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Up and Running vs. Wobbly Stepping

A Comparison of Two Healthcare Systems


Introduction

As the population’s life expectancy continues to rise, the elderly are developing more chronic health issues. Both the U.S. and Australia are faced with providing accessible, affordable, quality healthcare for their citizens. The U.S. healthcare system is one of the most expensive systems in the world with health expenditure as a percentage of the gross domestic product of 17.7 in the year 2010 (Niles, 2015 p. 60). Australia on the other hand had health expenditure as a percentage of the gross domestic product of 8.9 in the year 2010 (Niles, 2015 p. 59). While Australia runs a universal healthcare program which has proven to be successful, the U.S. has attempted some wobbly steps toward achieving universal healthcare, but is far from the strong strides which are needed.

The purpose of this research is to compare and contrast the healthcare systems of United States and Australia. The major areas which are explored are: 1) the unique histories of both countries, 2) information technology’s impact on healthcare systems, 3) the government’s role and involvement within their healthcare systems, 4) the differences between the two countries inpatient and outpatient services, 5) the makeup of their healthcare workforces, and 6) the financing of both countries’ healthcare systems. Much can be learned by studying the laws and patterns which a country takes throughout the course of its history. The importance of information technology in the healthcare industry has become almost essential as providers seek higher levels of efficiency. The government’s role in a country’s healthcare is tricky because there is a dangerous balance between its need to help in establishing laws for protection and over extending itself with the purpose of gaining more control than it should. Examining the disparities between both countries quality and focus in regards to their inpatient and outpatient services gives a good indication as to whether their level of service will become better or worse in the future. The healthcare workforce is expanding; analyzing its makeup may predict changes on the horizon. Though complicated, looking at financing shows the backbone of the systems.

History of Healthcare Systems

The history of the U.S. healthcare system has been molded by several events and various rulings. The American Medical Association (1847), the Council on Medical Education (1904), standardized admissions testing known as the MCAT (1928), group health insurance (1940-1960), and the Affordable Care Act (2010) have all been instrumental in the making of the history of the U.S. healthcare system (Niles, 2015, p. 4). One major event which has directed our health care is World War II’s economic effects as said by Fredrick Allan (2012), “American-style health insurance, which covers too few people too expensively, began as a strange byproduct of World War II economic sanctions, of all things” (p. 45). The war brought about employer-backed policies and by the 1960’s many working American’s had insurance through their employers (Allen, 2012). As seen, there have been many events which have brought the U.S. healthcare system down a long broken path.

“The Australian system has its origins in UK healthcare delivery before the NHS (1948) and it was only in 1961 that the Australian Medical Association was formed to replace the British Medical Association” (Leeder, 1998). In 1984, Australia instituted a universal healthcare system, “the premium being paid through taxation (a Commonwealth responsibility) (Leeder, 1998). Presently Australian healthcare ranks number four among the world’s top eleven best healthcare systems for overall performance” (Kollmorgen, 2014).

It would seem that the Australian healthcare system has been more open to following in the footsteps of other well-developed nations such as the U.K., whereas the U.S. continues to experiment through trial and error in hopes of finding a unique system that is the perfect match. Though universal healthcare has seemed to work fairly well up to this point for the people of Australia, is America really prepared to take the step of instituting a universal healthcare system of its own?

Information Technology’s Impact on Healthcare Systems

Though there have been some advances with information technology in the U.S. healthcare industry, there is still plenty of room for growth. In the article Timid, But Trying RFID, “Despite continuing concerns about costs, privacy and difficulty of integration, interest in radio frequency (RFID) technology is growing in health care organizations.” (Healthcare Timid, but Trying RFID, 2004) Radio frequency identification is being utilized in more industries than just healthcare. There are host of other form of information technology that could be taken advantage of, but high cost implantation is one of the biggest roadblocks. “Information technology’s use in the United States healthcare market place, known as health IT (HIT), significantly lags behind that of other industries and leaves much room for improvement.” (Hsieh, 2010)

Australia on the other hand has taken greater initiative in developing the use of information technology within their healthcare system. “As a part of its national health reform agenda, the federal government of Australia recently announced plans to spend up to $383 million to introduce personally controlled electronic health records (EHR) for every Australian who wants one starting from 2012-13” (Collingridge, M. 2010). Clearly Australia is becoming more technologically progressive in the health care industry, whereas the U.S. lags slightly behind in regards to such advances.

Both the U.S. and Australia are two of the world’s biggest online self-diagnosers (Johnson, 2013). One of the problems that have occurred, as society becomes more and more digitalized, is that it may pose a threat to direct life insurance. “Digital technology has great opportunities to make the advice process more productive and help it lead to better outcomes – it does not need to replace it or make it obsolete” (Johnson, 2013). Obviously both countries will continue to experience changes in regards to their use of information technology.

Government’s Role in the Healthcare System

The Social Security Act of 1935, the establishment of Medicaid and Medicare programs in 1965, and now the Affordable Care Act of 2010 have all been gradual steps that the U.S. government has taken with the chief aim of gaining more power and control over the healthcare system. The list of governmental agencies responsible for various areas within the healthcare sector continues to rise. The Affordable Care Act is deceptive because it promotes better access to higher quality healthcare, however according to one article, “Despite its insurance market reforms, the ACA falls short on the key areas of access, cost, and quality” (Idelson, 2013). To quote neurosurgeon Dr. Benjamin Carson, he says that the Affordable Care Act is “the worst thing that has happened in this nation since slavery.” He goes on to say that, “in a way, it is slavery, because it is making all of us subservient to the government.”

Australia’s universal healthcare, called Medicare, is funded by the Federal government and there is a “special tax levy on income, and provides universal access to doctors, hospitals and most ethical pharmaceuticals” (Parry, 1994). Fortunately, for Australian citizen this means that they pay very little to nothing for their healthcare because it is taken out of their taxed income. Though intentions are not completely certain, Australia’s government has a lot more control over their healthcare system than does the U.S. In the last year Australia’s government has had to introduce some drastic budget cuts in their healthcare system. “The government’s budget has drawn huge criticism from healthcare professionals and agencies, who believe the changes will exacerbate existing problems with healthcare affordability and inequality” (Sweet, 2014). Though both Australia and the U.S. have vast differences in the level of governmental involvement in their healthcare systems, it appears that Australia possesses better checks and balances. The twisted rout and failed attempts that the U.S. government has tried to take simply does not bid well for its future.

Inpatient & Outpatient Services Within the Healthcare Systems

The U.S. healthcare industry provides good outpatient services that are much more cost-effective, than the astronomical costs of inpatient services. Hospitals admit 35 million individuals annually which is a small amount in comparison to the 900 million individual outpatient visits made in 2013 (Niles, 2015 p. 164). Hospitals in the U.S. have not really been overly concerned about sustainability and green efforts. There is a relatively new hospital in Mississippi that has been focusing on innovative energy-saving systems, hopefully this pioneer will open up more opportunities and interest for other hospitals in the future. “Demonstrating its commitment to sustainability, Methodist Le Bonheur Healthcare, Memphis, Tenn., ensured that the recently opened Methodist Olive Branch (Miss.) Hospital features energy-saving innovations rarely seen in U.S. hospitals” (“New Mississippi hospital features innovative energy-saving system,” 2013).

Australia is extremely progressive with their healthcare facilities and their level of concern for the environment is astonishingly impressive. With better healthcare facilities, comes better inpatient and outpatient services; this equals healthier people, quicker recovery time, and overall heathier people. Melbourne’s Royal Children’s Hospital (RCH) has taken the lead by proclaiming that it desires to be Australia’s greenest hospital with its reduction in greenhouse gas emissions, water saving and rerouting, and renewable energy (McLaren, 2009). According to one survey done in Australia, “Indoor environmental quality has been acknowledged as the highest priority in choosing a healthcare building (Kim, S., Osmond, P. 2013). It seems apparent that Australia greatly values the healthiest of options when it comes to the environment of their inpatient and outpatient services. The U.S. has been a little sluggish on implementing green efforts within hospitals so Australia sets a better example in this regard.

Workforces in the Healthcare Systems

The demand for more doctors, specialists, physician assistants, pharmacists, phycologists, nurses, nursing assistants, and other health related jobs are only expected to rise for both the U.S. and Australia. The U.S. healthcare workforce is one of the largest employers in the country, is made up of 18 million workers, and is expected to rise (Niles, 2015 p. 181). According to the Australian Institute of Health and Welfare, “In 2013, there were 591,503 people registered as health practitioners. Over half of these (344,190) were nurses or midwives.”

The concept of geographic maldistribution has occurs because physicians prefer to practice in urban and suburban areas where there is a higher probability to increase income (Niles, 2015 p. 183). The healthcare workforce continues to grow at a rapid pace for both countries.

Financing of the Healthcare Systems

In 2010, the U.S. spent $2.6 trillion on health care; this is the highest in the world, despite the astronomical amount of money there were still 50 million uninsured U.S. citizens (Niles, 2015 p. 209). Financing for healthcare could not be much more complicated as it is derived from out-of-pocket payments, health insurance plans, public government funding such as Medicare and Medicaid, and health savings accounts.

“We know that many consumers overuse the system, are uninformed about the costs of health care, and make poor lifestyle choices that lead to costly illnesses that are cost to treat. But we also know that consumers will make good choices when they are motivated to do so. We need to create incentives that will encourage us to care about our health, to live healthier lives, and to use the healthcare system more judiciously.” (“The U.S. Healthcare System Can Be Fixed,” 2004)

Herein lies the biggest problem with universal healthcare is that if it is too readily available for all, then it is more likely to be overused and abused. Americans and Australians should be encouraged to make wise choices about healthy living which will develop into good habits; this would act as a credit to the healthcare system. “Why can we not similarly offer people incentives in our health laws that will not violate civil liberties? If we keep such incentive simple, and ensure they are well established, we should be able to reap substantial savings” (“The U.S. Healthcare System Can be Fixed,” 2004). The U.S. healthcare financing has a backbone that has been severed in a few different places and the Australian healthcare financing has one that, though it requires some changes, it supports the system well enough for the present time.

Conclusion

Clearly, as this study has proven, neither the U.S. nor Australia has a perfect healthcare system. The U.S. could definitely learn from the Australian system, if in fact universal healthcare is where the U.S. is heading. The Affordable Care Act is a flimsy attempt at universal healthcare. If the U.S. were to reflect on its history and take note of what has not worked it would not fall into the same pattern of mistakes. The U.S. is at least making an effort in improving its use of information technology. The government’s responsibility is to produce laws that aid in the protection of citizens and their rights. When the government oversteps its bounds by taking too much control that is when the entire healthcare system will eventually topple over completely. Australia definitely leads the way on green efforts and in proving better inpatient and outpatient services. The healthcare workforce in both the U.S. and Australia continue to climb, meeting the futures high demands of healthcare personnel should prove to be interesting to say the least. The financing of the Australian healthcare system is left up to their government, whereas U.S. healthcare financing continues to be very complicated. If the wobbly-stepping U.S. system continues to push for universal healthcare, then it should take a closer examination at what other surrounding, developed countries are doing, such as up-and-running Australia.

References

Allan, F. (2012). Fixing Our Healthcare System. Saturday Evening Post, 284(5), 44.

Collingridge, M. (2010). Australia’s digital healthcare vision. Enterprise Innovation, 6(3), 28.

Healthcare Timid, but Trying RFID. (2004). Health Management Technology, 25(11), 10.

Hsieh, C. (2010). Electronic Medical Record System: Current Status and Its Use to Support Universal Healthcare System. Communications Of The IIMA, 10, no. 3: 79.

Idelson, C. (2013). Bad Medicine. National Nurse, 109(5), 16-19.

Johnson, G. (2013). Digital advice – threat or opportunity? Money Management, 27(44), 18.l.

Kim, S., Osmond, P. (2014). Analyzing green building rating tools for healthcare buildings from the building user’s perspective. Indoor and Built Environment. Vol. 23(5) 757-766.

Kollmorgen, A. (2014). Healthcare costs a barrier for Aussies. Choice, 10.

Leeder, S. R. (1998). Mixed heritage, uncertain future in healthcare. Lancet, 351(9115), 1570.

McLaren, W. (2009). Sustainable hospitals = healthier people. BPN: Building Product News. Vol. 45 Issue 10, p26-29. 3p.

New Mississippi hospital features innovative energy-saving systems. (2013). Health Facilities Management, 26(10), 9.

Niles, N. (2015). Basics of the U.S. Health Care System 2nd Ed. Burlington, MA: World Headquarters Jones and Bartlett Learning.

Perry, T. G. (1994). Costing and Funding of Healthcare in Australia. PharmacoEconomics 5 (3): 180-187

Sweet, M. (2014). Future looks bleak for universal healthcare in Australia. PharmacoEconomics & Outcomes News 706, p2-5.

The U.S. Healthcare System Can Be Fixed. (2004). hfm (Helathcare Financial Management), 58(1), 79.     

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