1.BY M.USAMA MANSOOR110603010

2. Overview What is the nature of Health Policy of Australia? What are the major health interest groups, and whatinfluence do they have? What role does politics, power, and ideology play inshaping the health system? 3. This chapter provides an analysis of the nature ofAustralias health policy. The financing and organisation of Australian healthpolicy are products of a clash between the ideologies of compulsion and freedom of choice. Ideological differences between the major politicalparties remain the principle reason for the frequent changes in policy direction. 4. These are the result of competing beliefs over the roleof the state, the individual, the community, and the market. The major players are politicians and doctors, withhospitals and the insurance industry playing supporting roles. The chapter examines toe role of politicians anddoctors with reference to the impact of ideology, politics, power, and structural interests on health insurance arrangements. 5. Australian Health Care System Australian Health Care system are its federal structureand a public/private division of responsibilities. These two characteristics provide a backdrop for the organisation of Australian health care system. 6. Federal Structure In 1901 six Australian colonies accepted the need for anational and central authority. They agreed to the passing of an Act for the establishmentof the Commonwealth of Australia known as the Commonwealth of Australia Constitution of Act As a consequence the people of New SouthWales, Victoria, South Australia, Queensland, Tasmania, and Western Australia were united in a federal Commonwealth under the name of the Commonwealth of Australia 7. The Constitution of Australia divided responsibilitiesbetween the Commonwealth government and the state governments The national parliament was given the power tolegislate for the pace, order, and good government of the Commonwealth in regard to the forty subjects named in Section 51 of the constitution. There were also concurrent powers on which both thenational and the State governments had the authority to pass law, but in the event of a conflict between the two, the nation legislation would prevail. 8. The national government was granted some powersexclusively, including customs and excise, defense, currency, external affairs and territories. Some areas of potential legislative activity wereprohibited to both national and State governments All other power remained with the states (Jeansch1988,p.30). 9. Shared responsibilities The responsibility for the organisation and delivery ofhealth services is shared between the three tries of government (Richardson, 1998, pp. 192-213) The federal government has a leadership role in policymaking, particularly in national issues like public health, and national information management (McGuiness 1999) It funds most hospitals medical services expenditure(AIHW 2000, p.404). 10. The universal, public health scheme known asMedicare is a Commonwealth responsibility. It provides for: Access to free treatment in public hospitals, including Medical treatmentas hospital in-patients or out-patients, through agreements between the federal and State or Territory governments, which compensate for loss of income as a result of the free, public hospitalization of those electing to be treated as public hospital patients (Grant & Lapsley 1993) 11. Universal insurance against the cost of private medicalservices. (Deeble 1991). 12. Public/private division of responsibilities There is a clear public/ private split in the organisationand financing of health care. In 1997-98 private sources accounted for 31.4% of totalhealth expenditure In contrast to expenditure of 23.4% from the Statesand local governments 13. 42.5% from the federal government ExpendeturesState and local PrivateCommonwealth 14. Health Insurance The purpose of insurance is to provide protectionagainst loss. This involves ;a contract whereby, for a stipulatedconsideration, called premium, one party to identify or guarantee another against loss by a certain specified contingency or peril, called a risk, the contract being set forth in a document called a policy ( Titmuss 1974, p.90). 15. The purpose of health insurance, be it private, is to provideprotection against the financial loss of unpredictable health care costs. It does this by eliminating or reducing out of-pocketexpenses through the pooling of costs. It generally incorporates a redistributive element in theform of cross subsidization of the sicker and poorer members of society by the healthier and wealthier members. This is known as community rating (Scotton & Macdonald 1993) 16. There are various health insurance models, and thoserange across two continuums: selectiveuniversal coverage and public private provision. Seletive coverage istargeted usually by meanstesting, so that only those considered unable to provide for themselves recieve benifits and/or services. Universal coverage seeks to provide benifits and orservices for the whole population. Public provision is largely defined as provision ofgoods and services by the state. 17. Private provision generally refers to good services thatare provided in the market, and is dependent on the efforts of individuals, families, and communities for thier on need. Selective coverage assumes that thr majority of thepopulation will be responsible for their own health care needs and hence favours private health insurance. Universal coverage assumes collective responsibilityand is usually financed through taxtaion. 18. Public financing of health insurance is likely to bemore equitable, as ability to pay is taken into consideration, with payments or contribution being calulated as a proportio of income for example, the medical levy is calculated on the basis of 1.5% taxable income. Private financing, however is likely to result in thesicker and poorer members of society bearing increased health cost. Threy are also likely to face increasing difficulty inmeeting those costs because of their poor health status. 19. The adoption of community rating seeks to addressthese problems. 20. International comparison The Australian health care system can be bestdescribed as mixed. The financing, organisation, and delivery to healthservices are drawn from combination of public an private sources. Services are largely delivered by private practioners inpublic institutions on a fee-for-service basis. 21. In the United States the Health care System is private The Federation insurance programme Medicareprovide financial assitance to the disabled and elders while Medicade provide financial assitance to the poors. 22. Power,Politics, and Health Care In Australia there are to major political parties ALP(Australian Labour Party) and then a collaition of the parties. With the ups and down in the political senario of Australia their is a variation in the healthcare policy of Australia Labours supports ALP While Doctors and Insurance, Pharmaceutical Companiesthe coilaton. 23. Healthcare System in Pakistan In the article 38 subclose (d) of the constitution of 1973 it iswritten that, to provide basic necessities of life, such as food, clothing, housing, education and medical relief, for all such citizens, irrespective of sex, caste, creed or race, as are permanently or temporarily unable to earn their livelihood on account of infirmity, sickness or unemployment is the responsibility of the state. 24. Healthcare System: Organization TERTIARY FACILITIESSECONDARY CARE: Tertiary health quarters, District health quarters PRIMARY CARE: first level healthcare facilities e.g. basic health units, rural health units, dispensaries 25. Healthcare System: Delivery 26. Health insurance in Pakistan The people in Pakistan are provided acidential deathinsurance of Rs 1,00,000/= for 2 years. Further the government provide free health facilities toits populace espacially poors on her expenses in public hospital Where as the private insurance companies also providehealth insurance via policy the agreement that in case of accident or death they will provide a fix amount. 27. Power,Politics,and Healthcare Before the 18th ammendment the health was federalsubject. After its passing from the NA and senate of Pakistan it became provincial subject. While federation and the Governement each decide thebudget to be spended in the healthcare sector. They also recuit the mangerial staff and invest for research on diffrent diseases such as, dengue. The also licence the Pharmaceutical companies and ensureits quality. They also decide the price of a medicine to be launced in the market to be in the limit of populce 28. Conclusion Healthcare system has a great importance in thedevelopment of a country. If the populace will be healthu they can work day in day out to pave ways for the progress of the country. For this the goverment has to increase the allocation inthe sector of health from 5% gradually to 25% Govt has to ensure the quality reserch facilities atterciary hospitals of Pakistan.