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Role of health-care facilities and services Overview
The role of health-care facilities and services
in achieving better health
The nature of health care in Australia

The role of health careTypes of health-care facility and serviceInstitutional careNon-institutional careCommunity supportsAccess to health-care facilities and servicesResponsibility for health care Funding of health care in Australia
Health insuranceThe costs of health care to consumersHealth-care expenditure versus health-promotion expenditure Alternative health-care approaches
Reasons for the growth of alternative medicineThe range of alternative medicine servicesMaking informed consumer choices Outcomes
On completion of this chapter, you will be able to:
• explain the different roles and responsibilities of individuals, communities
and governments in addressing Australia's health priorities (H5) CRITICAL QUESTION • argue the benefits of health-promoting actions and choices that promote social justice (H14) What roles do health-care facilities • critically analyse key issues affecting the health of Australians and propose and services play in achieving ways of working towards better health for all (H15) • devise methods of gathering, interpreting and communicating information bet er health for all Australians? about health and physical activity concepts (H16) • show a willingness to question issues that have an impact on health and performance. (V&A) THE ROLE OF HEALTH-CARE FACILITIES AND SERVICES IN ACHIEVING BETTER HEALTH Health-care facilities and services play a vital role in achieving better health for all Australians. They provide the essential services of diagnosing, treating and rehabilitating the ill and injured. As we saw in chapter 3, they also have an important role in preventing illness and promoting health. It is much more cost-effective to promote positive health and prevent illness from occur-ring. Traditional health facilities such as hospitals and doctors' surgeries are increasingly being used to provide accurate health information to the public. The state and territory governments provide services specifi cally aimed at both the prevention of disease and the promotion of health — for example, immunisation programs, anti-smoking campaigns, and school medical and dental health services.
The health of Australians depends not only on the provision of quality health-care services and facilities, but also on factors such as housing, employ-ment, education, hygiene, income and environmental safety. For health-care services and facilities to be effective in both curing and preventing disease, the health care sector must develop partnerships with other sectors of the community to implement health-related activities that promote health.
T RE OF HEA The health-care system in Australia is both extensive and diverse in nature. Traditionally, it has provided:• diagnosis• treatment• rehabilitation• care for people with long-term illness or disability.
Since the mid 1990s, the Australian government has strengthened its com- mitment to involving the wider health-care system in improving health out-comes and health gains (illness prevention and health promotion), rather than simply providing health-care services. Thus, our health-care Health pro
Health pr vider
system involves complex inter- relationships between: Commonwealth, state and local governments • health insurance funds • public and private providers of • promotion• diagnosis services (for example, doctors, dentists, optometrists, psychol- • rehabilitation ogists and physiotherapists) institutions (for example, • community health public hospitals and nursing • support groups • nursing homes .
other organisations (for • charities .
example, community health services, self-help groups and Figure 4.1
1 Features and roles of the health-care system
community support groups).
The role of health careThe role of the health-care system in Australia is to provide quality health facilities and services to meet the health needs of all Australians. Health serv-ices are organised, financed and delivered by both public (government) and private (fee-for-service) sources.
Health care is dominated by medicine in Australia. Emphasis has been placed on the diagnosis and treatment of illness by the medical profession. This medical dominance means medical professionals largely control and deliver health care. Some medical practitioners have acknowledged the potential posi-tive impact of alternative medicine on health and have referred patients.
Health care within Australia is mostly about clinical diagnosis, treatment and rehabilitation. Historically, health has lacked a preventative focus, but the
emphasis began to change with the new public health approach. The influence
of the media and an increasing emphasis on health education and promotion
have led to a greater understanding of health within the community. We are
increasingly recognising the important role of preventative health care in the
promotion of health. Health practitioners are recognising the importance of
their role in health education, community empowerment, advocacy and public
health policy.
Types of health-care facility and serviceThe many health-care services provided in Australia can be divided into two broad types: institutional and non-institutional. Institutional services include:• public hospitals, which provide acute care for people with temporary, often severe ailments who stay in hospital for relatively short periods — for example, medical, surgical or obstetric services • psychiatric hospitals, which treat and care primarily for patients with psy- chiatric, mental or behavioural disorders • private hospitals and other privately owned and operated institutions that provide either acute or psychiatric care • nursing homes, which provide long-term care for chronically ill, frail, con- valescent or senile inpatients or those with a disability • other services, such as ambulance.
Figure 4.2: Hospitals are an example of an institutional health facility.
Non-institutional health services include: • medical services, which are provided by medical practitioners and • health-related services — for example, pharmaceutical, dental, optical, physiotherapy and podiatry • community and public health services• community health promotion and illness prevention — for example, com- munity home care programs • the provision of aids and appliances — for example, hearing aids and • research — for example, the National Health and Medical Research Council's (NHMRC) coordination of information on major health problems • administration.
Institutional careHospitals — public and privateIn Australia, hospitals conduct the major proportion of institutional care. Hospitals are classified as either public or private, and the majority are accred-ited with the Australian Council on Healthcare Standards (which monitors the quality of care provided and the health outcomes of patients).
Public hospitals are operated and financed by the state governments and the Commonwealth Government. They serve a greater proportion of elderly and very young patients. Public hospitals also appear to provide more highly specialised and complex services, such as heart and lung transplants in the large teaching hospitals. They also provide same-day surgery and take most of the non-admitted patients (outpatients).
Private hospitals are owned and operated by individuals and commu- nity groups. They also provide same-day surgery and perform more short- e rocedure
stay surgery, elective procedures and less complex procedures requiring less
expensive equipment, such as operations on the eye, ear, nose, mouth, throat, musculoskeletal system and breast.
Patients in all hospitals are classified as being either private or public, according to their choice of service. If they choose to be in a public ward in a public hospital, then they are allocated a doctor by the hospital and pro-vided with a bed — all free of charge. If they choose private treatment, either in a public or private hospital, then they may choose their own doctor but must pay for the service and accommodation provided by the hospital and the doctor. Medicare and any private health insurance of the patient will refund much of this expense.
q ity is the a
The issue of equity of access to public hospitals has been debated in recent
years. Some evidence suggests that private patients have more rapid access to elective surgery (such as plastic, ear, nose and throat, and orthopaedic surgery) than do public patients. Urgency categories have therefore been applied to Australia's use of acute hospitals is outlined in table 4.1. Rates of admis- sion are comparatively high, but balanced by the short average length of stay. Factors that contribute to the reductions in the length of stay include:• the less frequent placing into acute hospitals of people requiring nursing • better anaesthetics• the use of less invasive surgical techniques 108 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA
incentives for hospitals to increase the proportion of same-day patients treated • the expansion of early discharge programs that provide follow-up care for patients at home • an increasing trend towards day surgery• improved drug treatments.
There has been dramatic growth in health technologies used in diag- nostic procedures, such as ultrasound and magnetic resonance imaging (MRI). In Australia, non-invasive surgery (laparoscopy, for example) is preferred in many cases to conventional ‘open' surgical procedures. It generally results in less pain, shorter hospital stays and faster recovery times. These advantages are particularly significant for the elderly, because they face reduced risks and improved recovery from surgery.
The highest number of patient admissions is to public acute hospitals (see table 4.1). There is a trend for people who are financially able to use private hospitals and those less advantaged to use public hospitals.
Table 4.1: Hospital use, 2003–04
Average length of stay
Figure 4.3: Improved hospital
Public psychiatric s techniques and follow-up care Source: Australian Institute of Health and Welfare, Australia's Health 2006, have led to a general reduction in the Canberra, pp. 361–2.
length of stay.
Nursing homesNursing homes provide care and long-term nursing attention for those who are unable to look after themselves — the aged, the chronically ill, people with dementia and people with a disability. Some nursing homes cater specifically for young people with a disability. There are three types of nursing home — private charitable, private for profit and state government — but the Commonwealth Government assumes responsibility for most of the financial cost of running nursing homes in Australia.
Aged-care assessment teams have been established to ensure only highly dependent people are placed in residential care. They also recommend the placement of a large proportion of clients in accom-modation outside of institutions, such as hostels. Hostels provide long-term accom-modation and a basic level of health care for young people with a disability, and the aged and frail.
Figure 4.4: Nursing homes are an
important health-care facility for the aged, the
chronically ill and people with a disability.
Psychiatric hospitalsTreatment of people with severe mental illness has changed over recent years, moving away from institutional care to a system of care that integrates both hospital services and continuing care within community settings. Given the resulting reduction in extended hospitalisation of people with mental illness, the number of public psychiatric hospitals has fallen. At the same time there has been a corresponding increase in the number of beds in community-based residential services. The range of service providers for mental health care today includes general practitioners (GPs), private psychiatrists, community-based public mental health services and specialised residential mental health-care facilities.
Non-institutional careMedical servicesDoctors, specialists and other health professionals provide a number of ser-vices. The most extensively used service is that of the GPs who diagnose and treat minor illnesses. According to the National Health Survey (2004–05), about 23 per cent of the population had visited a GP or specialist during the two weeks prior to the survey. GPs work in medical centres, hospitals and many private surgeries throughout Australia. Under Medicare, all Australians are eligible to claim refunds for their payments for medical services outside hospitals (and for services as private patients in hospitals). The whole or part of the cost of a GP consultation is reimbursed by Medicare.
The number of consultations with GPs has increased over the last two decades. This can be attributed to improved access to doctors and the increased promotion and awareness of individual illness prevention strategies, such as immunisation, Pap smears and general health check-ups.
General practitioners sometimes refer their patients to specialists, who have specialised skills in a particular field of medicine as well as the usual medical training. Some specialists are explained in the following list.
• Allergist — treats conditions related to allergies• Anaesthetist — administers anaesthetics and pain-relieving drugs during • Cardiologist — treats diseases of the heart and circulatory system• Dermatologist — treats skin ailments• Gynaecologist — treats disorders of the female reproductive system• Neurologist — treats diseases of the nervous system• Obstetrician — specialises in delivering babies and treating pregnant women• Orthopaedic surgeon — treats fractures and diseases of the bones, joints and tendons, ligaments and muscles • Pathologist — specialises in examining body tissue, blood and urine• Psychiatrist — specialises in diagnosing and treating mental illness• Radiologist — diagnoses diseases and bone fractures using X-rays• Urologist — specialises in treating diseases of the urogenital system Health-related servicesHealth-related services include ambulance work, chiropody, dentistry, health inspection, nursing, occupational and speech therapy, pharmacy, physio-therapy, optometry, radiography, counselling, social work, and dietary 110 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA
planning and advice. The number of dental services has risen in recent years as an increasing number of people retain their natural teeth, and also as a result of the trend towards preventative dental care.
PharmaceuticalsIn Australia, pharmaceutical drugs are supplied through hospitals and doctors by private prescription and over the counter in shops. Over-the-counter medi-cines account for about one third of all sales.
Most prescription drugs sold in Australia are subsidised through the Commonwealth Government's Pharmaceutical Benefits Scheme (PBS). Through this scheme, the patient pays a set amount for a prescription drug ($29.50 in 2007) and the government pays the balance of the cost of the drug to the pharmaceutical manufacturer. Drugs are subsidised further for people with special needs, including pensioners and conces-sion cardholders, for example, low-income earners, war veterans and invalids. This subsidy reduces the cost of a prescription to under $5.
Some people who are chronically ill or require regular long-term medications are protected from excessive cost by the PBS Safety Net. If the accumulated cost of their prescriptions exceeds a par-ticular amount within a year, called the threshold, the individual or family can then obtain their prescriptions for the rest of the calendar year at a low cost ($4.70 in 2007). The aim of the Safety Net scheme is to ensure no-one is precluded Figure 4.5: Pharmacists dispense drugs prescribed by general
for financial reasons from access to the practitioners. Most drugs are subsidised under the PBS.
medicines they need.
Community supportsCommunity supports are a significant factor in the provision of an environ-ment that is conducive to positive health. These supports promote health but are not a recognised part of the health-care system. The food industry, for example, implements policies to ensure the production and delivery of food that meets health regulation and food safety standards, and displays nutri-tion information on food packaging to inform the public about nutrition. As another example, town planners and engineers have a role in providing infrastructure that is safe and promotes positive health — for example safe roads, adequate sanitation and sewage facilities, areas for physical activity such as playgrounds and sports fields and the clear signage of environmental hazards.
Investigating health-care facilities Identify the major health-care facilities available to you. Choose one and investigate the services offered at that facility. Report your findings to the class.
1. Considering the health-care facilities and services that are available to you,
which is most relevant to you? Why? 2. Critically analyse the accessibility of this health-care service to you.
3. Would this health-care service be useful to all members of the community? Why?
4. Explain the factors that could act as barriers to access to this facility.
5. Is this service specifically aimed at curing illness or does it also provide health
promotion information? 6. Outline the features of an effective community health-care service.
Access to health-care facilities and servicesAccess to health facilities and services is about the health system's ability to provide affordable and appropriate health care to people when they require it. Access might be affected by issues such as:v shortages of qualified staffv lack of funding or equipmentv patient waiting lists for surgery or other treatment in public hospitalsv waiting times in outpatient clinics or emergency departments.
Access also refers to equitable distribution of health-care facilities and services to all sections of the Australian population. An individual's ability to access health-care facilities and services can reflect their:• socioeconomic status• knowledge of available services• geographic isolation• cultural and religious beliefs.
The majority of Australians have access to fundamental medical care through the national health insurance system — Medicare. This health insurance system does not cover all health services, so some health services are inaccessible to those who cannot afford them.
An individual's ability to access services and facilities can also be influenced by their knowledge and understanding of health information and the services available to help them. A knowledge gap may exist as a result of the indi- vidual's lack of education, their poor literacy skills or, in the case of migrants and some indigenous groups, a language barrier.
The two snapshots on pages 113–14 examine different approaches to addressing problems of access to mental health care.
Read the snapshot ‘Better access to mental health care' then answer the following questions.
1. Which groups will benefit from the additional funds contributed by the federal
government to the COAG mental health package? 2. Which health professionals are involved in the team approach to improving
access to mental health care? 3. List the changes that have been made to Medicare in relation to rebates and
benefits for treating mental illness.
4. How will this mental health package improve access to mental health care?
Better access to mental
Mental Health Care Consultation item will be avail-able for GPs to provide continuing management of health care
patients with mental disorders.
New Medicare items will support psychiatrists to On 5 April 2006, the Prime Minister announced the see more new patients. The rebates for items 291 and Australian government's contribution to the Council 293, for psychiatrists to undertake patient assessment of Australian Governments' (COAG) mental health and preparation or review of a management plan to be carried out by the referring GP, will be increased Costing $1.9 billion over five years, the Australian significantly to support management of patients by government's contribution will provide families, GPs where appropriate. schools and health professionals with more support Medicare items will be available to provide rebates in recognising and addressing mental illness, and for psychological assessment and therapy services new assistance to people living with mental illness provided by clinical psychologists. Medicare items and their families.
will also cover the provision of focused psycholog- The government will deliver a major part of the ical strategies by appropriately trained allied mental COAG mental health package on 1 November 2006, health professionals, including psychologists, occupa- with the introduction of important new Medicare tional therapists and social workers.
items to provide better and more affordable mental The new Medicare Benefits Schedule (MBS) items will pave the way for a range of other Australian gov- These new Medicare services, costing $538 million ernment mental health initiatives to be implemented over five years, promote a team approach to mental over the coming months, including $191.6 million health care, with general practitioners encouraged to over five years for mental health nurses to support work with psychiatrists, clinical psychologists, and private psychiatrists and GPs in caring for people other allied mental health professionals to increase with severe mental illness.
the availability of care.
A further $51.7 million will be provided over the Under the changes, Medicare rebates will be avail- next five years to increase access to mental health able for GPs to provide early intervention, assessment services in rural and remote areas.
and management of patients with mental disorders as part of a GP Mental Health Care Plan. A new GP Source: Australian Government Department of Health and Ageing, media release, 9 October 2006.
After doctors, they need
Julian Short runs a busy private practice in St and often these are long-term chronic conditions.' Leonards, on Sydney's North Shore, seeing people Perkins, who led the evaluation of the program's who suffer from depression and relationship diffi- trial in the state's far west, says local staff also feel culties, and providing services at hospitals. He started more valued and are more likely to stay in their job if flying to Bourke seven years ago, and now spends they receive support, training and supervision from two days every two months in the town, sharing the the visiting psychiatrist.
work with a colleague on alternate months.
Since the project began, thousands more patients ‘They previously had a very sporadic service and have been afforded regular specialist psychiatric care. there was a great deal of untreated mental illness,' Twenty psychiatrists now fly to the area.
Short says. ‘Now we are able to do community liaison, But the project is in jeopardy, says Russell Roberts, talk to the police, talk to the local Aboriginal medical the director of mental health, and drug and alcohol service and nurses, as well as see more patients. Out care at the Greater Western Area Health Service.
there you are really needed by the community — you The five-year trial, funded by the state and federal are really wanted and really appreciated.' governments and the area health service, has come to Teamwork is the focus in Bourke, and Short meets an end. The state and federal governments have not his colleagues professionally during his stay and guaranteed funding. Instead, the program is using socially, at the pub, once consultations have finished money ‘cobbled together' by the area health service for the day. ‘I see a lot of depression, lots of stressed while Roberts and Perkins work on securing the relationships, schizophrenia, bipolar disorder, drug- project's future. related problems and disruptions because of external ‘The community has become used to having a stresses such as the drought,' he says.
service like this over the past 6 ½ years and it is not The fly-in, fly-out model was providing very limited morally right to take it away when all indications are value, says David Perkins, from the Centre for Equity the mental health issues are becoming more common and Primary Health Research at the University of and more acute,' Roberts says.
NSW. ‘Mental health crises don't just happen when the Source: Sydney Morning Herald, 30 November 2006, psychiatrist flies in . . [they happen] at different times, Health and Science section, p. 16. Read the snapshot ‘After doctors, they need dollars' and answer the following questions.
1. Identify from the article:
(a) the health issues for the communities concerned (b) the strategies put in place to address the issues.
2. How have the equity issues been addressed?
3. What have been the benefits of the scheme?
4. From a social justice perspective, why is it important for such programs to be
1. Critically analyse the differences in access to health facilities and services that
exist between rural and metropolitan populations.
2. Explain how these differences in access have affected the health status of
these two groups of people.
3. Discuss how the government's funding of health-care facilities and services
affects access to our health system.
4. Why do people from lower socioeconomic groups have lower levels of access
to health-care facilities and services? 114 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA
Researching access inequities Choose one population group that suffers inequities in health status, for example: (a) Aboriginal and Torres Strait Islander people(b) migrants(c) rural dwellers(d) people who are homeless.
Research information and statistics about your selected group's access to health-care facilities and services (you will find some information in chapter 15). Create a PowerPoint presentation or an oral report on the impact of the level of access on the health status of your selected population group. Present it to your class.
Responsibility for health careVarious bodies provide and fund health services in Australia. Here, we examine the five existing levels of responsibility.
1. Commonwealth Government
The Commonwealth Government is concerned with mainly the formation of
national health policies and the control of health system financing through the
collection of taxes. It provides funds to the state and territory governments
for health care, and influences their health policy making and delivery. The
Commonwealth Government also has direct responsibility for special commu-
nity services, such as health programs and services for war veterans and the
Aboriginal community.
2. State and territory governments
The various state and territory governments have the prime responsibility for
providing health and community services. The principal functions of state
and territory health authorities include:
• hospital services
• mental health programs
• dental health services
• home and community care
• child, adolescent and family health services
• women's health programs
• health promotion
• rehabilitation systems
• regulation, inspection, licensing and monitoring of premises, institutions
and personnel.
3. Private sector
The private sector provides a wide range of services, such as private hospitals,
dentists and alternative health services (for example, chiropractors). Privately
owned and operated, these services are approved by the Commonwealth
Department of Health and Ageing. Many religious organisations, charity
groups and private practitioners run such services. Some private organisations
— such as the National Heart Foundation and the Cancer Council — receive
funding from both state governments and the Commonwealth Government.
4. Local government
The health responsibilities of local governments vary from state to state,
but mainly concern environmental control and a range of personal,
preventative and home care services. They include the monitoring of sani-tation and hygiene standards in food outlets; waste disposal; the monitoring of building standards; immunisation; Meals on Wheels; and antenatal clinics. The state health department controls some of these services (immu-nisation, for example), while local councils are responsible for implementing them.
5. Community groups
Many community groups also promote health — for example, the Asthma
Foundation and Diabetes Australia.
(policies, finance, health programs etc.) • HCF• NIB• FAI • Medibank Private• HBA• Australian Unity Health Fund • Community health services • Medical services • Health promotion agencies • Pharmaceutical services – psychiatric• Nursing homes Figure 4.6: The health-care system in Australia involves the interrelationship of many
government and non-government bodies.
1. Identify the health services and facilities funded by the state or local
government available in your local area.
2. Discuss the responsibility of the Commonwealth Government and state
governments in providing adequate health-care services to the community.
3. Discuss the level of responsibility that the community should assume for
individual health problems.
F NDING OF HEA i ure is the
Health expenditure refers to the allocation of funding and other economic
resources for the provision and consumption of health services. Mainly the Commonwealth Government and state governments fi nance our health system, using our taxes. The cost to taxpayers for the health care of the Australian people is signifi cant, and it is in everyone's interests to keep our health expen diture as low as possible. This involves being responsible for our own health by making positive health decisions and adopting appro-priate lifestyles.
The Commonwealth Government contributes major funds to: v high level residential carev medical servicesv health researchv public hospitalsv public health activities.
The state and territory governments contribute major funds to: v community health services v public hospitals v public health activities.
Pharmaceuticals are funded by both the Commonwealth Government and The total expenditure on health care consists of recurrent and capital 1. recurrent expenditure — the regular ongoing costs, including doctors' and nurses' salaries, bandages, meals and other overheads 2. capital expenditure — the infrequent costs, including new hospital buildings, Figure 4.7:
7 Recurrent health
diagnostic equipment and pathology laboratories.
expenditure by sector,r 2003–04 Recurrent health expenditure for health services in 2003–04 (see fi gure 4.7) was funded by:v non-government sources ($25 123 million)v state and territory governments ($15 426 million)v Commonwealth Government ($35 256 million).
Health insuranceAccidents and illness can cost individuals a considerable amount of money. The Commonwealth Government is committed to providing equitable health services to all people, which it attempts to achieve through its basic health insurance scheme, Medicare (introduced in 1984).
M dicare i
Medicare is Australia's universal health-care system, established to provide
Australians with affordable and accessible health care. The funds to operate the Medicare system are obtained from income taxes and the Medicare levy, A stralians.
paid according to income level.
Medicare provides individuals with access to: v free treatment as a public patient in a public hospitalv free or subsidised treatment by medical practitioners, including GPs, specialists, and some specified services of optometrists and dentists.
Regardless of what doctors or specialists charge, every Australian is covered for 85 per cent of an amount that is set down by the government as a common (scheduled) fee. Some doctors charge more than the scheduled fee. Many doctors ‘bulk bill' patients, which means the patient pays nothing and the doctor receives up to 100 per cent (85 per cent in the case of specialists) of the scheduled fee from Medicare.
Medicare benefits also cover optometrist services and oral surgery, but not private dentistry, physiotherapy, chiropractic treatment and appliances.
Private health insuranceMany people choose to ‘top up' their health cover by taking out private health insurance. The extra insurance allows people to cover private hospital and ancillary expenses (such as dental, physiotherapy and chiropractic services) and aids and appliances (such as glasses).
People choose private health insurance for a number of reasons, including: • shorter waiting times for treatment• being able to stay in a hospital of one's own choice• being able to have a doctor of one's own choice in hospital• ancillary benefits, such as dental cover• security, protection, peace of mind• private rooms in hospital• insurance cover while overseas.
Lower levels of private health insurance are found among the young, the elderly and other groups that have less available income. After the introduc-
tion of Medicare in 1984, many people opted out of private health insurance
(see figure 4.8). The fall in the membership of private health insurance funds
created pressures on the public health system, leading to lengthy debate by
politicians and health authorities. The strain on the health system was caused
mainly by the increasing demands for service from an ageing population and
the increased numbers of ‘free' Medicare patients. In 1998, to decrease this
burden on the public health system, the Commonwealth Government intro-
duced a 30 per cent rebate for people who have private health insurance. It
also introduced a 1 per cent levy (on top of the 1.5 per cent Medicare levy
on single people) on people who earn $50 000 or more a year and who do not have hospital insurance.
A further change was the lifetime health-care incentive, which was intro- duced from 1 July 2000. This incentive encouraged people to take out and retain private health insurance by ensuring eligibility for the 30 per cent rebate if they became insured before the 1 July start-up date. It also gives lower life-time premiums to people who join a health insurance fund early in life and maintain their hospital cover, compared with the premiums for someone who joins after age 30 (see the snapshot on page 120). These policies are aimed at attracting people to private health insurance.
In early 2007, the Australian Health Insurance Association stated there were 8.9 million Australians (43.4 per cent of the population) with private health insurance that covered surgery in private hospitals (see fi gure 4.8).
e of population

01982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Figure 4.8: Percentage of the population in Australia covered by registered private
health insurance funds, 1982–2006 (Source: Australian Health Insurance Association,
February 2007, data from Private Health Insurance Administration Council.)
Table 4.2: A comparison of Medicare and private health insurance
Private health insurance
• Commonwealth Government • Commonwealth Government • Private contributors • Levy or tax linked to salary • Monthly premiums for various forms of cover • Basic medical services (doctors and • Hospital cover – hospital services • Choice of general practitioner – doctor of choice • Basic hospital services in public hospitals – hospital of choice • Specialist health care – private or public hospital • Cover for 85 per cent of the scheduled fee for • Ancillary services — for example, dental, optical, • Some special benefi ts — for example, sports • Cover while overseas 1. Explain Medicare.
2. Describe the benefi ts of the Medicare system.
3. Explain why private health insurance is benefi cial to some people.
4. What are the advantages of having private health insurance?
5. Use fi gure 4.8 to describe the trends in the number of people with private
health insurance.
6. Outline government strategies for attracting people to private health insurance.
Private health insurance Whic
w n the same perio fi s and eroding the va changing funds — yo i ing times.
' mportant to remember that l A stralians are entit i led to free treat i al, regardless of their insurance v Bu ce Report by CHOICE Online, e Australian Consumers' The costs of health care to consumersThe extent of preventable illness and premature death in Australia indicates great potential for improving health through preventative activities. Given the high cost of health services and the continuing financial burden on govern-ments (and thus taxpayers), programs aimed at prevention rather than cure have gained wide acceptance. Funding for health promotion and illness pre-vention has increased in recent years.
Governments, individuals and communities are being made more account- able for their expenditures. Many people who have sound levels of health because they practise positive health behaviours (exercising, not smoking, eating a nutritious diet and so on) resent paying increased taxes to support those who choose inappropriate lifestyles. Insurance companies recognise the problem, and charge higher premiums for smokers who wish to be covered for life insurance.
Lifestyle factors could cause up to an estimated 70 per cent of all prema- ture deaths. Yet, more than 90 per cent of Australia's health expenditure is allocated to treating and curing illnesses. Unfortunately, it often takes some years for prevention measures to translate into a reduction in the incidence of lifestyle-related diseases. However, preventative programs for cardiovascular disease and traffic accidents have been visible over the past two decades — for example, Quit for Life, Stop/Revive/Survive and drink-driving campaigns. Together with treatment, they seem to have contributed to marked falls in mortality and morbidity rates from these problems.
Strategies that could be used to prevent illness and death in the com- munity include the education of school children about positive health behaviours; better coordination among the various levels of government; restrictions on advertising; legislation; higher taxes on products such as alcohol and tobacco; and the provision of support programs to help people give up addictive habits such as smoking and alcoholism. There are strong arguments for increasing the funding and support for preventative health strategies.
1. Cost-effectiveness — preventing illness and injury would result in huge savings in funds and resources used for acute health care.
2. Improvement to quality of life — the positive health outcomes for individuals that result from prevention include improvements in morbidity rates and longevity — that is, a longer and healthier life.
3. Containment of increasing costs — prevention is the best way of containing the continually increasing costs of health care. Otherwise, these costs could result in adequate health care being unaffordable for ordinary Australians.
4. Maintenance of social equity — a policy of prevention helps to provide greater equity (in the health-care system), which otherwise would be under threat as health costs continue to rise significantly.
5. Use of existing structures — prevention activities use existing and accessible community structures (such as general practitioners) rather than relying on special services and technological procedures. General practitioners are in a good position to measure risk factors and educate their patients on illness prevention and health promotion.
6. Reinforcement of individual responsibility for health — the use of prevention strategies empowers people to take control of their personal health by mod-ifying their behaviour.
The arguments for preventing various lifestyle diseases are convincing, but the quality of the extended life span experienced is an issue to be consid-ered. Some researchers are investigating whether delaying the onset of illness through preventative strategies and extending the life span has the effect of increasing the rates of sickness and prolonging the period of illness in the later years of life.
Health-care expenditure versus health-promotion expenditureHealth-care expenditure in Australia far exceeds expenditure on illness pre-vention and health promotion. An emphasis on medical treatments to cure illness dominates the allocation of public health resources and spending.
The new public health model focuses on the social factors that lead to ill health. This model places the emphasis on health promotion as the most cost-th. Read the snapshot ‘The price of a life' and answer the following questions.
1. List the arguments presented in the article that support greater health
spending on health promotion and illness prevention.
2. What strategies are suggested for improving health prevention measures?
3. Why is spending much higher for treating illness than for preventing it?
4. Do you think that spending on health promotion and illness prevention is a
good investment for the Australian people? Why or why not? The price of a life
Pharmaceutical Benefits Scheme in 2000, Australia spent $83 million in one year with a very limited By Ruth Pollard
effect, Moodie says. A 2002 study found that while If we are not, as the poet John Milton wrote, to ‘live a 10 per cent of smokers had tried Zyban since 2000, life half dead', how do we judge what a life is worth 80 per cent of people did not complete a full course of and how much should be spent to preserve it? As gov- ernments wring their hands over the spiralling cost of Moodie argues the money could have been better health care — now running at twice the rate of economic spent — for example $10 million was invested in growth — the obvious but long-term brake that could anti-smoking programs in 2000, resulting in 190 000 be applied is the creation of a healthier population.
people quitting and saving 1000 people from dying, he Chronic disease accounts for almost three-quarters says. ‘Why is the system so skewed that money pours of all health expenditure and that, along with the out to pharmaceutical interventions and not much to impact of ill health on labour force productivity, public health interventions that can reduce the disease increases the real cost of poor health, at a personal burden?'and an economic level.
Health economists have worked out to the dollar The bulk of health expenditure continues to what a life is worth. The answer? In Australia, $3.7 be directed at the acute end of the health system, million, or $162 561 a year, says Lynne Pezzullo, a treating people after they get sick with expensive senior health analyst and associate director of Access pharmaceuticals and diagnostic technology, rather Economics.
than preventing the illness from occurring — or at Taking into account factors such as what people least delaying its onset. are prepared to trade off for money — working in a ‘We spend 2 to 3 per cent of our budget on 40 risky profession or paying to install a smoke alarm, to 50 per cent of the disease burden, which is pre- for example — along with potential earnings and ventable,' says Dr Rob Moodie, the chief executive other measures, the value of a life is an important officer of VicHealth, the Victorian Health Promotion figure to consider when working out how much to Foundation.
spend saving it.
A classic example is the anti-smoking drug Added to that, the World Health Organization Zyban. When it first became available through the has developed a standard for the amount of money 122 HSC CORE 1 HEALTH PRIORITIES IN AUSTRALIA
governments should reasonably spend to gain one problems of health promotion and disease prevention year of life, a ‘quality-adjusted life year', or QALY. In was that the benefits were often invisible.
Australia it is a minimum of $40 000.
The money saved from preventing a death from ‘If we can purchase a quality-adjusted life year for smoking or obesity is not money that reaches the less than $40 000 we will do it, almost always,' says pockets of voters, like a tax cut or dividend, he says. Pezzullo.
‘So it is important for people to understand that the That $40 000 is spent on anything from pharma- return on public investment is not just money saved ceutical interventions, to awareness programs, to Pap — it is also good health, survival; it is the fact that we smear registers and reminder letters about breast are all living longer.
‘It means we are productive members of society, Often, though, governments will go well above the we contribute to the production and delivery of $40 000 mark, spending up to $120 000 to ‘buy' a year goods and services and that is good for the health of of quality life.
The new breast cancer drug Herceptin costs more Salkeld urges public health activists to discard the than $70 000 per quality-adjusted life year saved — a notion that industry is the enemy. ‘Public health needs cost Pezzullo says should be weighed carefully.
to be a real player, not sitting earnestly on the edges, and that means dealing with the private sector. Clinical The Prime Minister, premiers and chief ministers and curative medicine has been a whole lot smarter dipped their toes in the water last month, agreeing and better at getting the money, selling ideas and pro- to focus on promoting healthy lifestyles and the early moting what they do, [while] public health struggles to detection of chronic disease. ‘There were good signs sell what it is about in the good times.' of there being more of an understanding that produc- It is only in the bad times, when, for example, there is tivity is important and the link between health and an outbreak of communicable disease, that the benefit productivity,' Pezzullo says.
of good public health campaigns become obvious.
‘Unfortunately we still very much have a silo atti- Another snag is that you have to spend money to tude, where only the savings you get in the health save money. Much of the cancer screening done in system are taken into account when funding interven- Australia not only saves lives, but also costs money tions — clearly we need an economy-wide view.' — if cancer is picked up early then the cost of treating She cites psychotic illnesses as an area where there is someone must also be taken into account, even though huge scope to intervene. ‘If bipolar and schizophrenia that person would have been treated eventually.
are treated . . you can prevent a lot of episodes and ‘That will flow on to someone's productive capacity have a good, productive working life.' and quality of life, but you still have to spend quite a Pezzullo says health interventions such as coun- considerable sum to achieve that,' Salkeld says.
selling and support groups are highly cost-effective Australia spends close to 10 per cent of its gross — every dollar spent saves $7. Vision loss — from cata- domestic product on health but Salkeld warns we have racts, glaucoma and diabetic retinopathy — is another ‘hit the accelerator'. Pharmaceuticals make up 12 to area where prevention programs can produce signifi- 15 per cent of expenditure, hospitals and acute care cant cost savings.
make up the bulk of the rest, and each year people The most cost-effective move to make is to have are paying more and more out of their own pockets in an eye check, so diseases — 70 per cent of which are private health insurance premiums.
preventable — are picked up in the early stages. ‘Visual ‘There is a sense that we are letting prices get away impairment is linked to falls or getting hit by motor from us , and as our expenditure increases there is no vehicles, as well as depression . . there is higher co- evidence that we are getting a whole lot more out of morbidity and death rates for people who are visually the system. That means we must look at how much we impaired.' put into prevention versus cure even if the pay-off is Giving up smoking, getting tested for diabetes, some way down the track.' wearing sunglasses and using protective eyewear when The private health insurance industry — now playing sport all produce cost savings throughout the involving more than 40 per cent of Australians — economy, Pezzullo says.
also has a role to play, Salkeld says. ‘They are asleep Glenn Salkeld, an associate professor in health at the wheel when it comes to prevention; they do not economics at the University of Sydney, said one of the (continued ) CHAPTER 4 ROLE OF HEALTH-CARE FACILITIES AND SERVICES 123
offer the right incentives or provide the right services But the prevention of obesity requires a significant to encourage their members to take up preventive investment in policy change, in media, in effective activity.
regulation and legislation and in research, monitoring ‘We give them more than $3 billion per year in and evaluation, he says.
government-funded price subsidies — surely in return Governments must invest, Moodie says, if not to they could invest a little bit more in prevention.' avert spiralling health costs, then to improve labour Society is happy about paying for prevention market participation. .
when it is based on a pill, because it doesn't require ‘It is really tough for health ministers — you have a lifestyle change, says Stephen Leeder, a professor got communities demanding that they have hospi-of public health at the University of Sydney. ‘Look at tals open in small country towns, when it would be cholesterol-lowering drugs — there is no great far better to invest that money in a community health objection I hear from people about taking a statin, centre to manage the diabetes before they end up in there is no antipathy towards the notion of prevention hospital.'but there is antipathy about changing your diet and Australia is not alone with its disease burden. The World Health Organization notes that a few largely Leeder, co-chairman of the NSW Government's preventable risk factors account for most of the world's Public Health Priority Taskforce, says 2006 is a ‘make disease burden. or break' year, admitting that to date ‘we have made Chronic diseases — including cardiovascular condi- very little progress'.
tions, diabetes, stroke, cancers and respiratory diseases ‘We either get on with it or join the ranks of those — account for 59 per cent of the 57 million deaths annu- who tried and failed,' he says.
ally, and 46 per cent of the global disease burden.
A real preventive approach to health would look at The organisation says only a population-wide the food we eat and ensure access to fresh fruit and veg- prevention-based strategy will save us. Convincing etables was as easy and affordable as junk food. It would governments to change course and invest in it could look at cities and towns and the way they are planned, be the toughest campaign of all.
ensuring they were designed to encourage people to walk, to make use of parks, and to meet as a commu- nity to look after our mental health, Leeder says.
v Bipolar disorder: direct costs of $400 million, with NSW Health is interested in bringing other people indirect costs rising to $1.6 billion by 2013.
to the table — people who design our cities, who design v Schizophrenia: direct costs of $661 million per year, our transport systems and who make, produce and sell predicted to rise to $1 billion by 2013.
food products, and advertisers — they are the people v Obesity: direct costs are $1.3 billion per yearwho help create the social circumstance in which most v Heart disease: direct costs will be $11.5 billion by non-communicable diseases emerge, he says. Business can make a big contribution. ‘McDonald's spends about $8 billion on advertising in the US a year What's working
— if McDonald's could be convinced that it spend 1 per v Needle distribution. Estimated HIV infections pre-
cent of that money on health promotion then you could
vented among injecting drug users by 2010: 25 000. be spending a whole lot more money on health promo- Estimated lives saved: 4500.
tion without it costing government anything extra.' v Anti-smoking education. Estimated benefit of A tiny 2 per cent of the public health budget is reducing smoking rate to below 20 per cent of popu- invested in health promotion; the rest goes on chronic lation: $12.3 billion per year.
care and the acute end of the health system.
v National Pap smear screening program: death rate Australia's lack of investment in physical activity from cervical cancer has dropped from 13.3 per 100 will also come back to haunt us, says Moodie. ‘We 000 women to 7.7 per 100 000.
have done a terrific job in changing our behaviour on v Safe sex program: focus on behaviour change and road trauma and tobacco use — these programs have condom use has contained Australia's HIV preva- really shifted the norms of behaviour and to say that lence rate to less than 1 per cent of the population.
it is not possible in other areas is tossing in the towel too early.' Source: Sydney Morning Herald, 2 March 2006, p. 11.
ALTERNATIVE HEALTH-CARE APPROACHES Alternative medicine has existed for many centuries, particularly in many Asian countries. Traditional Chinese medicines account for 30–50 per cent of all medicines consumed in China. Japan has the highest consumption of herbal medicines in the world.
Populations of developed countries have steadily grown more interested in alternative treatments and medicines over the past decade. Herbal medicines are becoming a popular alternative to modern medicine in developed countries, resulting in an increase in international trade in herbal medicines. Australians spend an estimated $930 million per year on alternative medications or practitioners.
Practitioners of modern medicine are starting to recognise the value of alternative health-care approaches and are incorporating some of these into their treatments of clients. The World Health Organization supports countries in their development of national policies on alternative medicine to study its potential usefulness. Australians are increasingly buying herbal remedies and consulting alternative health-care practitioners such as chiropractors, homeo-paths, naturopaths and Chinese herbalists.
Reasons for the growth of alternative medicineThe increasing popularity of alternative medicine in developed countries can be attributed to a number of factors. These include:• the World Health Organization's recognition of the usefulness of many alternative approaches and its endorsement of a list of medicinal plants to be used in the preparation of herbal medicines • recognition that alternative medicines are the traditional medicines of the majority of the world's population • the effectiveness of treatment for many people for whom modern medicine has proved ineffective • the desire of many people to have natural or herbal medicines rather than synthetically produced medicines • the holistic nature of alternative medicine, which is attractive to many people• the strength of traditional beliefs for many cultures• the increasing acceptance by Australians of the value of multicultural infl uences.
The range of alternative medicine services The following examples are from the wide range of alternative health-care approaches.
Acupuncture is an ancient system of healing that has developed over thou- sands of years as part of the traditional medicine of eastern countries. Acupuncture treatment involves inserting very fi ne needles into the skin. They are left in either briefl y or for up to 20–30 minutes. Acupuncture is Figure 4.9
. : Acupuncture can
claimed to be effective in a wide range of conditions, stimulating the mind assist with pain management.t and the body's own healing response.
Aromatherapy is the use of pure essential oils to seek to influence or modify the mind, body or spirit. Aromatherapy acts in accordance with holistic principles by strengthening the person's vital energies and self-healing capabilities, thus having a direct effect on the mind and body. Essential oils can be inhaled through vapourisers and applied through baths and massage. Aromatherapy is used in the treatment of depression, sleep disorders, stress symptoms and anxiety.
The Bowen Therapeutic Technique is a system of muscle and connective tissue movements that gently realigns the body and balances and stimulates energy flow. This has the effect of supporting the self-healing properties of the body. The technique is believed to be effective in the treatment of soft-tissue injuries, musculoskeletal problems, back and neck aches, arthritic symptoms, stress, migraines, asthma, sinus and bronchial symptoms, and menstrual irregularities.
Chiropractic is based on the relationship between the spine and the func- tioning of the nervous and musculoskeletal system. Chiropractors ‘adjust' the spine, using specific rapid thrusts delivered by the hand or small instru-ments. The adjustments are aimed at correcting subluxations, removing interference to normal nervous system control over bodily function, and promoting healing and better health.
Herbalism uses plants and herbs exclusively. The oldest form of medicine, it is still used as a primary source of medicine for over 75 per cent of the world's population. Herbalists use the whole plant form of a medicine rather than chemical extracts from plants. They believe that we have an innate ability to heal ourselves. Thus, herbal medicines are used to restore and support the body's own defence mechanisms. Herbal treatment is based on the individual's symptoms, lifestyle and overall health.
Homeopathy is a system of medicine that recognises the symptoms unique to each person. It aims to stimulate the individual's healing powers to over-come the condition. Homeopathic medicines work gently and rapidly to alleviate symptoms.
Iridology is the analysis of the human eye to detect signs of the indi- vidual's physical, emotional and spiritual wellbeing. A range of naturopathic treatments can then be prescribed to improve general and immune system health.
Massage is one of the oldest and simplest forms of therapy. It is an excellent method of inducing relaxation. It helps reduce blood pressure, stress and anxiety levels, and overall it is beneficial to the immune system. Forms of massage include remedial massage, thera-peutic massage, sports massage and Swedish massage.
Meditation is a state of inner stillness. It involves focusing on an object, breathing or verbally repeating a word (a mantra). With practice, the individual can reach a meditative state, in which they experience inner peace and stillness. The benefits of meditation include strengthening of the immune system, improved sleep, lower blood pressure and increased motivation and self-esteem.
Naturopathy focuses on the holistic treatment of the individual by seeking to address symptoms of illness as well as resolve underlying causes of illness. Naturopaths recognise the importance of devel-oping a partnership with their clients, because it is important for Figure 4.1
1 : The many forms of massage
the individual to take responsibility for making positive lifestyle help to relax and reduce stress.
Find your way, naturally
and public liability insurance. Services by member practitioners may be recognised by health funds and By Anne Fawcett
In the not so distant past there wasn't much training Tamsin Rossiter, who teaches remedial massage at for students wanting a career in natural therapies. TAFE NSW's Western Sydney Institute, says health According to Jim Olds, president of the Australian fund recognition has led to a big increase in demand Natural Therapists Association (ANTA), the quality for natural therapies.
and level of training has increased in the past decade, ‘Fifteen years ago, one or two health funds offered along with public demand for skilled practitioners.
rebates for natural therapies,' Rossiter says. ‘Now ‘We're finding that a lot of people are disenchanted almost all of them do, and people on worker's com- with the mainstream medical model, so we've seen pensation can claim remedial massage as part of their a huge amount of growth in demand for alternative ongoing medical expenses.' . .
modalities like herbal medicine, remedial massage, But Rossiter warns studying natural therapies is homeopathy, naturopathy and traditional Chinese not a soft option. medicine,' Olds says. ‘I think there is a big shock for people when Where the highest level of training in a particular they start the course and realise they have to learn modality might have been a certificate, there is a anatomy and physiology to understand the principles growing number of diploma and degree-level courses of natural therapy. These programs are very practical, run by universities and private colleges.
but they are founded in science.' . .
Students can choose from programs such as the After finishing the advanced diploma in naturop- University of Technology's Bachelor of Health Science athy at Nature Care College in North Sydney, Ruelle in Traditional Chinese Medicine, the University Down intends to study for a further year to attain her of Western Sydney's Bachelor of Health Science in Bachelor of Naturopathy degree.
Herbal Medicine, or Nature Care College's Bachelor of ‘There's definitely greater demand for higher quali- fications in the industry,' she says . .
‘Degrees were once seen as the pinnacle of training Down enjoys the variety of the course, which includes [in natural therapies], but they're now becoming subjects such as nutrition, herbal medicine, homeop-almost the baseline,' Olds says. As of this year, for athy and iridology. The workload can be heavy, with example, ANTA no longer recognises acupuncturists weekly assignments, course readings, practical classes without a degree.
to prepare for and about 16 contact hours a week . .
‘Graduates have a very good standard of education The course has a large practical emphasis, allowing and very sound clinical training, but it also gives students to develop skills early. ‘You're studying some-clients quality assurance.' thing you can immediately use in life. I've helped family There's also a growing number of institutions members overcome gastric problems, heartburn, a tight applying to the association for recognition of advanced neck and shoulders — things people usually put up diploma and degree programs. Graduates of recog- with and may not realise we can do a lot about.' nised courses are eligible to become members of the Source: Sydney Morning Herald, 12 October 2005, association, which provides professional indemnity ‘Radar', p. 12.
Alternative health-care approaches Use the internet to research one type of alternative health care. Write a report and present your findings to the class. Include information on:(a) the history of the therapy(b) its nature(c) the benefits(d) the treatments involved(e) the cost(f) the level of training required to be a practitioner(g) groups of people whom it would benefit.
Making informed consumer choicesWhen choosing any type of health or medical service it is important to inves-tigate the service offered and the credibility of the practitioner. A client needs to ask the following questions.
• What is the treatment you offer? How can it benefit me?• What experience and training do you have?• What are your qualifications?• How much will the treatment cost?• Can this treatment be combined with conventional medication? An important first step in making informed choices is to gather such spe- cific information about the nature of the alternative medicine, its credibility as an effective type of treatment, and the qualifications and experience of prac-titioners. Asking friends and community members about their experiences and recommendations can also be valuable.
Some of the alternative medicines are considered to be very effective, and the World Health Organization recognises them to be valuable and significant treatments. Chiropractic medicine, naturopathy and acupuncture, for example, are offered as university courses within Australia. Other forms of alternative medicines have endeavoured to ensure the highest quality of treatment by providing courses within their organisations; for example, the Bowen Therapy Academy of Australia offers an introductory course followed by a six-month practitioner course to obtain accreditation.
Developing personal consumer skills Using the questions listed above as a guide, or your own questions, investigate the credibility of one type of alternative medicine. Your investigation methods may include: (a) gathering information from local practitioners(b) experiencing the chosen treatment(c) researching the qualifications required to practise(d) contacting training organisations to collect information(e) interviewing people who regularly use this treatment.
Present your findings as a report and share this with the class.
1. When selecting an alternative medicine, what information would you require to
make an informed choice? 2. Discuss methods of accessing correct and relevant information about
alternative medicines in your local area.
3. How do you know which practitioners and health-care organisations to
4. In small groups or in pairs, create a PMI chart as follows to summarise the
advantages and any drawbacks of alternative medicines.
• Health-care facilities and services are essential in diagnosing, treating and rehabilitating the ill and injured. They also play an important role in pre-venting illness and promoting health.
• Efficient and effective health-care services, along with adequate public housing, employment, education, hygiene and environmental safety, are all crucial factors that have an impact on levels of health.
• The role of health care in Australia is to provide quality health facilities and services that meet the needs of all Australians.
• The range of health-care facilities and services in Australia include public and private hospitals, psychiatric hospitals, nursing homes, medical prac-titioners and specialists, community programs, health-promotion services and other health professionals who offer alternative health care.
• Access to health-care facilities and services is affected by a number of factors, including affordability, location, knowledge of service and language barriers. These factors result in inequity in access to health care.
• The private sector within the community plays an important part in pro- viding health services such as the health promotion strategies undertaken by the National Heart Foundation.
• Individuals have a responsibility to take actions to promote their own health, thus lessening the financial burden on taxpayers.
• Medicare is the national health insurance program that was introduced to support the health of all Australians. It covers a proportion of basic medical and public hospital expenses.
• Medicare is funded by Australian taxpayers.
• Private health insurance allows people to be covered for extra medical and private hospital costs.
• The Commonwealth Government has introduced a 30 per cent rebate as an incentive for people to join private health insurance. It has also introduced a levy on individuals who earn over $50 000 and who do not have private health insurance. Most recently, it set up the ‘lifetime health cover' scheme to encourage membership.
• Ill health is costly to the government and the individual. Our taxes fund the medical system within Australia.
• A large proportion of health expenditure in Australia is devoted to curative services, with a small fraction allocated to health promotion.
• Health promotion is a much more cost-effective means of reducing disease and illness in the long term.
• Alternative medicine is growing in popularity in developed countries. Many people are becoming disillusioned with the biomedical treatments on offer.
• There are a range of alternative health-care approaches, such as acupunc- ture, chiropractic, herbalism, naturopathy and iridology.
• It is important to make informed decisions when choosing an alternative health-care approach. The individual needs to investigate the services on offer, the costs, the qualifications and experience of the practitioner, and the health claims being made before committing to it.
7. How has t
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    Microsoft word - 7 antidoping.rtf

    Club Information Manual Section 3.7 Dec 2001 Orienteering Australia Operational Manual 4.2 What do Words used in this Policy Mean? What is the Federation's Position on Doping? Who does this Policy Apply to? What is a Doping Offence? Investigation of a Doping Offence and Referral to Hearing How are Hearings Conducted? What Sanctions Apply? How long do Sanctions Apply?

    The kalish method fundamentals of functional level i

    Thank you for joining us for An Influx of Reflux: Managing GERD and Other Debilitating Digestive Conditions We will start promptly at 12 noon EST. Please note that until that time, the line will be silent. Proudly Hosted by 1. All attendees are muted. If you have a technical question, please send a message to the host. 2. Questions: If you have a question for Dr