Health Contributions Various Populations

Question: Discuss about the Health Contributions for Various Populations. Answer: Introduction The end of the last century was a landmark in the history of modern societies for its health contributions to the various populations of the world, particularly the older people. In Australia, the enhanced health care was the greatest, causing a considerable decrease in their mortality. Though the health status is a continuum, the health care system is often criticized for its diverse policy formulations, life quality, and self reliance in older people. The problem partly lies in the laxity of families and communities, as well as the socioeconomic and health service delivery systems, in becoming supportive of older people. That means, the system is more inclined to the conditions in which the Australians are born, brought up, live, and toil, as well as the all encompassing social, political, and economic factors (AIHW, 2014). The situation makes it a necessity for the concerned, to identify the elements of old age- health services that are impacting on the Australian economy, policy, and the various components of health care. It is true that the health care approaches of Australia are initiated, considering the needs of its different population, by sex, age, health history, attitude and behaviors, geographies, socioeconomic backgrounds, and cultural traits. For the effective working of the Australian health system, there exists a web of governance and support engineering, that propel policies, law making, coordination, control and funding, facilitating the delivery of quality services. These mechanisms regulate the planning and implementation of service delivery, jointly shared by the governmental and non-governmental bodies (AIHW, 2014). In spite of all these systems that are said to be effective, the older people are still vulnerable to poor and inhumane treatment (Kollmorgen, 2016). Australia's health system for older people Currently, the Australians live healthier with a longer life span than the earlier generations. During the 1960s, the life expectancy for males and females was 74 and 67 years, respectively (AIHW, 2016). The recent mortality status shows that the females who were born in 2013 might live, till they reach the age of 84 (AIHW, 2016). Compared to this, the males have a life expectancy of 80 years. The increase in life expectancy is due to the fact that the Australians are getting more access to high-quality health services that provide greater living standards. According to the recent health data, the number of Australians aged 65 and above have tripled in the last fifty years, and has reached 3.4 million in the year 2014 (AIHW, 2016). Similarly, those people who were aged 85 and above recorded an astonishing ninefold increase in life expectancy during the same period (AIHW, 2016). The Australian Bureau of Statistics predicts that by 2064, the number of aged people of 65 and above will r each 9.6 million, and those aged 85 and above will become 1.9 million (AIHW, 2016). The accountability of these statistics is in mist for some, as there are allegations that many of the assessment made by the Australian Aged Care Quality Agency (AACQA) is far from the actual (Kollmorgen, 2016). However, the claim of Australia about improving the mortality rate among the older population must be seen with a confirmatory perspective, as the global health status of older people has not shown an encouraging trend in the past few years. It is apt to note here that the World Health Organization has already admitted in its recent report that the global life expectancy during the year 2015 was only 71.4 years (WHO, 2016). This affirms that Australias health status represents the positive outcomes of a competitive approach of the Australian health system, and that there would arise situations of increased illnesses, like arthritis, dementia, and the likes, and several impairments, including hearing loss, which are the direct accompaniments when people get older (AIHW, 2016). The accumulation of physical alterations and psychological changes that occur naturally over time in a person will increase the life expectancy, causing increased risk of aging-associated diseases (Disabled Worl d, 2016). In spite of these disadvantages, most of the Australians feel that their health is quite good, reducing the demand for extended aged care services (AIHW, 2016). Australian health service-An overview A countrys health system, with its complexities, work within a political and institutional framework, incorporating all public and private organizations and resources towards maintaining and restoring health, all the while reforming the operation of the health system (Kutzin Sparkes, 2016). As per the World Health Organization, a quality health system delivers quality health care to all people (AIHW, 2014). If the definition is taken as the guiding principle, Australias health service system conforms to the quality health service criteria, performing through multi level functional mechanisms, like public and private health care providers in multi settings, with relevant supporting and delivery systems. The key players in the system are the health care givers and the care receivers, consisting of medical practitioners, nurses, health care workers, hospitals, clinics, and governmental and non-governmental agencies. They are supposed to deliver multiple health services, such as public health services, hospital treatment, community centered preventive services, primary care, emergency health care, rehabilitation, and palliative care (AIHW, 2014). Yet, the aging population of Australia is more dependent on the predominant care and support from family and friends, who are mostly women (CPA, 2014). The health service structure, functioning, and reforms The public sector involves local, state, and territory governments, as well as the Australian government (AIHW, 2014). The private sector care providers are the pharmacies, private hospitals, and the medical practices. The public or government hospitals get their financial support from the state, territory, and the Government of Australia, and are controlled by the states and territorial governments. The private sector hospitals have their own management and infrastructure. Apart from imparting health services to the public, the Australian government and the allied bodies manage the funding and delivery of several other systems of health care. These include (i) the population health care programs, (ii) the community oriented health services, (iii) the researches in medical and health, (iv) the health services for the Aboriginal and Torres Strait Islanders, (v) the mental health care, and (vi) the health infrastructure (AIHW, 2014). In spite of these elaborate health service provision s, there are several shortcomings, which keep the system away from addressing the needs of the older Australians. For instance, there are complaints that the staffing is inadequate and the care is substandard (even though the existing legislation forbids it), placing the aged care in peril (Kollmorgen, 2016). The people get their initial health care when they fall ill and meet the general practitioners (GP). After the initial diagnosis, the GPs may refer the patients to specialists or public hospitals to initiate better treatment options. Though these two steps seem to be the primary activities of the health care system, it involves several providers in various settings, aided by the legislative, regulatory, and funding mechanisms. The configuration of health services varies from one geographical location to another, but the common elements of health care do not change at all (AIHW, 2014), and yet boasting about an efficient funding system, trained and skilled workforce, decisions and policies, material provisions, quality medicines, and technologies to meet the requirement. The failure of the system is evidenced by the fact that the NSW parliamentary inquiry conducted last year, have located 93 NSW nursing homes, that were supposed to provide aged care facilities, lacking accreditation s tandards for more than three years. This means that most of the aging Australians were not having access to the basic needs of nutrition, hydration and safety, during the past few years. At the national level, there were 371 failures of this kind, in the same period, which is an eye opener to the grave situation, the aging people are facing in the health care sector (Kollmorgen, 2016). Therefore, the health service system needs to focus on universal health coverage, offering equity in service and quality, and removing the fear about financial hardship in using the services. Since people require both individual and public health services, private and public services are delivered to optimize quality outcome. The strengthening of the health system should be maintained through stringent policy instruments that underline universal health coverage reforms (Kutzin Sparkes, 2016). Such interventions must be based on cost effectiveness for older people, in order to focus on improving their health status. To facilitate this, new instruments need to be developed to cope with the declining health status, due to the emergent socioeconomic reasons, as the older people value the components of health and social dignity, in terms of quality of life (Luszcz, M.A., Milte, C.M., Walker, R., 2014). In Australia, the health sector is the States responsibility, even though the Commonwealth Government enjoys more power in raising revenue. This necessitates the States to depend on the financial transfers from the National government to meet the expenditure of the health care systems. The complex division of roles, power, and responsibilities cause the systems rely on public, as well as the private sectors. The system is funded mainly through taxation, and the governments contribution is 43% of the total expenditure, while other sources provide 25%. The Medicare covers public hospitals, pharmaceuticals, and medical services. The government provides subsidies for private health insurance protection (Commonwealth Fund, 2017). Types of health care The principal users of the Australian health system are the Australian citizens, foreigners visiting Australia, visa holders (temporary/permanent), and the asylum seekers. The health care sector consists of primary health care, secondary health care, and hospitals, where various health care professionals deliver primary health care services through different settings. Though a large part of the expenditure goes to primary health care (AIHW, 2014), the required transparency is wanting. The Productivity Commission's 2011 inquiry has pointed out this aspect in its report Caring for Older Australians, by stating that the funding models for nursing homes and their residents must be made more transparent and affordable for the aging people (Kollmorgen, 2016). Presently, the funding for primary health care includes the financial support to health organizations that give care services to the Aboriginal and Torres Strait Islander people (Department of Health, 2016), like The Aboriginal and Torres Strait Islander Health Performance Framework (HPF), for coordinating the health sector activities to derive better outcomes among the Aboriginal and Torres Strait Islander Australians (Department of Health, 2016a). The Secondary care denotes the medical service rendered by a specialist/faculty, on a referral from the primary care physicians (Nicholson, 2012). To address the health care needs of the aging people, the government is all set to implement a new funding model in February 2017, in which the allocations will be made straight to them instead of channelling it through the service providers. This will enable older people to avail better care than before (The Commonwealth Fund, 2016). Health care reforms The health care system of Australia is successful in extending quality health at a reasonable cost, and by its virtue the Australians now enjoy a greater life expectancy with a long healthy life. This performance was derived out of the intermingling of the public and private services, and sharing the responsibilities between the national and state governments. Although this system supported the primary care effectively, there was a lack of proper coordination in managing care (Hall, 2015). The factors that steer health reforms are complex, multidimensional, and interlinked.Australias population is growing and will live longer than before, increasing health costs and sustainability threats. Such a population, with sedentary lifestyles, and low health literacy and high consumer expectations need advanced medical technology (Bartlett, C., Butler, S., Haines, L., 2016). The compelling need has already forced the government to give priority in committing reforms in the aged care system t hat is supporting the older Australians, while making it more affordable and sustainable (DOH, 2017a). The significance of the National Health Reform Agreement of 2011, arise in this context, as it is the most important reform after Medicare in 1984. The reform process was started in 2007 under the Kevin Rudd Labor Government. At that time there were hardships in public hospitals, such as long waiting for elective surgery, overcrowding in emergency departments, and safety and quality issues. The Federal government, states and territories blamed each other on insufficient funding and fund management. As a result, the new Government instituted the National Health and Hospitals Reform Commission to formulate reforms in the health sector. The Commissions Final Report, was subjected to various levels of negotiations and changes in the Commissions recommendations (Commonwealth Fund, 2017a). The revised funding package of the government responds to several issues that were hovering over the health sector, by making it more advantageous to Aged Care(DOH, 2017a). The Commissions report contained 123recommendations (Bennett, 2013). The key principles of the reform are: The local decision making: It pertains to the establishment of Local Health Networks that are responsible for regulating the public hospitals, as well as the State health programs. The Local Health Networks are entitled to receive Commonwealth funding directly, and are made responsible for the managing and monitoring of own budgets and delivery of services, thereby transferring the States responsibility of direct involvement in the working of public hospitals to overseeing and managing them. Activity based funding (ABF): This establishes a national system for classifying coding scheme to ensure the steady collection of national data and fixing an efficient price, suggested by the Independent Hospital Pricing Authority (IHPA). The Authority has the responsibility for determining the nationally efficient price. The ABF came into force on July 1st of 2012 catering the needs of acute inpatients, hospital outpatient services, and emergency department services. In order to address mental health and sub acute health care, the ABF was made applicable on 1st July, 2013. The Agreement supports block funding for facilities and services to areas where ABF is not feasible, and allows to continue joint funding of national and states governments for running public hospitals (Commonwealth Fund, 2017) Public performance reporting: Under the provisions of this reform the National Health Performance Authority (NHPA) is constituted to watch the functioning of public hospitals, by means of thewebsite: myhospitals. The NHPA will furnish a series of reports on the functioning of primary care to maintain national consistency. The newly formed 61 Medicare Locals are geographically based, having the responsibility of managing all activities of primary care, including identification of service gaps and developing strategies to fill the gaps, and integrating and coordinating the services. The main aim of the reforms is the restructuring and innovating the public hospital system, with enhanced facilities for preventive activities (Commonwealth Fund, 2017). The reform will bring together all of the key players of the health systems to ensure a high quality delivery of health care to patients, incorporating new technologies. It will also enable the Aboriginal and Torres Strait Islanders and rem ote communities who are isolated from the rest of the Australian society to access health care easily (Perkovic, 2015). The models of health care The adoption of new health care models, like walk-in centers, provides high quality care quickly, for managing minor illnesses and injuries. It enhances the access to public health care in the ACT community, adding value to health promotion (ACT Health, 2015). Other models of care are the personally controlled electronic health (e-health) records (Department of Health 2016b) and tele-health services. The tele-health service utilizes the latest communication technologies, like video conferencing for transferring health information and delivering health services for older people living in remote settings (Department of Health, 2015). DiversityConceptualModel Though the majority of older Australians is enjoying quality in life, the subgroups do not have adequate health. People, like Aboriginal and Torres Strait Islanders have a shorter life expectancy of 12 years than the other Australians. The low level literacy affects their interaction with the health care system, resulting in increased physical and mental health issues in older people, especially the lesbians, gay, and Transgenders, contributing severe health disparities. Therefore, the National Health and Hospitals Reform Commission (2009) has insisted for more reforms in the aged care system, to cope with the demands of the older population in diverse settings. Since the government has adopted diversity as a policy for the reforms in the aged care sector, the health care providers and institutions are incorporating diversity in aged care delivery. Accordingly, a Diversity Conceptual Model was developed for employing it in the aged care sector, for linking diversity as an advantage, while identifying the negative elements in health care delivery. TheDiversityConceptualModel was developed with the help of literature review, questionnaire, target groups, and stakeholder interviews, and got approved by the Clinical Governance Committee for implementation. The participants in this model included external service providers from CALD backgrounds, Indigenous Australians, older people with dementia, and LGBTI people. Additionally, people with dementia and Indigenous Australians, along with a national service provider working in residential aged care facilities. During its development phase, though a detailed search in various literature was made, it could not evolve any tool for supporting the aged care sector. Therefore, the Model included twelve diversity characteristics shared by aging people, according to the special needs groups that are identified in the Aged Care Act 1997, as well as the human rights based approach for ageing and health. The Diversity Conceptual Model considered a diversity approach for addressing all sorts of differences and disadvantages, because the exiting tool, like the Australian Bureau of Statistics Socio?Economic Indexes for Areas, was not designed for the aged care. Moreover, many of the aged care service providers are extending service to the diverse older people, with a policy of caring equally and same, which will not be enough, as it only increase disparities in health care. So, the Model focused more on equity in policy, access, quality of care, sharing, and organizational participation. After incorporating all the relevant information, five themes were worked out for constructing the Diversity Conceptual Model. These themes were: (1) Reason for referral (2) Cultural identity with diversity characteristics (3) Diversity characteristics that are shared in common by the aged people (4) Quality improvements for increased equity, and (5) Application of client narratives for using in the Div ersity Conceptual Model. TheModel thus developed, acted as a visual tool, comprising of several elements that are centered on diversity characteristics. With this model, the gains and loss are identified effectively, in helping the aged people to achieve greater benefits. It also provided consistent quality improvement provisions, along with enhanced equity sharing for them (Michael, 2016). Health Care Policy The health system in Australia is an amalgamation of government funding and private financial resources with a vague jurisdictional line. The system has a policy involving multiple providers and regulatory instruments, and is known to possess a mixed system (Biggs, 2013). It is a mixture of federal and state government responsibilities and funding, and the service delivered through both public and private sectors. The states, territories, and the national government jointly fund the public hospitals, where the states act as hospital system managers. The federal government will have the lead responsibility of primary health care. Private hospitals work as per the requirement of the federal and state governments. The states have the right to the licensing of private hospitals, while the private health insurance is controlled by the national government (OECD, 2015). The key elements of the policy are: (i) integrating health care at governmental level, (ii) improving the information transfer between the health care services, (iii) promoting medical home type primary health, (iv) improving the quality of health care and preventive health care (v) public reporting of health care variation and raising awareness, (vi) informing the practitioners regarding their practice patterns, (vii) improving the shared decisions among patients, (viii) supporting the practitioners by clinical guidelines and decision tools, and (ix) implementing the complementary payment system (OECD, 2015). The primary health care integration at macro levels have strengths and weaknesses, along with weaknesses and opportunities. The integration policies supporting the Australian health reforms call for stakeholders cooperation, consistency in performance, and target oriented objectives. The interdependency of the national government, and the State and Territory governments with the shared policies, promote opportunities for building efficiency, through sharing resources and patients care perception. The difference in the health care approaches of the multiple level governments has potential to reflect the disparities in the care delivered and the distance in accessing the care by the different populations (Brown, L., Bywood P Oliver-Baxter J, 2013). The Australian Government is supporting all forms of continuous and respite residential aged care, determined by needs assessment (The Commonwealth Fund, 2016). The impact of providing health service to older people The health service system in Australia provides residential aged care, as well as community-based aged care for the older population. Initially, the older people enter the community-based care, and then to permanent residential care. The residential aged care includes permanent care, as well as respite care. The community based aged care is divided into two, namely, the Commonwealth Home Support Program (CHSP) and the Home Care Packages Program (HCPP). The first one provides entry level support services and helps the older people to live independently at home. The second one extends four levels of support. In addition to these are several other packages, like the Transition Care Program, the Veteran's Home Care Program, and the Multi Purpose Services Program, for special groups that live in mixed settings. In spite of all these, a good part of the caring for aged people in the community rests on informal caregivers, such as family, friends, and neighbors who are unpaid, and render se rvice on emotional grounds (AIHW, 2017a). The available statistics show that 7.8% of the people aged 65 and above were availing residential aged care, and 2.4% of people aged 65 and above received home care during 201314. Additionally, 263,788 subsidized operational settings were made available to them the same year (AIHW, 2017a). The revelation is an eye opener to the strain on the health care system, due to the burden of old age care. The increasing number of older people demands more workload from the health care providers and caregivers. Moreover, the reduced pay and low level of employment have transformed aged care an unwanted profession for the workforce. Many caregivers feel that age care services is not at all promising to stick with, as a career. The situation is an indicator of the problems the old aged people and the health care system face (Berechee, 2013). Various studies on the health status of the older people and their reduced mortality rate have predicted that by 2050, the number of aged people who are between 65 and 84 will double and that the people who are 85 and above will increase to 1.8 million from the present 0.4 million (Private Healthcare Australia, 2016). That means the real health expenditure for the aged people who are over 65 would increase seven times and the people above 85 will increase 12 times. These rises in life expectancy will create a crisis in the health care sector, demanding more and more medical services, pharmaceuticals, newer technologies, and drugs. Moreover, the ageing population and associated health issues will impose unprecedented economic and social constraints on the communitys socioeconomic settings. Therefore, it is essential to develop new strategies to cope with such situations (Private Healthcare Australia, 2016). Aged care spending As per the health statistics 201112, the direct expenditure incurred by the Government of Australia on ageing care programs and services was $12.9 billion, excluding the expenditure incurred by the government and statutory bodies in other areas of health care. It is estimated that the residential aged care alone incurred an expenditure of $9 billion, while $3 billion was spent on community care (AIHW, 2017b). The Intergenerational Report 2015 underlines that the longer life expectancy coupled with the rise in health costs, will crumble the budget allocations, threatening the health service sustainability. The rise in the rate of aging people, passive lifestyles, poor level health literacy, increased consumer expectations, and higher incidents of chronic diseases will strain the whole system of health care (Bartlett, C., Butler, S., Haines, L., 2016). Though population ageing is a global phenomenon, it will create major challenges along with opportunities that affects the health econ omics, as well as geriatrics (Couzner, L., Crotty, Laver, K., , Ratcliffe, J., 2012). Conclusion The Australian health care system provides quality health care to the Austalians, and as a result, the life expectancy of older people increased considerably. People live healthier with a longer life span than the previous generations. This increase shows that the older Australians are getting more access to high-quality health services that provide greater living standards. However, such reduction in mortality rates poses long standing challenges to the future economy and health care system, as it would invite more fund allocation and resources for meeting the demand of quality health care for the older people. The health care reforms were intended to meet such contingencies, but it is insufficient to address the future health care demands. However, a systemic change and positive collaboration between the Commonwealth government, and the governments of the States and territories could address the problem efficiently. 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