All people across the globe are entitled to the health attention they require. The World Health Organization has identified five elements to achieve this goal. These include reducing social disparities in health, providing services that meet clients’ expectations, altering public policies to address health, leadership reforms and increasing stakeholder participation (WHO, 2013). With the focus on these five areas, Governments in each country are creating health systems that aim to provide services that are affordable, equitable and accessible.
To achieve a sustainable health system, cooperation and participation of all health care providers is vital. This will work towards WHO’s goal of achieving “better health for all” (WHO, 2013). One of the systems, structured by the United Kingdom (UK), is called the National Health Service (NHS). This system is generally publicly funded. To allow this, the UK government uses a percentage of the taxes paid by members of the public to fund health services. This is also the case for Australia’s healthcare system, Medicare. However despite the common basis of the two health systems, there are also many differences that result in contrasting health outcomes.
Differences between the two systems
Private health: The private sector is a vital component of the healthcare system in Australia. The Federal Government has introduced some incentives to promote private health insurance. This includes offering a 30% rebate on annual premiums of those who take up private health insurance (Department of Health and Aged Care, 2000). However, in the UK, it is often by individual’s own initiative to take up private health insurance. This is due to patients in the UK experiencing much longer waiting periods compared to Australia, and would often consider the NHS undependable (Gillies, 2003).
Funding health care services: In Australia, public funding is a combination of contributions at the federal, state and local levels of government while in the UK there is a single payer system that is funded by general revenues (Brown, 2003, p. 53). The Australian Government funds almost 70% of total health expenditure (Wilcox, 2001, p. 156). The PBS by Medicare in Australia, subsidizes some services for patients; whereas, the NHS in the UK does not offer any deductions on services (Gillies, 2003). In Australia, public funding is a combination of contributions at the federal, state and local levels of government while in the UK there is a single payer system that is funded by general revenues (Brown, 2003, p. 53).
Prescription costs are different in Australia and UK. Under the NHS, there are certain groups that are exempted from paying for prescribed medication. These include “children under the age of 16; young people aged 16-18 and enrolled in full time education; people over 60; people with low incomes; pregnant women and those who have given birth in the past 12 months; and people with certain conditions or disabilities” (The Commonwealth Fund, 2012). In Australia, prescriptions are not free of charge for any individual. However, The PBS does provide subsidies for those entitled to a health care card or concession card, to ease the pressures of expensive medications.
Similarities between the two systems
While there are many differences between the health care systems in Australia and UK, there are also many similarities. Both health care systems believe in the ideology of a universal health system for their residents and are both largely publicly financed (Harley et. al., 2011). In both Australia and the UK, healthcare funding requires employees to contribute a portion of their wages. Although they are very similar in nature, in Australia, this is known as a Medicare Levy; while, in the UK it is referred to as a National Health Insurance contribution.
In Australia, public funding accounted for 68% of the total funds and in the 88% in the UK (WHO 2009). Similarly, private health insurance (PHI) is offered in both Australia and the UK, although much higher in Australia, and is perceived as providing more options for individuals and taking the burden off the public (Harley, et. al., 2011). Health service accessibility by individuals in rural and remote areas is a problem central to both countries. Reports indicate that compared with metropolitan populations, non-metropolitan populations, in both Australia and the UK, experience poor access to health services (Watt, Franks, Sheldon, 1994, p. 16).
As in the primary care sector of the UK, majority of the doctors in Australia are self-employed and reimbursed on a fee-for-service approach (Gillies, 2003, p. 77). GP’s are the initial point of contact for patients in both Australia and the UK. Additional specialist medical services such as physiotherapy and optometry are only available when patients are provided with a formal referral from their GPs (Piterman, Koritsas, 2005). Although the NHS is similar to the Australian health system in certain ways, both systems also possess some differences.
Strengths and Weaknesses of the United Kingdom’s National Health Service
The NHS provides many benefits to its residents in the UK. Specific benefits include the cost, care and coverage of the system.
Cost: Health care in the UK relies heavily on a public market rather than a private driven market; thus, giving free care to its people. NHS services are free of charge to patients in England unless stated (Department of Health, 2013). Free health care in the UK aim to prevent ill health and improve the physical and mental health of the population (Light, 2003, p. 25). The system ensures that healthcare is free at the point of use by everyone regardless of their financially status. The NHS is an advantage since it covers all patients in the UK. The NHS permits free access to a range of services including treatment by a GP, chronic conditions, surgery, dental care, pregnancy and birth and vaccination (Ingleby, McKee, Mladovsky, Rechel, 2012, p. 1). Health care entitlements are broad in the UK permitting specialized care in most areas.
Care and coverage available: The NHS in the UK provides many health care services to its residents depending on the nature of health. This represents an advantage since NHS aims to provide a wholesome approach to health that enables its resident to access all psychological and physical aspects of health. NHS offers mental health services, occupational health services, screening/ prevention services, treatment in hospitals and dental and optical services (Goddard & Smith, 2001, p. 1153). Another advantage is that health services accessed are made by individual choice (Knowles, Munro, O’Cathain & Nicholl, 2006, p. 262). This represents an approach that aims to minimize health inequalities as a result of culture and language differences.
Waiting Lists: Due to the National Health Service being a largely public system, it is often the case that there are long waiting lists for services (Gillies, 2003). This results in the delay of appropriate health care provided. In turn, this does not always encourage the quickest recovery for patients.
Long waiting lists for hospital treatments and delays in accessing general practitioners (GPs) have been reported as a problem in the health care system (Child, 2013, p. 141). Individuals who need a consultation with a specialist, surgery and any other specialized health treatment, are often put on a waiting list before they access the specific services they require. Reports have documented more than a million people during the 1990’s who were on waiting lists for treatments within the NHS (Walley, Silvester, Steyn & Conway 2006, p. 310).
People fear that delayed access to health services in the NHS may reduce service efficiency and service quality in the system (Walley, Silvester, Steyn & Conway 2006, p. 310). While, health care professionals feel that the problem is due to inadequate funding, the government feel the issue will not be resolved with higher expenditure (Stahr, 2001, p. 174). The issue of waiting lists is largely recognized and the government has taken initiative to make good progress especially within areas that have high patient demands.
High Running Costs: While the NHS aims to provide free healthcare to all UK residents, the price of running such a system costs the country a lot of money. Public expenditure on health care accounted for an estimate of £50 billion in the year 2000 (Propper, 2001, p. 151). The current figures indicate that the value for 2012/13 is estimated at around £108.9 billion (NHS, 2013). These figures represent the large contribution made by taxpayers.
Most of the views support that the NHS is an expensive system and these views are raising concerns amongst people about the way in which the money is spent (Brubaker, Picano, Breen, Marti-Bonmati, Semelka, 2011, p. 34). Although cost effectiveness is a key theme for the NHS it challenges the capacity of the health care system to efficiently provide quality services if costs were lowered. Maynard (2005) suggests that since public spending is high and private spending is relatively low in the UK, a larger demand for privatization may be a source for revenue for the NHS.
Strengths and weaknesses of the Australian Healthcare System
Low Cost and Affordability: The Australian healthcare system has been popular due to its low costs and affordability for patients. The Australian government is responsible for funding approximately 70 percent of all health expenditures (Department of Health and Aging, 2013). The two main contributors to its low cost schemes are Medicare and the Pharmaceutical Benefits Scheme (PBS). PBS offers copayments for prescription drugs with no variance between drugs and some groups such as pensions are entitled to lower cut costs (Doorslaer, Clarke, Savage & Hall, 2007, p.99).
Medicare provides ongoing free or low cost medical treatment in hospitals and other subsidized specialist areas. Key features that complement Medicare’s affordability are Bulk Billing and the Pharmaceutical Benefits Scheme. The Australian healthcare system gives patients the option to bulk bill (patients pay no direct fee and the care providers directly bill Medicare), or the option of Medicare rebates following initial upfront payments known as a Medicare Rebate. Increases in the use bulk billing through Medicare, as reported in a study suggesting the use of bulk billing increased from 50% to 70% in a period of approximately 15 years, provides grounds that it is a positive aspect of the Australian healthcare system (Doorslaer, Clarke, Savage & Hall, 2007 p.99). Bulk billing is used in many health services including GP visits, surgical, optical and dental; thus, providing the public with a broad range of options to their health.
Equity, Accessibility and Availability: In addition to low costs and affordable treatment choices offered by Medicare within Australia’s healthcare system, another strength is achieving equity within the system. Healthcare treatments and accessibility of health services are not influenced by the socio-economic status of an individual covered by Medicare. The healthcare system in Australia attempts to provide equal, accessible and available healthcare to those who are eligible to Medicare funding within the system; thus, is perceived as a strong characteristic of the system.
The philosophy of the Australian healthcare system is to offer services that are equally accessible by all Australians; however, health statuses in non-metropolitan areas are significantly poorer than urban areas. Provision of services to rural and urban areas is a part of the Australian healthcare system that needs improvement. There are several factors that influence an individual’s access to health care in these areas such as low levels of income and restricted access to services. Due to these factors, people in rural and remote areas do not always receive the health attention that they require (ABS, 2008).
However health care is becoming more affordable for rural and remote Australians. Bulk billing as a payment option has contributed to affordability and is perceived as an advantage within the Australian healthcare system. Tony Abbott, the Federal Minister for Health and Aging, reported that bulk billing rates for rural and remote areas are higher than ever at 72.6 percent (Leveratt, 2006-2007, p.16). However, bulk billing is not the only measure determining health care accessibility for people living in rural and remote regions of Australia. Reports suggest that remote Australians are disadvantaged due to a shortage of health professionals (by a figure of 700-800) practicing in these areas (Leveratt, 2006-2007, p.16). Australia’s healthcare system recognizes that the delivery and practice of health services in non-metropolitan areas should be different to their urban counterparts and considerations should be given to the drivers of these inequalities before health policies are made.
Conclusion Despite the differences between the two healthcare systems, both systems are based around the aim of providing health care that is appropriate to all. In both the UK and Australia, private health insurance in encouraged to citizens to relieve some of the stress placed on public health services. If more people seek out private health insurance, higher level of service is provided. Thorough attention enables patients and consumers with better quality advice and recommendations to aid recovery. Both systems are providing care at discounted costs to enable affordability to citizens. However this costs the two governments an extreme amount of money. If the healthcare systems could direct a portion of the taxes on prevention rather than medical treatment, this would most likely reduce the health care expenditure.