Healthcare Systems - Director of Informatics For The Metro Hospital - Assessment Answer

Healthcare Systems Assignment

Assignment Task

Task:You have recently been employed as the Director of Informatics for the Metro Hospital in Brisbane. The Metro Hospital is a 363 bed facility on theNorthsideof Brisbane. The services include general surgical, general medical, oncology, vascular, ear, nose and throat, palliative care,

ophthalmology and maternity and children’s services. It has good links with the Division of General Practitioners in the local area.

Introduction

International health is an important aspect as it helps to understand the health system of other countries on broader level. Lessons learnt from countries can be used to improve the health services of another region. For the comparison purpose across different countries, it is important to have quality data collected in same time period. Hence, the following comparison between Australia and Canada have been done to understand the health indicators and the related aspects. The reason behind selecting these countries is that both have similar pattern of healthcare funding consisting higher percentage of public sector including insurance system. The healthcare service comprises of federal, state and territory public system. Authentic and consistent data have been collected through national level surveys in both the countries within same time period.

Healthcare Funding System

Internationally, Australia and Canada both the countries are comparable in terms of several health indicators. The healthcare structure follows the similar pattern in these countries. Discussing about the healthcare funding system, it is majorly funded by the government along with support of private insurance system in both. Approximately 68% of the Australian healthcare spending and almost equally, 70% of the Canadian spending is funded through public system which is lower than average of OECD countries (72%). A total of 20% is contributed by out of expenditure while 8% of funding is contributed by private insurance mechanism in Australia. Medicare, a national health insurance scheme of Australia is administered by the government. State or territory government is responsible to fund, deliver and manage a diverse range of healthcare services. Private health insurance provides an additional support and healthcare services within the country. The funding mechanism of public system includes following-

• Rebate for medical services is provided through Medicare Benefit Schedule, a component of Medicare.
• Financial relaxation to private patients through Pharmaceutical Benefit Scheme (PBS), a component of Medicare.
• Healthcare funding to public hospitals through national healthcare specific purpose payments.
• National partnership agreements provide funding for specific projects by state or territory government.

It is aimed to provide quality healthcare services by increasing accessibility and affordability to Australian people through Medicare. Healthcare services such as pharmaceutical and medical are subsidized to increase the universal access. Private health insurance is another source of funding of hospital services by covering allied health services, accommodation charges, dental services, and management of chronic diseases (Australian Bureau of Statistics, 2012).

Similarly, public insurance plans have been developed under the Canada Health Act where each province is responsible to implement the act and the associated rules & regulation of the system. Healthcare services being provided in Canada are clearly defined in the act. Along with public health insurance, private health insurance also plays an important role (Canadian Institute for Health Information, 2014). For the policy makers, it is important to adopt the benefits of Medicare from Australia in Canadian system to improve the efficiency of current services though they are considered as strongest among industrialized counties.

Governance System

Government and private both types of institutions are involved in providing healthcare services in Australia and Canada. The healthcare system of both can be divided into three levels of government administration – federal, state and territory government. Similarly with Canada, Australian healthcare system follows top to bottom approach of governance which means that policies laid out at federal level are implemented at state level. Overall authority of providing and managing the services remains with the federal government while the other governments are responsible for administration of elements of healthcare system. Healthcare policies are framed by the federal government and implemented by the state and territory government at lower level of the system. A major part of the healthcare services is paid by the federal government. Each state is responsible for operations of the public hospitals along with regular monitoring of healthcare program and initiatives. In Australia, National health policy has administered Medicare by the federal government to achieve universal healthcare and to pay patient’s healthcare cost. The policy covers 85% of the medical specialist, 75% of general practitioner, and 100% of public hospital costs (Australian Institute of Health and Welfare, 2014). The Canada Health Act has introduced public insurance system to increase the accessibility of the healthcare services (Canadian Institute for Health Information, 2014). Federal level legislations are under the purview of health act and the health insurance comes under the responsibility of each province known as provincial health insurance. Both the countries have strongest healthcare governance system to address the basic needs at different administrative level.

Health Indicators

Maternal Mortality Rate (MMR)

MMR data is available for Australia and Canada by reviewing deaths and births records from the reliable source. Australian Institute of Health and Welfare and Canadian Institute for Health Information act as an important source of information for various health indicators. These institutes are involved in conducting national level surveys to collect the required and relevant information.

MMR statistics are available to provide an estimate of maternal death in Australia within a time frame of 2008-2012. As per the Australian government report, 105 maternal deaths have been occurred within 42 days’ time period after delivery. Primary data was collected from registrars of births and deaths by the state and territory health departments. The methodology adopted was to review the death records to find out the cause of maternal deaths. The population in reproductive age was covered to analyze age specific maternal death and deaths by age & parity. Women’ characteristics who had experienced direct and indirect maternal death were also studied. These were maternal BMI during antenatal care, smoking habits and alcohol consumption in pregnancy, antenatal visits, mode of birth, country of birth, need of caesarian section, the place where women died, baby outcomes, autopsy incidences etc. The report depicts that 49 maternal deaths were directly related to pregnancy, 53 were indirect maternal deaths, and 3 were because of unknown reasons (Australian Institute of Health and Welfare, 2015). Obstetric hemorrhage, hypertensive disorders, and thromboembolism have been the direct causes of maternal deaths and accounted for approximately 60% of the maternal death in Australia. Cardiovascular disease was found as a key cause of indirect maternal death. MMR has been increased within the country but is not known that it is related with more number of cases or improved reporting (Australian Institute of Health and Welfare, 2015).

MMR has also been calculated in Canada based upon the data discharge abstract database (DAD) from Canadian Institute for Health Information (CIHI). The same population age group (15-54) has been analyzed for consecutive four years’ time period. Around 85 deaths were reported due to several reasons. Problems associated with circulatory system contribute for the highest number of maternal deaths followed by postpartum hemorrhage and obstetric embolism. The rate was higher among 25-29, 30-34, and 35-39 age groups (Public Health Agency of Canada, 2013). Exclusion of small maternal deaths occurring outside the hospital is one of the main limitation of the study.

Infant Mortality Rate (IMR)

The government has reported IMR of 3.3 in 2012 and 3.8 in 2011. The number of infant deaths has been reduced due to improved quality of healthcare services (National Health Performance Authority, 2014). Almost 70% of the total infant deaths have been reported during neonatal period (28 days’ time period after birth). Half of the deaths have been occurred on the first day of birth and maximum number of infant deaths have been found among boys. Maternal complications and congenital anomalies have been the leading causes of infant deaths (Australian Bureau of Statistics, 2012).

The above results are based upon data collected from the registrars of death and birth in each states and territories of the country (National Health Performance Authority, 2014). National wise data is collected pertaining to childbirth and pregnancy. Midwives and other staff assist in data collection process. These data are submitted at AIHW (Authoritative information and statistics to promote better health and well-being) to compile into national data set. The data is known as perinatal national minimum data set for further analysis purpose (AIHW, 2014).

On the other hand, Canada has also shown decreasing trend for IMR which was 4.8 in 2012 and 4.9 in 2011. It is higher than the Australian IMR rate which could be because of over representation of the related data. National Population Health Survey (NPHS) is conducted after every two years of time period to collect all relevant household. The longitudinal sampling design is followed over time and sampling clusters are selected through probability proportional to size. Much of the survey data is self-reported so the results are solely based on the respondent’s knowledge and provides accurate information (Statistics Canada, 2012).

From international perspective, Australia and Canada both have improved the IMR as find out the national level surveys. A positive note can be taken by others to slow down the infant deaths in the same way as these two countries have done successfully.

Life Expectancy (LE) at Birth

Life expectancy defines population health and mortality pattern within the country. It measures the number of years a person is expected to survive born today. Australia and Canada both have recorded a dramatic increase in life expectancy for both, male and female and has performed better among OECD countries. In Australia, a girl born during 2011-2013 is expected to live around the age of 84.3 while a boy is expected to survive till the age of 80.1 years. Life expectancy at different age’s changes and it is represented as an additional number of years a person can survive. The above data has been calculated based upon life tables generated from sex and age specific death rates of the given population. ABS (Australian Bureau of Statistics) publishes life tables after a gap of three years (AIHW, 2014). Following the same line, a male born in 2012 has life expectancy of 80 years while a female has of 84 years in Canada. Increased life expectancy is due to improved mortality rates and fewer number of patients are dying before 60 years of age from heart or other diseases (Statistics Canada, 2012). LE has been calculated through NPHS in Canada which is similar to Australian Health survey.

Health Status

Low Birth Weight

Analysis of the national perinatal data depicts that 11,895 babies were born to 11,729 indigenous mothers in 2010-11. Almost all births were recorded as live births in that particular year. Indigenous mothers have higher chances of having low birth weight babies in comparison with non- indigenous mothers. Approximately 12% of the total babies born to indigenous mothers were found with low birthweight of 2,500 gram while 86% were found between 2,500 – 4,500 grams AIHW, 2014).

Annually vital statistics are calculated through an administrative survey in Canada. The survey has adopted cross sectional design of sampling methodology to capture date & place of birth, type of birth, parity, parent’s age etc. During same period as Australia, approximately 6.2% of the total infants born were of low birth weight (less than 2,500 gram). Birth weight was lower among more number of girls comparatively (Statistics Canada, 2012).

Obesity

Rate of obesity is continuously increasing in Australia. The analysis was done based upon the data from Australian health survey. Different age groups were considered – 18-24, 25-34, 35-44, 45-54, 55-64 and above 75 years. Obesity rate was 28.3% in 2011 which is slightly higher than OECD. People within older age group were more obese than adults. 70% of the men were obese in comparison with 55% of the women during 2011-12 (Australian Bureau of Statistics, 2013).

Based upon health survey including body mass index has been used to calculate obesity rate in Canada. Country’s obesity rate (25.4%) is almost equal to Australia and it increases along with age. The rate has been roughly doubled over the years because of sedentary life style and lack of exercise (Public Health Agency of Canada & CIHI, 2011).

Diabetes

Diabetes has become one of the main public health problem is Australia as the rate has been doubled over the years from 1.5% to 4%. It was 4.2% in 2011-12 and approximately 85% of those who had diabetes are suffering from type 2 while 11% of total diabetic patient are found with type 1. The following main data source are available to analyze the current situation of diabetes – NHS (national health survey), ABS (Australian bureau of statistics), AHS (Australian health survey), NDSS (national diabetes service scheme), and ERP (ABS estimated resident population). The following population groups have been included to analyze the situation – general population, people from cities and remote areas, nonindigenous people, and people from different cultural background. For diabetes rate calculation purpose, numerator is the total number of diabetic people taken from NHS, ABS or AHS and denominator is taken from ERP (AIHW, 2014).

The diabetes rate has increased tremendously in Canada as it was 6.5% in 2011-12 with more number of cases among males (7.2%) rather than females (6.8%) (Public Health Agency of Canada, 2011). This has resulted into huge public health burden for the system and people as well. Data has been extracted form Canadian Chronic Disease Surveillance System that contains reliable information.

Asthma

Asthma is the leading cause of increased hospitalization in Australia and Canada. Asthma treatment has a huge impact on healthcare spending and out of pocket expenditure of people. The reasons behind increased hospitalization rate would probably assist in implementing preventive measures.

The rate has been analyzed based upon Australian health survey data and the whole population has been covered through the survey. The prevalence rate is high among males of age group 0-14 while higher among females after 15 years of age. In comparison with people residing in remote areas and cities, the prevalence has been found higher among people living regional areas. The hospitalization rate is high among children below 15 years of age. In 2012, 0.3% of all deaths have been resulted because of asthma. The mortality rate is high among indigenous than nonindigenous people (AIHW, 2014). .

Asthma rate has somewhat decreased from 2011 in 2012-13 which was 7.9%. Males have been found with higher rate (8.9%) than females (6.9%). Canadian Community Health survey conducted during 2007-2013 was used as the data source (Statistics Canada, 2013).

Hypertension

In general practice, high blood pressure is the frequently managed public health problem. High BP is one of the risk factor for cardiovascular diseases and kidney failure. Hypertension is the major contributor for high public health burden. Understanding the role of

The rate is 8.7 per 100 patients according to Australian health survey. The rate has been calculated by considering population of 18 years and above. It was depicted that the rate is higher among males (34%) than females (30%). Approximately one third of the population is having hypertension problems, comprising 20% has hypertension and rest 10% has normal BP but at high risk of hypertension (Australian Bureau of Statistics, 2013).

Based upon Canadian Community Health Survey, the rate was found 6 per 100 patients. Approximately 32% of the Canadian had high BP problems along with the obesity (Statistics Canada, 2013). Canada has lower rate than Australia so strategies adopted in Canada can be used to observe the effectiveness in an order to reduce burden of hypertension.

Cancer

Cancer has become one of the major cause of illness in Australia. The prevalence rate is high among males for prostate cancer. Death due to cancer has encountered among 3 in 10 patient newly diagnosed in the country. Five year survival has improved from 2007 to 2011 and the calculation is based upon the data obtained from Australian association of cancer registries covering general population above 18 years of age (AIHW, 2014).

Following the disease pattern of Australia, the prevalence rate is high of prostate cancer and then breast cancer, lung cancer, and colorectal cancer. More than half of the cancer cases occur in older age group. The above results are based upon Canadian Cancer Registry Database targeting people above 18 years of age (Statistics Canada, 2013).

Health System Performance

The following performance indicators can be used to measure the system’s performance for both the countries-

• % of GDP spending on healthcare services
• % of public/private spending on healthcare services
• Out of pocket expenditure
• Policies dealing with health inequalities
• Increased life expectancy
• Waiting time to receive appropriate health services
• % of people availing health insurance
• Number of medical professionals per 1000 population
• Hospitals following National Safety and Quality standards or Accreditation Canada

% GDP Spent on Health

Money spent for healthcare services comes under the purview of healthcare expenditure. It includes health expenditure of public/private sector, out of pocket spending and non-governmental sources. Australia’s healthcare expenditure has increased at a faster rate than the population growth. Expenditure per person is $6230 in 2011-12 in comparison with $4276 in 2001-02. In Australia, 9.5% of GDP is spent for healthcare services. For the country, healthcare has become the largest part of Australian economy. Healthcare spending represents 10.9% of GDP in Canada which is slightly higher than Australia. Expenditure has fallen as a result of global economic recession by 0.4% after 2008 in the country (Canadian Institute for Health Information, (2014). Almost 70% of the funding comes from the public sector in these countries which means that government plays a significant role in the system. In contrast to this scenario, out of pocket (OOP) expenditure is high in Australia ($731) than Canada ($690). This depicts the role of providing universal health coverage that might have reduced OOP expenditure.

Healthcare Measures

Acceptable

Healthcare providers must respect the dignity of the people. Healthcare service being provided must be ethically correct and culturally appropriate to all. The system must be responsive towards the needs of the population. The above feature can be measured through policies dealing with health inequalities. For example, In Australia, health inequalities have become quite apparent for indigenous people in mental health, communicable diseases etc. This has led to fundamental shift in healthcare practices in the country by considering the role social factor in planning and designing new policies (Bainbridge et al, 2015).

Appropriate

Everyone has the right to receive the healthcare services which they need and address the health issues appropriately. Healthcare service must be in favor of better health outcomes in a positive manner. The systems appropriateness is measurable by analyzing the type of services received by the people in a definite time period.

In an order to avail the right services, people have to wait for longer duration that reflects the negative sign for the health system. Health As per the commonwealth fund international health policy survey, waiting time for elective surgery is longer even in countries like Australia and Canada. People have to wait to avail the appropriate medical treatment.

Effective

Improved healthcare indicators along with increased healthcare spending are the main attributes of the system. More healthcare expenditure would increase the efficiency in terms of increased life expectancy, decreased mortality rate due to asthma, cancer and other illnesses. Earlier healthcare accessibility was a barrier in both the countries, Australia and Canada, due to high cost but now government efforts along with insurance system have decreased the healthcare cost effectively. In Australia, about 21 million people are availing Medicare (public health insurance) services while Canada has universal healthcare system which does not cover prescription medications. These are covered by the public spending for elderly people in some province. Healthcare services have been effective in form of increased life expectancy in both the countries.

Efficient

Australian and Canadian health system are highly efficient to address the health needs of all person. Medical advancement has made it easier to provide quality services. Substantial increase in health workforce has been witnessed to deal with patient’s need on time. Increased healthcare spending in Australia and Canada has contributed for highly efficient system. As per the world bank data, Australia has 3.3 physicians per 1000 population while the number is lower in Canada (2.07). It can be interpreted from the data that the Australian system has performed efficiently. So major healthcare reforms are much needed to deal with system’s efficiency.

Safe

To improve the safety and quality healthcare services, NSQHS (National Safety and Quality standards) have been implemented in Australia to ensure the safety of health services. These standards explain about the level of care expected from each consumer(Australian Commission on Safety and Quality in Healthcare, 2011). Accreditation of the hospitals as per NSQHS has been effectively commenced in the country from 2013.Compliance with required organizational practices developed by Accreditation Canada has improved the performance of system (Accreditation Canada, 2015).Hospitals in Australia and Canada are practicing the above mentioned guidelines to provide safe healthcare services.

Conclusion

Australia and Canada both have increased public health spending to improve their health status. Accessibility, affordability, availability of services have been at the center of all healthcare policies and programs. People have been benefitted through public insurance scheme and is the main funder of healthcare services. Efforts are needed to bring down the various health indicators such as IMR. MMR, and other chronic diseases. Improved LE shows the performance of health system in both the countries.