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= Health care system in Australia =
 * This article is about the Health care system in Australia. For the general health issues see Health in Australia
 * This article is about the Health care system in Australia. For the general health issues see Health in Australia

The health care system in Australia, officially the Commonwealth of Australia, is the "complex web" of services, providers, recipients and organisational structures that deliver health care services to meet the health needs of the Australian population over a landmass of 7 692 000 KM2.

The structure and configuration of these services, providers, recipients and organisational structures are caries from country to country. In Australia the health care system is characterised by a series of often complex relationships between public and private providers, organisations, and supporting mechanisms. It is a federated health care system, with shared national, state and local roles, public and private driven with mixed funding. Together, these elements delivery a diverse range of health care services. These vary in complexity, location and include public health and preventive health services, primary health care, emergency and hospital-based services as well as rehabilitation and palliative care.

In 2011-12, health expenditure in Australia was estimated to be AUD$140.2 billion, or 9.5% of Gross Domestic Product. Health expenditure is growing, a factor which is attributed to population ageing as well as the change in prevalence of chronic conditions, diseases and risk factors.

History
Australia is the sixth largest country in the world being, taking up its own continent. About the size of Western Europe or the Continental United States (excluding Alaska), the landmass itself is vast. Its geography and spread of the population presents a range of particular challenges to the organisation and effectiveness of the health care system.

For at least 40,000 years before British Settlement in the late 18th Century, Australia was inhabited by Indigenous Australians. The arrival of non-Indigenous people "introduced illness from non-Indigenous people, initially smallpox and sexually transmissible infections (gonorrhoea and venereal syphilis), and later tuberculosis, influenza, measles, scarlet fever, and whooping cough." Indigenous people generally experienced better health than European counterparts prior to this time.

The health care system post-1788 was staffed by doctors and those trained overseas. During the time of initial British colonisation, there were 10 medical officers on the 11 ships of the First Fleet, under the direction of Surgeon General John White. Hospital construction was started in 1800, with the first permanent hospital, Sydney Hospital, opened in 1816. It was not until 1838 that the first trained nurses arrived, they were five Irish Sisters of Charity.

Overview of the Australian health care system
The Australian health care system is divided into three fundamental forms of care.



The Australian health care system is one of the most affordable, accessible and comprehensive systems in the world. Its form and activity are a product of history, culture, political, economic, social and legal influences which are unique to Australia. Like the health care systems of all nations, it is unique. Despite this uniqueness, it shares many characteristics with other health systems.
 * 1) The first, Primary health care, does not require referral and is usual accessed outside of the hospital setting. The first point of contact for a person with the health care system, this includes General Practice services, dental services, allied health and pharmacy services. Primary health care accounts for a significant portion of the Australian health care system, with expenditure on primary health care accounting for 36.1% ($50.6 billion) of total health expenditure in 2011-12 compared with 38.2% ($53.5 billion) on hospital services.
 * 2) The second, known as 'secondary care', requires referral, in the case of specialist services, and includes the health care support and research services which form a part of the Australian health care system.
 * 3) The third, tertiary or hospital care are services provided by both public and private hospitals in Australia. In 2011-12, there were almost 9.3 million separations from 1,345 hospitals in Australia.

The health care system provides services to citizens, those with a variety of visa and those visiting from nations with whom Australia has reciprocal health care agreements.

Health System Program Logic
Whilst the configuration of a health system changes from country to country, the structure and function of the system can be understood through a commonly used framework, or logic model which links inputs and processes to outputs, outcomes and eventual impacts. This framework is used to structure the outline of the Australian health care system found here.

Health care financing
Australia's health care system is financed by the Commonwealth, State or Territory and finally local governments. Particular parts of the health care system are partially financed by private health insurance arrangements. Medicare is a central national universal insurance scheme and is administered by the Commonwealth Government.

Health expenditure
In 2011-12, health expenditure in Australia was estimated to be AUD$140.2 billion, or 9.5% of Gross Domestic Product. Health expenditure is growing, a factor which is attributed to population ageing as well as the change in prevalence of chronic conditions, diseases and risk factors. Governments funded a pproximately 70% of total health expenditure during 2011-12 with the Commonwealth Government contributing 42.4% and state and territory governments 27.3%. In 2011-12, patients funded 17% (AUD$42.4 billion), private health insurers (8%) and accident compensation schemes (5%).

The national average level of recurrent expenditure on health was AUD$5,881 per capita in 2011-12, with such spending the lowest in the state of New South Wales (AUD$5,711) and highest in the Northern Territory (AUD$8,512). Australia's average health expenditure per capital is higher than the OECD average (AUD$5,484) and median (AUD$4,851) expenditure.

Recent attention has been focused on a debate surrounding the sustainability of current government expenditure on health.

Commonwealth Government
The Commonwealth Government tends to fund, rather than directly provide health services in the Australian health care system. The Commonwealth Government is responsible for key health financing elements, including the national universal health insurance scheme (Medicare), the Pharmaceutical Benefits Scheme and maintaining the assessment and other processes which govern the financing of the health system and services, such as the Medical Benefits Schedule (MBS). It plays a significant role in the regulation of the private hospital and day surgery sector by its part-responsibility for regulation, however, does not regulate the provision of public hospitals, which are regulated and directly provided by State and Territory governments. The Commonwealth Government largely regulates and provides significant funding to residential aged care facilities and aged care services which form a part of the Australian health care system.

The role of the Commonwealth has variously increased and decreased over time. With the National Health Reform Agreement, made through the Council of Australian Governements process in 2011, the Commonwealth gained significantly more funding and regulation of the Australian health care system. The Commonwealth is responsible for the funding and operation of a variety of veteran's health services. No longer offered in specific Veterans Hospitals, such as Concord Repatriation General Hospital in Sydney or Greenslopes Hospital in Brisbane, the Commonwealth funds services through the Department of Veterans Affairs. These include General Practitioner services, a specific veteran's Pharmaceutical Benefits Scheme and the treatment of eligible veterans in a private hospital.

State and Territory Governments
The eight States and Territories administer and fund health services within their own jurisdictions. In particular, public health and other outpatient services are operated or controlled by State or Territory governments. A national approach to activity-based funding of public hospital services and block funding for small regional and rural hospitals was introduced in the National Health Reform Agreement. State and Territory health services are funded through National Health Reform funding and National Partnership Agreements (NPAs) used to fund the delivery of specific projects or reforms by states and territories.

Local Government
Local government has a limited role in the direct provision of health funding or operation. Local government is partially responsible for environmental health and other public health and sanitation services. Baby health centres have been a traditional exception to this rule, continuing to be operated by local government.

Private health insurance
Particular parts of the health care system are partially financed by private health insurance arrangements. For those who pay for private health insurance, part of the cost of being admitted to a private hospital, public hospital or for ancillary services are met by the private health insurer, the government through the MBS and PBS and the patient themselves as an out-of-pocket payment. Out-of-Pocket payments in Australia are significant and rising, with hospital services seeing the largest proportional increase in expenditure. In 2010-11, approximately $2.5 billion was spend by private patients in private and public hospitals on out-of-pocket costs.

Private health insurance is regulated by Commonwealth legislation which defines the benefits and activities which it can pay for. These include treatment in a private hospital, treatment of a private patient in a public hospital, some extended chronic disease management services as well as a range of ancillary and allied health services.

Approximately 12.6 million Australians currently pay for private health insurance. In Australia, the stated goal of private health insurance includes the provision of patient choice. whilst reducing reliance on the public health sector. These discourses have been described as "neoliberal discourses of choice and individual responsibility, partnership and healthy lifestyles." Evidence is also not yet clear if private health insurance uptake does in fact achieve its goal of patient choice or reducing the pressure on public sector services. The uptake of private health insurance has been driven by a range of "policy ‘carrots’ (the private health insurance rebate) and ‘sticks’ (the Medicare levy surcharge)." Private health insurance is supported by an insurance mandate in the form of the Medicare Surcharge Levy combined with a 30% Private Health Insurance Rebate. Evidence shows that the mandate has several distinct effects on behaviour: "compliance with mandate is relatively low: the proportion of the population with PHI coverage increases by 6.5 percentage points (15.6%) at the income threshold where the tax penalty starts to apply."

Private health insurance policy is an area of controversy and is often at the centre of political debates in Australian health care service management. Scholars working in health policy and economics have argued that the system of private health insurance "leads to implicit transfers of wealth from those most at risk of adverse health to those least at risk. When considered oversociety as a whole, these transfers are both inequitable and increase the risk faced by individuals and families."

Medicare
Medicare is the Commonwealth funded and administered national, universal health insurance scheme. It provides a range of rebates for approved health services, including General Practitioner and Specialist consultations and medical procedures. It is funded by tax revenue.

See also Medicare (Australia)

The Medicare Benefits Schedule is a schedule maintained by the Department of Health. The Commonwealth Government defines subsidies paid by Medicare for outpatient care and outpatient physician services such as General Practitioner consultations.

Opposition from medical groups to the creation of a national health service.

Pharmaceutical Benefits Scheme
The Pharmaceutical Benefits Scheme is a Commonwealth Government program which provides subsidised access to pharmaceuticals for Australian citizens and residents.

See also Pharmaceutical Benefits Scheme

Commonwealth regulation of workforce
Since 2008, all health professional registration has been managed at a national level through the Australian Health Practitioner Regulation Agency (AHPRA). This reform was achieved by a national legal reform which saw each State and Territory (with some variance between each) enact a version of the Health Practitioner Regulation National Law in their own jurisdiction.

There are a range of National Boards, one for each professional grouping, which implement the scheme, with AHPRA acting as the agency responsible for supporting the work of the National Boards. Each National Board designs and sets the registration standards which apply to each health profession. Applicant health practitioners must meet these standards in order to receive registration. Once registered, yearly renewal of registration is required with the National Board.

Occupations
The following health professions are now nationally registered by AHPRA:
 * Aboriginal and Torres Strait Islander health practitioners
 * Chinese medicine practitioners (including acupuncturists, Chinese herbal medicine practitioners and Chinese herbal dispensers)


 * chiropractors
 * dental practitioners (including dentists, dental hygienists, dental prosthetists & dental therapists)
 * medical practitioners
 * medical radiation practitioners (including diagnostic radiographers, radiation therapists and nuclear medicine technologists),
 * nurses and midwives
 * occupational therapists
 * optometrists
 * osteopaths
 * pharmacists
 * physiotherapists
 * podiatrists, and
 * psychologists

Education
Education standards for health professionals who are registered by the National Boards of the Australian Health Practitioner Regulation Agency are set by the relevant National Board.

Registration
The registration of health practitioners is designed to assist in the protection of the public, facilitate professional mobility across jurisdictions and to establish standards for health practitioner education. In Australia, health practitioner registration is managed by National Boards, who are supported by the Australian Health Practitioner Regulation Agency and is governed by the Health Practitioner Regulation National Law (national law).

The Health Practitioner Regulation National Law reserves a range of 'protected titles' such as 'physiotherapist'. It is an offence to use a protected title without being registered with the relevant National Board. Beyond the use of specific titles, it remains a offence to either use symbols or language which may lead a reasonable person to believe that a person is a registered practitioner, or to claim to be qualified or registered as a health practitioner.

Registration is required of any person who: #							uses the title “registered health practitioner” with or without any other words (s. 116(a)) #							take or use a title, name, initial, symbol, word or description that, having regard to the circumstances in which it is taken or used, indicates or could be reasonably understood to indicate,that the person is a health practitioner (includes osteopaths) or is authorised or qualified to practise in a health profession (s. 116(b)) #							claim to be registered under the National Law or hold themselves out registered under the National Law (s. 116(c)) #							claim to be qualified to practise as a health practitioner (s. 116(d)) #							undertake a restricted act (which are specific dental acts, prescription of optical appliances and manipulation of the cervical spine). The Australian Health Practitioner Regulation Agency maintains an online register of all registered health practitioners. A separate register is maintained of those practitioners whose registration has been either cancelled or whose registration has been surrendered, agreeing not to practise their profession.

Workforce supply and demand
The Health system is staffed by a diverse range of clinical and non-clinical professionals, support staff and volunteers. This includes registered and non-registered members of the health workforce.

There are a variety of specific health occupations which are defined by their responsibility to "diagnose and treat physical and mental illnesses and conditions or recommend, administer, dispense and develop medications and treatment to promote or restore good health" within the health care system.

In 2013, there were 593,188 registered health practitioners. The majority of registered health practitioners are nurses or midwives (344,190) who constitute a portion three-times the size of the next largest professional group (medical practitioners).

Source : National Health Workforce Data Set 2013, Australian Institute of Health and Welfare

The Commonwealth agency, Health Workforce Australia, closed in 2014, was charged with research and development of information and policy in relation to the Australian health care system's health workforce needs.

Governance
Public Sector

Private Sector

Not-for-profit sector

Relationship between Public, Private and Not-for-Profit Sector

Health professional colleges

Accountability
Consumerism

Consumer advocacy

Policy and media influence

Interaction of need

Demand and supply

Healthcare regulation

Recent Reform
National Health Reform Agreement

Australian Commission on Safety and Quality in Health Care

Independent Hospital Pricing Authority

National Health Performance Authority

Services
Public health & health promotion

Primary health

Rural and remote health

Aged care and disability services

Mental health

Emergency

Maternity

Acute care

Critical care

Transplant

Indigenous health and wellbeing

Dental

Allied health

Complementary and alternative medicine

Palliative care

Sub-acute care

Cancer

Hospital in the home

Home nursing

Medical tourism

Efficiency
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= Rural Health Care in Australia = Rural health care in Australia involves the delivery of health services by private, community and public hospitals in areas classified as rural and remote. Researchers note that the health of those living in rural areas is quantitatively and qualitatively different to those living in major metropolitan areas. These differences include often significant gaps in service delivery, accessibility and lower health outcomes.

Rural areas and those who live in them are often understood as living in a spatially, economically, socially and culturally distinct group,  although there are criticisms of this perspective. Despite the questions about the framing of rural and remote areas and health services as 'other' to the metropolitan norm or majority, the framing does "highlight a serious social and equity issue," particularly the gap in access and health outcomes for rural and remote populations.

Rural & Remote Health Care
Rural and remote areas of Australia are classified according to a number of different schemes in relation to health care services and reporting.

Rural areas are classified by the Australian Institute of Health and Welfare as those extending from large rural centres (urban centre population 25,000-99,999) through to rural areas with an urban centre population of less than 10,000. Remote areas are classified as remote centres (urban centre population > 4,999) through to those areas with less than 5,000 inhabitants. The Commonwealth Department of Health utilises a similar classification structure called the Australian Standard Geographical Classification - Remoteness Area which was created by the Australian Bureau of Statistics. Alongside its 'Districts of Workforce Shortage' data, the Department provides interactive mapping of the Country.

Statistics
The Australian Institute of Health and Welfare (AIHW) provides statistical and other data relating to rural and remote health system performance, health status and determinants of health.

In recent reports, the AIHW noted findings that "compared with those in Major Cities, people in regional and remote areas were less likely to report very good or excellent health", with life expectancy decreasing with increasing remoteness: "[c]ompared with Major Cities, the life expectancy in regional areas is 1–2 years lower and in remote areas is up to 7 years lower." It was also noted that Aboriginal and Torres Strait Islander peoples experienced worse health and non-Indigenous Australians.

Rural Health Policy
Rural health care policy is driven by a combination of Commonwealth (Federal), State or Territory and Local Government. The Australian Health Ministers Advisory Council (AHMAC) Rural Health Standing Committee published a 'National Strategic Framework for Rural and Remote Health' in 2012. This document is an agreed statement made by Health Ministers of the Commonwealth, States and the Northern Territory to identify systemic issues which require government attention and to guide future government action. The agreed statement included a 'vision' that "[p]eople in rural and remote Australia are as healthy as other Australians." It also identified access, service models and models of care, health workforce, collaborative partnership and planning at a local level and strong leadership, governance, transparency and performance as its five goals and outcome areas.

Recent statements by the National Rural Health Alliance, argue that the Commonwealth Government's introduction of a co-payment for Medicare funded primary care services will compound the already poorer access to General Practitioners which rural and remote populations already experience. In a statement on the first proposal, it opposed the major policy change arguing that the consequences for access to primary care in rural areas would "include higher rates of potentially preventable hospitalisations."

Critical Literature
The definition of 'rural health' has been criticised by researchers and health practitioners who question why the phrase ‘rural’ is used. For them, "it implies a unified, fixed and identifiable space that is empirically unproven." In particular, scholars question the accuracy of the construction of rural geographic classifications, and the links between rural classification efforts as "recent impositions of government for facilitating resource allocation."