Periodically, the US-based Commonwealth Fund organisation compares the US health system to that of other countries, including Australia.
The Australian health system ranks very high in its performance and i2P believes there are two major reasons for this outside of the criteria established by the Commonwealth Fund.
The first is the diversity of health practitioners in the natural and complementary field using safer treatments and therapies than that of mainstream medicine.
The second reason is the high level of self-care by Australians, even though health literacy overall is regarded a “patchy” with lower socioeconomic demographics presenting with low levels of literacy (and much higher levels of chronic illness), while the reverse applies to the opposite-high socioeconomic demographics with lower levels of chronic illness.
It is reported that natural and complementary medicines are used at least once per annum by 70 percent of the Australian population, with that level of market expansion predicted to increase even more in subsequent years.
It is ironic that currently there are multiple attacks on the above by mainstream medicine and global pharma political lobbyists that has culminated in a government review titled: “The Review of the Australian Government Rebate on Private Health Insurance for Natural Therapies”.
The Review advisers are strongly represented by members of Skeptics Australia and Skeptic-influenced representatives (members of the Friends of Science in Medicine).
As such, the Review is subject to a strong level of bias because of the hidden agendas they carry.
Even the NHRMC is represented in the Review – the organisation that unfairly attacked homeopaths through limiting evidence (to only evidence reports developed in English-speaking countries, refusing evidence from the Australian Homeopathic Association and not allowing their own review committee to appoint an expert homeopath to interpret and create levels of literacy as to how homeopathy achieves good outcomes.
This is not only unfair, but also un-Australian.
The plan is to remove government rebates from natural therapy modalities (both direct and indirect through health funds).
This will limit access to a diverse health system and pull it back to a monocultural medical system – the most expensive modality that has the highest level of patient death and injury (from drug adverse events and medical procedures) and the driver behind the poor performance of the US health system
Pharmacy has been developing an integrative model and is positioned to share in a cycle of substantial growth.
It lags, however, in its ability to deliver a higher program of health literacy to its patients because of time-involvement in a moribund PBS system (at the end of its product life-cycle), and continuous attacks by medical and Skeptic organisations promoting pharma marketing policies they wish to be the “norm” for all of pharmacy.
If pharmacy leadership can rally sufficiently to navigate around the above hazards, then Australian health rankings would improve in the range of indicators measured by the Commonwealth Fund (and also provided natural health modalities remain diverse and work under their own evidence base and culture).
Pharmacy’s future is thus tied to its ability to deliver optimal levels of integrated health literacy as an expanded clinical service based on a generalist platform.
i2P also believes that a single plant-based product, medical cannabis, will alter health costs across a broad range of chronic illness.
That is, of course if government can shake loose pharma lobbyists and let this substance flow through pharmacies under appropriate supervision and access for all.
Culture must change!
|Health Care Outcomes+||1||9||5||8||6||7||3||2||4||10||11|
An explanation of the above rankings follow.
Overall Ranking: This number is a weighted composite of all the domains that follow underneath.
Australia sits in a comfortable ranking at #2, but this is not a cause for complacency as underlying agendas concerning natural therapies are in play.
Generally, these are “wellness” therapies and if they disappear from the health mix then the “illness management” strategy of mainstream medicine will dominate and all of the above health rankings will begin to deteriorate.
Is measured over four sub-domains of prevention, safe care, coordination, and patient engagement.
The U.K., Australia, and New Zealand are the top performers in the Care Process domain. These three countries consistently perform above the 11-country average across all sub-domains (except for Australia on coordinated care – low-level collaboration between pharmacy and the medical profession is just one example).
The U.K. excels in safety, while Australia is the top performer in patient engagement.
On the other end of the spectrum, Norway and Sweden’s performance is below average on each of the Care Process sub-domains.
Access encompasses two sub-domains: affordability and timeliness.The six measures of affordability include patient reports of avoiding medical care or dental care because of cost, having high out-of-pocket expenses, facing insurance shortfalls, or having problems paying medical bills.
One measure reflects primary care doctors’ views of the difficulty patients face in paying for care.
Timeliness includes nine measures (three of which are reported by primary care clinicians) summarising how quickly patients can obtain information, make appointments, and obtain urgent care after hours.
It also addresses the length of time needed to obtain specialty and elective non-emergency surgery.
Overall, the United States ranks last on Access.
The U.S. has the poorest performance of all countries on the affordability subdomain, scoring much lower.
The Netherlands performs the best of the 11 countries on Access, ranking first on timeliness and in the middle on affordability.
Germany ranks second on Access, and is among the top-ranked countries on both subdomains.
The United Kingdom, Sweden, and Norway are the other top-ranked performers on affordability.
Australia leans towards middle-average performance, and access will decrease if rebates to natural health modalities are removed.
Administrative Efficiency includes seven measures.
Four measures evaluate barriers to care experienced by patients, such as limited availability of the regular doctor, medical records, or test results.
Three indicators measure patients’ and primary care clinicians’ reports of time and effort spent dealing with paperwork, as well as disputes related to documentation requirements of insurance plans and government agencies.
The United States ranks 10th on Administrative Efficiency.
Compared to the other countries, more U.S. doctors reported problems related to coverage restrictions. Larger percentages of U.S. patients also reported Administrative Efficiency problems compared to those in other countries (except France).
The top performers in this domain are Australia, New Zealand, the United Kingdom, and Norway.
At the lower end of the range, respondents from France were most likely to report problems in this area among the surveyed countries.
Although Australia ranks #1 in this indicator , there are worries about possible government intention to privatise Medicare and scale down the Pharmaceutical Benefits Scheme.
In their place privatised alternatives called Patient Benefit Managers and Health Insurance would fill the void.
This would create Australia as a clone of the US health system – the worst system in the world.
Patient Benefit Managers in the US are driven by global pharma marketing policy, and as such, could never be affordable.
The United Kingdom, the Netherlands, and Sweden rank highest on measures related to the equity of health systems with respect to access and care process.
In these three countries, there are relatively small differences between lower- and higher-income adults on the 11 measures related to timeliness, financial barriers to care, and patient-centered care.
In contrast, the United States, France, and Canada have larger disparities between lower and higher-income adults. These were especially large on measures related to financial barriers, such as skipping needed doctor visits or dental care, forgoing treatments or tests, and not filling prescriptions because of the cost.
In Australia, we are seeing a trend separating the “haves” from the “have-nots” as the population ages and pensions do not increase at the same rate as average wages.
Also, poor financial planning that did not factor in lifespan increases means that there are not enough wage earners to pay tax and sustain the costs of retirement pensions.
Health Care Outcomes
The United States ranks last overall in Health Care Outcomes.
However, the pattern of performance across different outcomes measures reveals nuances.
Compared to the other countries, the U.S. performs relatively poorly on population health outcomes such as infant mortality and life expectancy at age 60.
The U.S. has the highest rate of mortality amenable to health care and has experienced the smallest reduction in that measure during the past decade.
In contrast, the U.S. appears to perform relatively well on 30-day in-hospital mortality after heart attack or stroke.
The U.S. also performs as well as several top performers on breast cancer five-year relative survival rate and close to the 11-country average on colorectal cancer five-year relative survival rate.
Australia has the best Health Care Outcomes overall.
Seventy percent of Australians access nutritional supplements and studies among populations such as the Adventists support the fact that good diet coupled with nutritional supplements extend the average life expectancy by a period of eleven years.
Is this an “under the radar” reason for Australia’s good outcome rating?
Sweden and Norway rank second and third in the domain.
While the United Kingdom ranks 10th in the health care outcomes domain overall, it had the largest reduction in mortality amenable to health care during the past decade.
One other change was the introduction of pharmacists to clinical settings which involved a mix of shared and independent prescribing.
Inexplicably, a reduction in services occurred towards the end of the decade citing budgetary reasons.
The three countries with the best overall health system performance scores have strikingly different health care systems.
All three provide universal coverage and access, but do so in different ways, suggesting that high performance can be achieved through a variety of payment and organizational approaches.
Experts generally group universal coverage systems into three categories: Beveridge systems, single-payer systems, and multipayer systems.
These three systems are represented among our highest performers.
THE U.K.’S NATIONAL HEALTH SERVICE
The Beveridge model takes its name from the creator of Britain’s modern welfare state, William Beveridge.
In the NHS, initiated by Aneurin Bevan in 1948, health services are paid for through general tax revenue, as opposed to insurance premiums.
Furthermore, the government plays a significant role in organising and operating the delivery of health care.
For example, most hospitals are publicly owned, and the specialists who work in them are often government employees.
This is not true of all providers.
Most general practitioner practices are privately owned.
Health care in the U.K. and other Beveridge countries is centrally directed and has more direct management accountability to the government than in other health systems.
AUSTRALIA’S SINGLE-PAYER INSURANCE PROGRAM
In Australia, everyone is covered under the public insurance plan, Medicare.
Much like the NHS, Australia’s Medicare is funded through tax revenue.
Medicare is distinguished, though, by lesser public involvement in care delivery.
Many Australian hospitals are private, and roughly half the population purchases private health insurance to access care outside the public system.
To put into an American context, Australia’s Medicare resembles Medicare in the U.S.
However, various lobbyists are trying to remove access to a range of natural health practitioners, through influencing government to remove rebates already established for these modalities.
In so doing patient access will be reduced to Australia’s diverse health system, with patient choice becoming limited and reduced to the mainstream medicine “illness management model”.
If that happens we are likely to see Australia dip in world heath rankings.
NETHERLAND’S COMPETING PRIVATE INSURERS
Unlike Australia and the U.K., the Dutch health system relies on private insurers to fund health services for its population. Dutch insurers are mainly financed through community-rated premiums and payroll taxes, which are pooled and then distributed to insurers based on the risk profile of their enrollees.
All plans include a standard basic benefit package; subsidies are available for people with low incomes; adults are required to enroll in a plan or must pay a fine.
Dutch health care providers are predominantly private. This multi-payer system—partly inspired by the managed competition model—shares many similarities with the insurance marketplaces created under the Affordable Care Act in the US.
Pharmacy has always had the potential to step up through creating different methods to fulfill its scope of practice more efficiently, but is often opposed by the medical profession which chooses to see scope improvement as “turf encroachment”.
One recent example was the disruptive behaviour of the medical leadership organisations in blocking a pathology service negotiated with Sigma/AMCAL.
Threats of commercial pressure disrupted the launch of this service despite the fact that pathology is well within the scope of a pharmacist and was legally tested as far back as 1964.
While the medical profession is choosing to be disruptive against pharmacy and a host of allied and natural health modalities, we will see uncertainty and a loss of patient trust in our health systems in total.
If that trend continues to exacerbate with the medical profession continuing to waste resources and operate inefficiently, we will see Australia’s health system lose out dramatically in its global health ranking.
And the Australian health consumers will lose their ability to pay, through ever increasing mainstream medical costs and a government refusal to subsidise those costs.
This does not need to happen!