Topic 2: Australia’s Health Care System & Health Care Workforce

Introduction

After completing this topic you will be able to:

• Discuss Australia’s health care system.
• Discuss the role of the Commonwealth Department of Health.
• Explain the role of SA Health and/or your state or territory Department of Health.
• List the factors that influence the delivery of quality health services in Australia.
• Describe the health care workforce in Australia.
• Describe the role of the public hospital system in Australia.

As a registered nurse you need to have an understanding of how Australia’s health care system works. Duckett and Wllcox (2011, p.11) summarise Australia’s healthcare system:

Health care is a system involving inputs (finance, workforce), processes, outputs and outcomes and is situated in a broader socio- cultural –political system.

The outputs and outcomes of the health care system include individual or person level outputs (patients treated) and outcomes (improved quality of life) and wider systemic outputs/outcomes (research outputs, strong communities and changed environments). Health outputs and outcomes are not always distributed evenly across all members of society.

The healthcare system can be evaluated in terms of equity, quality, safety, acceptability, efficiency and effectiveness.

The organization of and design of health care systems must consider the differences between the need, demand and supply of health services. The ‘need’ for health services is not objective, but is framed within a social and political context.

Management of Australia’s health care system is devolved to state and territory governments from:

Commonwealth Government Department of Health
Last viewed 18 June 2015

In South Australia, the public health care system is managed by SA Health:

SA Health
Last viewed 18 June 2015

Students in other states and territories should access their state and territory Departments of Health to see the level and type of health services provided to those communities

Using the hyperlinks provided in the preceding section, discuss in your virtual classroom and on the Topic Two discussion board the role of the registered nurse in Australia’s healthcare system.

Now that you have some hard data (evidence) from reliable sources, discuss how the health care system could be improved.

This link will take you to the Australian Institute of Health & Welfare (AIHW), where you will find further evidence describing the different aspects of Australia’s health care system.
Last viewed 18 June  2015

There is also access to a wide range of information relating to Australia’s health care system and workforce.

Bring to your virtual classrooms answers to these questions for discussion:

• What are the main features of Australia’s health care system?
• How essential are registered nurses to the health care system?
• How safe is the role of the registered nurse? Could the registered nurse be replaced by an unlicensed health care worker?
• As a health care consumer what are your expectations of the health care system?

The Australian Health Care System

The Public Hospital System

The majority of graduate nurses will work in the public hospital system in Australia. ‘In 2012-13, there were 746 public hospitals down from 756 in 2008-09, with 58,311 available beds in Australia and while the geographic distribution of hospitals does not ensure  equal population access, this amounts to 2.6 public beds per 1,000 population’ (Australian Institute of Health and Welfare 2014).

The role of public hospitals was primarily to provide acute care, and this is reflected in the funding models used in health care organizations. Over time, public hospitals developed sub acute services, continuum of care services, geriatric rehabilitation and palliative care, as well as providing care for nursing home residents.

Why is knowing about funding important?  At a most basic level the funds are necessary for salaries of healthcare professionals so you can see how funding shortfalls relate to staffing levels.

The Private Hospital System

Australia also has a private hospital system, funded on a fee paying basis from private health insurers. In 2012-13 there were 592 private hospital facilities up from 564 in 2008-09. This reflects approximately 1.3 beds per 1000 population (Australian Institute of Health and Welfare 2014).

The rapidly growing private health care system currently provides approximately 40% of al health care services with the publicly funded health sector depending on this support to reduce the burden of free public health (Foster & Flemming 2008). Having some six million Australians with private health insurance directly pays for around one-third of the costs of hospital care in Australia.

In the private sector individuals take out private health insurance to cover private hospital fees, but as you are aware, there is often a ‘gap’ payment.   Also, patients with private hospital cover can still go into the public hospital system. Another point of difference between the public and private sector is the waiting lists. Waiting lists for elective procedures in public hospitals are long (can be up to 10 years for certain procedures), making access to health services for a large section of the population problematic.

Australian Health Care Workforce

Duckett and Willcox (2011, pp. 76-77) summarise Australia’s health care workforce:

• Almost 1 million people or one in every 10 employed people in Australia (9.8%) work in health and social assistance industries.
• Nurses are fairly evenly distributed across metropolitan, regional and remote areas.
• Improving workforce productivity is the key to addressing health workforce needs in the future. Productivity depends on a number of factors, such as the proportion of paid hours given to patient care, how work is organized and the contributions of other health professionals.

In 2013, the total number of registered and enrolled nurses in Australia was 344,190 (AIHW Nursing and Midwifery Labour Force Survey 2009; NHWDS: nurses and midwives 2013). This overall number reflects 248, 542 registered nurses, 31,190 nurses who are both a registered nurse and a registered midwife, and 58, 452 enrolled nurses.

For further information on the health care workforce go to:

Health Workforce Australia
Last viewed 18 June 2015

SA Health’s model of care for hospitals
SA Health
Last reviewed 18 June 2015

Other factors which impact on addressing health workforce needs are professional skills escalation and the expansion of scope of practice (the nurse practitioner role).

As new registered nurses you will be essential members of the health care workforce, and the skills and knowledge you will bring to the health care workplace support the delivery of safe, competent care to patients.

The scope of the registered nurse’s role is changing due to:

• The burden of disease in Australia
• Changes in services delivery
• Community (healthcare consumer) expectations
• Workforce expectations
• Workforce specialisation.

Health care is a system involving inputs (finance, workforce), processes, outputs (patients treated) and outcomes (improved quality of life). The Australian health care system is a delicate balance between, need, demand and supply of health services (Duckett & Wilcox 2011). Of particular note is the South Australian Governments’ recent initative of Transforming Health. What implications does this reform have for nurses, patients and the wider community?

Of the almost one million Australians employed within the health care sector, nursing continues to be an integral component in meeting the health care needs of the future. Despite these significant numbers of personnel, nursing continues to be plagued by the constant national and international pressures of shortages of staff. The following reading reflects this concern in Australia.

Trends in Health Care

In response to World Health Organisation’s global strategy Health for All by the year 2000 and its subsequent revisions,the National Health Priority Areas (NHPA) initiative was introduced in Australia  by the State, Territory and Commonwealth governmets. It is a program of collaborative action between Commonwealth and State and Territory governments, non-government organisations, health experts, clinicians and consumers, for specific diseases and conditions. From this initiative priorites of health care were established with diseases and ilnesses that were thought to have the biggest burden on Australia’s population. Through focussing on these dieases or ilnesses it is thought that significant improvements in the overall health of the population would be improved thus reducing the burden on the acute care hospital system.

National Health Priority Areas
AIHW
Last viewed 18 June 2015

Now that you have some knowledge regarding the priorites of the Australian Government in health care funding, where do you think the priorites of nursing should be?

Share your answers in your virtual classroom or online in the Topic Two discussion board.

References

• Australian Institute of Health and Welfare 2014. Australian hospital statistics 2012–13. Health servicesseries no. 54. Cat. no. HSE 145. Canberra: AIHW.
• AIHW Nursing and Midwifery Labour Force Survey 2009; NHWDS: nurses and midwives 2013.
• Commonwealth Department of Health & Ageing, Last viewed 18 June 2015.
• Fedoruk, M & Hofmeyer, A (eds) 2014,  Becoming a Nurse- Transition to Practice,Oxford University Press, Australia.
• Health Workforce Australia 2013, Last viewed 18 June 2015

Suggested reading

• Leggatt, S 2012 ‘The public Hospital System’ in wills, L Reynolds & H Keleher ( eds), 2nd ed, Understanding the Australian Health-care System, Churchill Livingstone Elsevier, Sydney, Chapter 2 pp 13 -26.