Equity of Access in the Australian Healthcare System
As Stated in National Health Reform Agreement-Equity of Access is the fundamental base of the Australian Health Care System (DHA. 2013a). Effectiveness, which focuses on ratio of outputs to outcomes and efficiency, which defines as achieving maximum outputs with available inputs or resources, these are other elementary component of the Australian Health Care System. Equity, effectiveness and efficiency these represents ideal health care system, which tends be effective and efficient and able to achieve the efficacy (specified outcomes) in a way that maximize access (distribution); Productivity (output) and outcomes within the resource provided (NHHRC. 2009. P.4). Responsibilities like funding, delivery & regulation is shared by the national & state government of Australia makes the Australian Health Care system universally accessible within the people (AIHW, 2000). Public hospitals & community care funding is joined effort of common wealth (i.e. federal government), states & territories where common wealth use its revenue and tax to fund most of hospital medical service & health research (Common wealth Department of Health & age care, 2000). Since 1990’s National & State health Minister worked alongside of many health care professional to develop a certain Universal framework to assessing the Australian health system (NHPC, 2000). A new framework for measurement of Australian health performance was inspired from Canadian Health information Roadmap Initiative Indicator framework, which was commenced by NHPC (NHPC, 2001).
Equity in health and health care with context of social objective can be defined in many different ways. As Amarty sen argued, when we talk equity we forget to ask on fundamental question ‘equity of what?’ (Sen, A.,1992). But for the context of our knowledge and study we base our understanding on the definition of culyer & wagstaff, ‘the appropriate positive criteria for mormative judgement regarding equity in distribution of health and health care is equality of health status and health care access (Culyer, A.J., & Wagstaff, A., 1993). By adding the equality in the process of equity gives the sense of clear fairness to the consumer. But equality is not equity; equality is just simply described as similarity of status, capacity and opportunity. Equity is an ethical value. A unequal opportunity of being healthy associated by people in socially less privileged groups such as poor people, different racial people to others native land, religious & ethnic group, women and rural resident is reduced by equity in health ( Braverman, P. & Gruskin, S., 2003). Further Braverman et.al stated that the equity in health pursued by eliminating disparities of health that are connected with certain social disadvantage or marginalized or disfranchised community and group within, but may not be limited to the poor.
This definition argues for need for the health care services by individuals which is completely result of both of their medical condition and their social condition. As we know the problem of health care system is not only related to the inequity in health. According to Mathews, social, cultural and educational and more or less classical medical causes are related to the poor health of the indigenous Australian (Mathews, C., 2003).
Equity of Access
Equity in health has been spoken and written frequently by many economist but they never tends to do or continue to do more consistently, clearly & passionately. As Gavin Mooney stated, ‘equity means equal access to equal care for equal needs,’ (Gavin, M., 2003). Since 1960’s quest for equity in health has been major issue and concern to Australian health care system. The introduction of Medibank in 1975 and reinstatement as Medicare in 1984 was the most significant development in term of equity of access after the access of financial barrier (Scotton, R. B., & Macdonald, C. R., 1993). The equity of health service and the consultation time frame for consumer of lower socio-economic status and consumer of high socio-economic status doesn’t shorten by breaking and disappearance of financial barrier (Furler, J.S., et.al 2002). The result in context of other dimension of equity is not good. Access of health care (both primary and hospital care) in term of geographical equity is significantly different between urban and rural area. Fewer doctors per 1000 population in rural Australia relative to urban area is the best example to describe the complex nature of geographic equity in simple. Rural communities considered access of specialist service, access to hospital service to be a problem due to traveling of significant distance to gain and access those service.
Equity of Outcome
Environmental factor and the quality of health care provided equally affects the result of equity of outcomes. Major Policy attention is needed by the appalling health status of our Aboriginal & Torres strait Islander population is one of the best example is equity of outcomes. By action in health sector will not remedied the factor Affecting health status, issue of dignity, identity and justice should be the strategy for the improvement of the health status of Aboriginal & Torres Strait Islander. Reconciliation is one of the key elements required for progress further (Jackson, L.R., & Ward, J.E., 1999).
What is efficiency? According to Farrell efficiency is production of maximum amount of outputs from given amount of input or alternatively minimum input quantities producing a given amount of output (Farrell, M.J. 1957). It is referred as to a concrete goal oriented index indicating how well socially desirable health system is achieved desirable. Health Service efficiency is also considered to be great important dimension of quality health because service affordability is affected by it with the context of limited available resources in health care. Efficient service means providing optimal service and care to patient and community rather than maximum care to patient and community; it is about providing greatest benefit with available resource (Brown, L.D., et.al 1992). One of the key criteria for evaluating the health care system is efficiency. According to the economic point of view, efficiency divided into two key elements; allocative efficiency and technical efficiency.
To provide best outcomes health care system dependent on distribution and allocation of resources; technical efficiency, effectiveness and priority are involved in the process of best outcomes. The optimized ratio of outputs to outcomes, which is also known as effectiveness is the second key element of allocative efficiency. The priority setting in term of overall ratio of inputs to outcomes is the third and last element of allocative efficiency.
Flexibility and adaptability to change and innovation of health care system as a whole and as its constituent elements, is known as technical efficiency. Development of casemix measure for hospital services by palmer was a unique contribution both nationally and internationally (Palmer, G.R., et al, 1986; Palmer, G.R., 1991). Over last decades significant improvement in allocative efficiency was achieved after introduction of casemix funding in Victoria in 1993 (Duckett, S.J., 1995). There have been constantly adaptations of new technologies (like drugs, surgical instrument, surgical technique and diagnostic instrument & technique) since the development of Australian Health Care system. Over the decades of increase in publication and citation, Australia has been able to build up strong and dynamic medical research system (Butler, L., 2001). Comprise of allocative efficiency & technical efficiency gives ‘overall efficiency’, firm can operate on cost or revenue frontier if it’s able to achieve overall efficiency.
It acts as a key dimension for achieving desirable outcomes with correct provision of evidence based health care service to all who couldn’t benefit, but not to those who would not benefit (Aran, O.A., et.al 2003; WHO, 2000). Donabedian argued then effectiveness is the extent to which attainable improvements in health are in fact attained (Donabedian, A., 2002; Donabedian, A., 1982). In same way Juran & Godfrey argued effectiveness to be the degree to the process which result in desired outcomes without any error (Juran, J. & Godfrey, A.B., 1999). The ratio of output to outcome is optimized by effectiveness. Out of number of elements, ‘efficacy’ act as one of key component to the certain extent of which health care sector output leads to the ideal outcomes under best ideal condition (Cochrane, A.L., 1972). The major objective is to ensure the actual effectiveness (in term of ratio of outputs to actual outcomes) which helps to move closer to objective. Effectiveness is the dimension of Australian Health Care which explicitly includes time element, so we can evaluate whether the health intervention are primarily achieve the desired and appropriate outcome within the time frame. The interventions are the care must be provided to people most needed is advocated and supported by effectiveness framework. Early detection and prevention performance within a population area is the indicators for the effectiveness. Effectiveness conceptualize framework of health care system as dimension of performance where “care/intervention/action” achieves the desired result in an appropriate time frame (NHPC, 2001). Norms and specification at central level defines effectiveness to be an important dimension of quality. Effectiveness issue should be handle in local level too, where manager implement norms and work on how to adapt them to local condition.
Actual outcomes (effectiveness) for an intervention or system is affected by numerous factor like the care system design, surrounding environment of discharge patient, safety of device manufactured & pharmaceuticals used and care quality. Proof of evidence of significant level of preventable adverse events occurring in hospital leading to drastic outcomes can be provided by the quality in Australian health care study (Wilson, R.M.et al., 1995). As stated by McDermott, it is suggested that large number of death related to trauma can be preventable or potentially are preventable, which is has be documented after analysis of care following trauma (McDermott, F.T.et al., 1996). These study shows that there are important effectiveness issues in Australian healthcare system with respect to quality of care and it can be described as inability to provide high-quality care.
Interaction between equity, efficiency and effectiveness
The concept of equity, effectiveness and efficiency in term of health input and its outcomes are internationally tackle by WHO and OECD (Organization for Economic Co-operation and Development) to reflect an economic way of thinking. Due to growing concern about safety, service delivery and quality of patient care there have been interesting trends of implicit and explicit link between the concept of equity, efficiency and effectiveness, which is understandable (Berwick, D.M., 1998). As we know second element of allocative efficiency is optimized ration of outputs to outcomes which is also known as effectiveness. Which shows that efficiency and effectiveness are linked and interacted? After the implementation of equity, sick individuals who seek help have their need meet. The value of treatment provided by health service organization is equally distributed to the people in need. With the equity you are not judge or treated and cared on the basis of your fame, fortune, you ability to pay. When the resource is equally distributes between the need of people then equity taken an affect and when there is the equity then we can evaluate the efficiency and effectiveness of the health care service of that organization or of any country.
Health policy where attributes and value plays prominent role, ideological driven problem related to it are inevitable as part of the policy. Perception of problem is affected by attributes and value which plays significant role in policy academics so as to attempt to shape public debate for making rational and reality based perception. There are many problem identified in the context of equity of access in the Australian healthcare system based on efficiency and effectiveness by many writers like Palmer, Wilson, McDermott, Jackson & wards, Farrell and many more; even the solution to that problem have been presented by them but we haven’t yet identify the problem and adopted the solution presented by them. But important aspect is that progress are being made and hopefully health care system will experience continuous improvement in near future.
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