place on our family members, and the community at large means that there is a moral imperative to invest in the wellbeing of known individuals (Sigh & Coble 1999).
Health consumes a considerable portion of our national budget. Nevertheless, it generates a significant proportion of economic activity employing over 7.3% of the population.
On the other hand, it underpins our economy making it a highly contentious and political issue at the time of election. Despite the important role of the health system, other sectors like education and employment are equally important and influence the status of a country’s health and wellbeing.
The health of our populations and the health systems have continued to improve to prevent, diagnose, and treat. The concern of Australian government is to meet the growing healthcare needs with the limited resources. The Australian health system is under pressure.
It is under a constellation of problems and gaps harassing the health care system. This is a critique to a report by the National Health and Hospitals Reform Commission (2009): A Healthier Future for all Australians. The paper looks at several areas of the proposed plan, which I feel are inadequate.
A System Out Of Balance: Challenges
Illnesses
Disease tops the rank of biggest of Australian health problems. Lifestyle and chronic diseases have become more common. In the year 2004-2005, 77% of Australians were suffering from at least one long term health related condition. More than 70% of the health sector spending is consumed by chronic conditions (Spiegel & Hyman, 1991).
The health sector has always been skewed towards the management of sickness rather than encouragement of wellness. Nationally coordinated mechanism to deliver health promotion services to a margin required to influence the cost of chronic diseases are lacking (Singh, Hinze, & Coble, 1999).
Workplaces’ role in support of healthy employees is ignored. Level playing field for funding of community based activities and allied healthcare is not maintained.
Tension between Private and Public Provision
The existence of competitive tension between the private and the public hospitals in the provision lack balance. Patients have to wait for many days in private hospitals as the credibility of public hospitals wane.
Health System Is Provider Focussed Than Patient Focussed
In the current system, it is the patient who has the role of seeking multiple health professionals. The professionals should instead act as a team and practise together to provide care around the whole needs of a person.
A Disjunction between Service Provision, Teaching and Research
Provision of health care, teaching, and research cause a misunderstanding between corporate and clinical responsibilities of hospitals. Balancing between the three facets of the health system leaves their budget strained while service providers have to balance between being teachers and their patient obligations (Lewis, 2003).
Inequities
There is a proven gap in access to and in the outcome of health services to different groups in Australia:
- There is a gap in life expectancy at birth for Aboriginal and Torres Strait Islander peoples
- Poor support for mentally unstable patients
- People living in remote areas have little or no access to health care
- Basic dental care is beyond the reach of common Australians
Inefficiencies
A high degree of inefficiencies in terms of poor processes, high costs of medical provision, errors, high administrative costs and ineffective treatments adversely impact on patients’ access to quality health care (Carrin, 2009). There is variation in hospital cost per patient, inefficient primary care delivery, neglect of older patients and so on
Vision and Reform Goals
The report proposes a sustainable, high quality, and responsive health system. To achieve this level, the government should develop a plan that entail moves to improve health. This is achievable under the three reform goals, namely;
- the system be geared towards tackling major access and equity issues that are among issues affecting the health system today
- Restructuring of the health system to make it better positioned to respond efficiently to emerging issues
- Creation of a quick and self-improving system capable of long term sustainability.
It should be understood that these three reform goal are not phases of reform, they should run concurrently beginning now (Lewis, 2003).
Steps to Tackle Major admittance and impartiality concerns
- Finances to be engaged towards construction of (public) hospitals with major disaster units. This will cater for availability of ready beds and staff. This means that critically sick patients are not kept waiting for long.
- The maximum time allowed for a sick individual to obtain a range of healthiness services will be identified by the set targets.
Redesigning the Health System
- Propose for establishment of more stand-alone elective surgery services to allow both the planned and emergency patients to be attended efficiently without delays
- More recovery facilities be built and staffed
- Establishment of Comprehensive Primary Care Centers and Services for provision of a “one-stop shop” service.
- Development of better forms of mutual care across common traditions and specialists.
- People with chronic diseases and the minority groups will have a choice for registering either with general practice or a primary health care service to provide them with a “health care home”.
- Aged care services are given a greater choice, improved primary health, and palliative care support.
Embedding liveliness and Self-Improvement
- Give every citizen a possibility to keep an eye on time.
- Fund public hospitals depending on the number and the complexity of the patients they treat. The hospices should also be rewarded for performance pointers such as effective communication.
Tackling Major Access and Equity Issues
This move aims at ensuring that all Australians have access to effective and high quality health services. “The plan will be turning the aspiration principle into a real and achievable step” (Glanz, Rimer & Lewis, 2003). The basis of this goal arises from the realization that there exist health service gaps and inequities in the current health system. The focus should be on dental care, public hospitals, and mental health services.
Dental care
Serious gaps exist in dental health care where a large number of Australians are on the waiting list. Another bigger group cannot access dental health due to high costs associated with treatment. This report proposes a new universal scheme for access to basic dental services – Dental care.
Timely access to quality care in public hospitals
The reform will improve access to quality care in public hospitals. The whole system will be overhauled. The redesigned system will ensure improved access to primary health care services, recovery after an operation, and support to people with chronic illnesses (Bracht, 1999). Major improvements will be directed to the emergency departments and elective surgery waiting lists.
The establishment of National Access Targets will improve on the timeliness of care especially in public hospital services. These changes should serve to strengthen hospitals and make them institution for caring for patients with complex needs (The Commission, 2008).
Mental Health Services
This plan intends to provide the platform for increased effective response to high prevalence mental health disorder. The reform proposes provision of right support and care services for mentally disturbed people. Ways to ensure there is a range of treatment and support services across health care. Sub-acute services in the community will be expanded (NHHRC, 2009).
Aboriginal and Torres Strait Islander health
Reduced life expectancy, high maternal and infants rate of mortality and morbidity and low birth weights are some of the issues affecting the Aboriginal and Torres Islander Health. A radical change should be implemented to alter how we take responsibility for improving the health of the Aboriginal and Torres Islander people (Gardner & Barraclough, 2002).
A new National Aboriginal and Torres Strait Islander health Authority should be formed mandated with the management of funds set aside for their welfare, affordability of fresh food, fruits and vegetable to the remote communities should be beefed up.
Redesigning the Health System to Respond To the Emerging Challenges
The current health system is only focused on sickness. It is rather reactive not proactive. Measures should be enforced to avail precautionary interventions, change in ailment patterns, and the aptitude and support to initiate and carry on with prevention. Such a move is highly unlikely as it is not possible for the health sector to go out seeking to encourage people to keep healthy.
The proposal to form a new agency geared towards carrying out a strategic and premeditated role in driving an elementary paradigm shift in how populace think about wellbeing is a good idea. However, this is a big job (Bell & Shalit, 2003). The work itself will require many hands from both the governments and the public. Perfecting the agency by reaching out to individuals, the health sector
Shifting the curve of health spending towards prevention may likewise meet some challenges especially the service and population based interventions. Research reveals that there is presently no comparable sponsor to invest in such field. This role has to be taken by another agency such as the National Health Promotion and Prevention Agency.
Trying to plan on intervention, a common approach to evaluation has to be established. This will entail a consistent evaluation of medical care, pharmaceuticals, prevention and population health intervention etc. Such a wide coverage demands cooperation, which is not always guaranteed from all the sectors.
Factors Hindering the Implementation of Planning Health Services
Political Factors
Certain factors are likely to delay the plan such as the increase in demand for, and the expenditure on the healthcare. These factors include the advances in medical technology, ageing population, increasing chronic diseases and shifts in consumer expectations. If all these issues are to be addressed, the leadership of all governments must be involved.
There is no ‘one health system’ in Australia. If the recommendations are to be met at national level, the leadership must be involved (Bratch, 1999). The problem is that Australia does not have a single government responsible for the health policy, its programs and funding. The reform of the health care will call for the leadership and commitment of all the states as well.
Funding
Reform covers a wide range of initiatives. The initiatives have differing degrees of implementation difficulty ranging from increased funding for health services. This is a tough call especially during this time of aggravated economic crisis.
The government is already carrying extra burden funding existing health service and social insurance. Although health service planning is a means to improving health services, duplication of duties in other areas of the systems means the government has to dig deeper for more funds that might be unavailable.
Genuine Participation
Most of the steps advocated for in health plans require genuine participation, which is not always easy to achieve. Serious measures have to be taken to promote community participation in a meaningful and non-tokenistic way. This participation should also be sourced from regional level.
Patients’ Perception and Decisions
Some areas will require patient’s decision especially when they are dying. This presents yet another uncontrollable factor in health planning (Carin, 2009). In some instances, the decision making will involve more than just the patient and will include informal and family carers supporting health care services.
Time
The whole process sometimes requires too much time. Educating millions of people about the new health care plan may take years considering that very many areas have to be integrated into the society.
Health Workforce
The scale and magnitude of health plan transformational change requires that the number of service providers be more than tripled. The government budget cannot afford the training of such a large workforce bearing in mind that a large proportion of the workers are aged (Eikenberry, 1990).
Conclusion
Health planning service is vital constituent in health service delivery. Several factors hinder successful implementation of reforms. Factors such as political play, inadequate funding and lack of enough cooperation, insufficient participation and inadequate health workforce hinder implementation of change. The aspects of time and the breath of the health sector are some of the other hindering factors.
Reference List
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Carrin, G. (2009). Health Systems Policy, Finance, and Organization. Amsterdam; Boston: Elsevier/Academic Press.
Eikenberry, G. (1990). The Seeds Of Health: Promoting Wellness In The 90’s An Anthology On Health Promotion. Ottawa, Ont.: Canadian College of Health Service Executives.
Gardner, H., & Barraclough, S. (2002). Health Policy in Australia (2nd ed.). London: Oxford University Press.
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The Commission. (2008). Beyond the Blame Game: Accountability and Performance Benchmarks for the Next Australian Health Care Agreements, A Report. Washington: The Commission.