What+is+the+best+model+of+healthcare+for+the+population's+health?

Tutor: Sophie Miller n7528345 Student: Jared Smith


 * __Artefact __**

(Bateman, n.d.)

This artefact comes from American political cartoonist Scott Bateman. The cartoon highlights the discrepancies that are present within America’s healthcare system, and what the serious problems are that affect many uninsured Americans. This cartoon highlights the fact that most Americans cannot afford healthcare coverage, and as a direct result contributes to one of the largest health inequalities within arguably the most advanced medical nation on the planet. This depiction alone highlights the argument of how a user pay’s medical system is something that does not work, and the problems that are associated with a health model that undermines a large proportion of its population.


 * __Public Health Issue __**

The public health issue is trying to ascertain whether the political commentators are speaking the truth about the narrow-mindedness and ineffective nature of the user pays healthcare model, or can it actually be successful within the population for the greater good of the community. If we typically look at the two most obvious cases of healthcare models (user pays and universal access), then the answer would be no. Within Australia a ‘universal – access’ system is present, where everyone is covered under some form of healthcare insurance, depending on your circumstances either covering just the basic levels of health, or a larger amount of services (Medicare Australia, 2010). As opposed to the United States of America’s ‘user pays’ models that had in 2010 49.9 million people without any form of healthcare insurance (U.S census bureau, 2011). While universal access looks far more appropriate for the entire population’s health, there are other options of healthcare besides pure universal access.


 * __Literature Review __**

To ascertain whether the user pays medical system holds any benefit for the population’s health, a literature review on the most appropriate information was completed to answer this question. Information within this literature review was chosen using a five tiered process. This included checking the accuracy (are references supplied), the authority (the origin of the document), the objectivity (goals and aims of the creator(s)), the currency(are dates supplied?) and the coverage of the information (how in depth is the research). Topics that will be analysed within this literature review include; does universal access really mean universal access?, various approaches to the unclogging of the system, and comparing the two systems within similar settings.

It has been highlighted within Meessen, Tashobya, Tibouti, & Van Damme’s study (2007 ) that universal access health systems being advertised as free healthcare is a form of false advertisement. The literature review analysed hospital utilisation and other health related information for Uganda and Cambodia, after both had switched to no user fees and established health equity funds for their respective populations. While it was found that this had greatly improved the utilisation rate for people of lower socio economic backgrounds, it was also found that a serious problem created, was trying to access these services if you were someone of a lower socioeconomic position. As a direct result of trying to reach these ‘free’ services, other costs such as transportation and food increased. While these are considerable problems it can be argued that these difficulties are a neccessary evil and greater access by people of lower socioeconomic backgrounds are now able to access these services. Financial situations however do not only prevent people of third world nations from accessing the benefits of health services. In Australia it was identified by the Australian Bureau of Statistics (2010) that //“1 in 16 people had delayed seeing or not seen a GP”// (Australian Bureau of Statistics, 2010) and //“around 1 in 11 people with a prescription had delayed getting or did not get their medication”// (Australian Bureau of Statistics, 2010), due to financial constraints. While these examples show the many different stances of 'free' products, other problems such as overuse of services can also be present with universal access.

Problems met by ‘universal access’ systems have been discussed within Foubiser, Mossialos, & Thomson’s (2010) review of the English heathcare sector. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">It was found that //“When healthcare is free at the point of use, patients seek care for as long as there is some benefit to be had – however small, and irrespective of its cost”//(Foubiser, Mossialos & Thomson, 2010). This point can be contrasted with the user pays model basic underlying principle of //<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">“improve efficiency by moderating demand and containing cost” //<span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;">(Foubiser, Mossialos & Thomson, 2010). <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">User pays encourages patients to make wiser decisions in relation to their healthcare choices. As opposed to the universal access healthcare ideation of ‘it’s free so I want it’ (Foubiser, Mossialos & Thomson, 2010). Foubiser, Mossialos and Thomson further discuss the positive effects of an appropriate user pays model. They propose that //“ by building on the primary incen­tive effect of user charges—to forgo care—in such a way that patients only forgo low value care” // <span style="color: #000000; font-family: 'Times New Roman','serif'; font-size: 16px;">(Foubiser, Mossialos & Thomson, 2010), a health system will run much more effectively and efficiently, as patients who are burdened with the cost of healthcare are more deliberate and purposeful in healthcare decisions in relation to their primary access. <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The problem of ‘ultra access’ within the universal healthcare model is not only featured within the patient’s mentality. Palmer and Short (2000) discuss how the ease of admission for patients in Australia have been increased by the instigation of universal healthcare, highlighting the relative ease associated with patient refferal from practitioners, when there are no constraints of user fees preventing them from doing this. While these points rally strongly for the benefits of a user pays health model, the best gauge of the benefits of a functional model can really only be ascertained by studies comparing both models of healthcare delivery within their appropriate settings.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Within <span class="authors" style="font-family: 'Times New Roman','serif'; font-size: 16px;">Fang, Sham, Tang, and Woo’s (2008 <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">) study of the health of elderly people within the Beijing user pays system and the Hong Kong largely subsidised version of healthcare, health outcomes were compared to see if major health disparities were present. It was found that better health had been identified within the Beijing (user pays) cohort as compared with the people of Hong Kong (subsidised health services). It has been discussed that this result was achieved due to the higher socioeconomic nature of the Beijing Cohort as compared with their Hong Kong counterparts, however lifestyle risk factors have also been discussed as a reason for the health difference. While within Rakick’s (1991) article disparities between Canada’s universal access and America’s user pays system have been discussed with the arguments presented highlighting the disparity and ideas of the two models basic principles. Problems that have been argued for in Canada’s system include lengthened waiting times (in terms of surgery, and general checkups), with a too great of an emphasis on acute-care. While these are very pro user pays findings, a universal point in comparison with the U.S.A’s healthcare system is that Canada’s system of universal healthcare provides a universal benefit for the population and //“helps to achieve the objective of promoting the collective good for all Canadians”// (Rakick, 1991), while arguably the American Healthcare system does not. While these last point again provide greater problems in choosing the right model of healthcare, the most appropriate gauge would have to be the comparison of demographic information. Canada has a slightly higher life expectancy (80.7 years) when compared with the U.S.A (77.9 years) (OECD, n.d.). While this is the best indication of the benefits of universal access, there is very little disparity between the two life expectancies truly showing the debate that is present when discussing health models and their overall benefit for health.


 * __<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Cultural and Social Analysis __**

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">In a functional society everyone would be able to reap the benefits of user pay’s health system, as everyone would be comfortable with their weekly income and be able to afford a system that gives the user a wide range of choices in respect to their health care. However the truth of the matter is roughly 1 in 5 people live on a dollar value of $1 or less a day (Earth Trends, 2007). While the last piece of information is very third world orientated, the fact is that under a user pays health model 16.3% of the American population have no healthcare coverage at all (U.S census Bureau, 2011), and (as outlined within the artefact presented) have serious problems everytime they need to utilise the health services available. It is outlined within the World Health Organisation constitution that every person has the right to health, which means that //“governments must generate conditions in which everyone can be as healthy as possible”// (World Health Organisation, n.d.). This point has been strengthened by Hausman’s (2011) interpretation of John Locke’s theory of property, indicating that the protection of property extends to the protection of lives, (as we are the governments ‘property’). It can be argued that the U.S government (or any government still using a user pays model of healthcare) are not tending to these basic requirements and that they are not able to do this, under the user pays model of healthcare.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">While this literature review highlights the fact that other model’s of healthcare (besides universal access) have merit and can be functional, it is collectively agreed that the user pays form of healthcare is not super effective for an entire populations health. While user pays healthcare has been discussed as a functional model within Fang, Sham, Tang and Woo's study (2008) it must be highlighted that this was a higher socioeconomic area of the population. What has been shown is that a user pays system (traditional liberal) is essentially a system that rewards people of a higher socioeconomic position while a universal access model (traditional labor) is the correct model of choice for people of a lower socio economic position ( <span class="authors" style="font-family: 'Times New Roman','serif'; font-size: 16px;">Fang, Sham, Tang, & Woo, 2008).

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">It is important to discuss health and its various implications as it is one of the most basic principles of human life, and the healthcare models which are present, are one of the major determinants for not only the individuals, but also the populations health. While Australia’s health system is not perfect, and popular information sources would backup this belief, it must be understood that we do compare very well when compared with any other first world nation. Our life expectancy, infant death rates and suicide rates are among the best in the world (OECD, n.d.), and it is important to realise that as a health system, and the health of Australians as a whole are both very strong. Australia’s mix of universal access, and private health insurance provides a reasonable ground base for the population and the system, which does a reasonable job of combining both models of healthcare; universal access for the lower socioeconomic population; and reducing the pressure on the public sector by providing higher levels of care (private) for those who can afford it. The ‘Australian’ combination of universal access whilst still having the freedom and choice available to make your own decisions in respect to your healthcare has been typified within Hausman’s ‘Lockean’ universal access model (2011). Hausman highlights the need of governments to take ownership of healthcare, whilst still being able to offer basic liberalistic rights to the population.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The best gauge of the healthcares performance has been identified within Armitage's study (2009), where over 800 Australians were randomly interviewed to assess the healthcare and the collective satisfaction in its performance. Respondents indicated a strong tendency for the public healthcare system, with an even stronger tendency for greater action resulting in better health outcomes for all citizens (Armitage, 2009). While this is a strong analysis depicting Australia and the universal access model in a positive light, it must be stressed that this ideology is not universal. Australia's society is a cultural melting pot, and so are our political parties. Even the Australian Liberal party rallies for universal access now as they can see the collective benefit to the population, a once strictly Labor point. Other nations need to be able to see Australia's success of combining the best of all parties and being able to come to collective agreement for the greatyer good of the population. Pressure needs to be put on various other nations and political stakeholders to make sure that everyone can enjoy the benefits of a functional and ethically sound healthcare system whether it be consisting entirely of a universal access model or a 'blend' of various different types of healthcare.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">__**Analysis of the Artefact and your own Learning Reflections**__

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">The cartoon presented is a perfect depiction of the troubles that are associated within America's user pays healthcare model. Problems listed within the artefact include the fear of bankruptcy, not being able to afford a regular health check up and other health related items that many Australians take for granted. Clearly the male within the cartoon is supposed to be depicted as being sarcastic about his health finance situation, while the female character looks genuinely upset about the lack of health services being available.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">I myself have never had to suffer from any form of healthcare unavailability or troubles, that are present within the artefact. I am from a working class (non Indigenous) Australian family, who are not rich, but are comfortable, and as a direct result am able to enjoy the benefits that are associated with being able to afford private health insurance coverage. Before completing this assignment I had a basic understanding of health models and their relationship to health, and I too was one of the many critics of the Australian health system. However (as stated earlier) I now know how well Australia is placed in terms of healthcare when compared with many other nations. My thinking has now been altered to a different state where I can now see the benefits associated with a traditional Labor view of universal equity and access, but also knowing the importance of individual rights and liberty that are associated with traditional liberal views. This assignment alone has made me want to become more heavily involved in healthcare and its funding models, as I can now see that a little bit of information can go a long way to making a big difference.

**__<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">References __**

<span style="font-family: 'times new roman','serif'; font-size: 16px;">Armitage, M, H (2009). Public perceptions of Australia's doctors, hospitals and health care systems. //Medical journal of Australia//, //190//(2), 102 - 103. Retrieved from []

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Australian Bureau of Statistics (2010). MOST AUSTRALIANS USE HEALTH SERVICES BUT ACCESS, COST AN ISSUE FOR SOME. Retrieved from []

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Bateman, S (n.d.). American health insurance cartoon [image]. Retrieved October 20, 2011, from []

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Earth Trends (2007). Ask Earth Trends: How many people live on less than $1/day? Retrieved from []

<span style="font-family: 'times new roman','serif'; font-size: 16px;">Fang, X, H,. Ho, S,. Sham, A,. Tang, Z,. & Woo, J (2008). Influence of different health-care systems on health of older adults: a comparison of Hong Kong, Beijing urban and rural cohorts aged 70 years and older. //Australasian journal on ageing//, //27//(2), 83 - 88. doi: 10.1111/j.1741-6612.2008.00297.x

<span style="font-family: 'times new roman','serif'; font-size: 16px;">Foubiser, T,. Mossialos, E,. & Thomson, S (2010). Can user charges make health care more efficient? //BMJ. British medical journal (International ed.),// //341//(7771), 487 - 489. doi: 10.1136/bmj.c5225

<span style="font-family: 'times new roman','serif'; font-size: 16px;">Hausman, DM(01/07/2011). "A LOCKEAN ARGUMENT FOR UNIVERSAL ACCESS TO HEALTH CARE". //OCIAL PHILOSOPHY & POLICY//, //28//(2), p.166 - 191. doi: 10.1017/S0265052510000257

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Medicare Australia (2010). What Medicare covers. Retrieved from []

<span style="font-family: 'times new roman','serif'; font-size: 16px;">Meessen, B,. Tashobya, C, K,. Tibouti, A,.& Van Damme, W (2006). Poverty and user fees for public health care in low-income countries: lessons from Uganda and Cambodia. //The Lancet,// //368// (9554). 2253 - 2257. Retrieved from []

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">OECD (n.d.). Statistics from A to Z (beta version). Retrieved from []

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Palmer, G. R., & Short, S. D. (2000). Health care & public policy: An Australian analysis (3rd ed.). Australia: Macmillan Publishers Australia.

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Rakick, J, S. (1991). Canada's universal-comprehensive healthcare system. //Hospital topics, 69//(2). 14. Retrieved from []

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">U.S census bureau (2011). Health Insurance; Highlights 2010. Retrieved from []

<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">World Health Organisation (n.d.). The right to health. Retrieved from []

[]
 * __<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">My Discussion __**
 * __<span style="font-family: 'Times New Roman','serif'; font-size: 16px;">Discussion 1: __**
 * <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">'Theory of dominance'?... I never thought of that ideology **

Hi Sam,

I really enjoyed reading your wiki. You raise some very interesting points in relation to the sexism that is present in relation to female sport. However i am wondering what made you choose to use Karl Marx’s theory of ‘dominance’? I can’t help but feel that Jean Baudrillard views on the way sport acts on all of us were the most accurate. He has argued for decades that sport (in its gladitorial nature) creates a form of ‘hyperreality’. While also stating the reproduction of events (sports on television, articles like your artefact ‘Australian Open hotties’) known as social reproduction has replaced the actual production of these events (Stanford Encyclopedia of Philosophy, 2007). I strongly feel that the powerful shots of masculine ‘heterosexual’ males roaming the sporting fields, with the scantily clad women cheerleaders on the sidelines watching and cheering on does little to change the age old ideal that women don’t have a rightful and respectful place on the sporting field. However changes have been made and thankfully it is starting to become a gender equal stage on the sporting media landscape with the hope that this ‘hyperreality’ is slowly changing to a more equal society. Popular magazines like Inside Sport have since removed these revealing images of women from their magazine with many others following suit, whilst in sport prize money has been raised or even equaled for men and women (BBC sport tennis, 2007). While these are great steps forward I feel if the sporting landscape is to truly change, then media will have the largest role to play in making this happen. BBC sport tennis (2007). Wimbledon pays equal prize money. Retrieved from []
 * __References__**

<span style="font-family: 'Calibri','sans-serif'; font-size: 15px;">Stanford Encyclopedia of Philosophy (2007). Jean Baudrillard. Retrieved from []

__**<span style="font-family: 'Calibri','sans-serif'; font-size: 15px;">Discussion 2: **__ []
 * <span style="font-family: 'Calibri','sans-serif'; font-size: 15px;">This is a big problem, but... **

Hi Jack,

I strongly agree with your (and the green parties) statements in regard to climate change and making changes now so that future generations are not suffering for our mistakes. However i have noticed that a large part of your discussion focuses largely on American studies. Was this because you were trying to indicate the ideologies of the western world or was there a lack of information in relation to ‘green schemes’ within Australia? Further into the literature review you have elaborated on how Australia (population close to 23,000,000) (Australian Bureau of Statistics, 2011) have made some in roads to the crisis (within the greens party policy) I feel that it must be understood that these are only really ripples in the larger pool of trying to improve the planets carbon footprint. You further state that the programs (like the chicago one) are sometimes done half – heartedly and to no obvious success. While it is obvious (and well stated) that this is a major issue, i cannot help but feel that these funds spent on trying to fix the planet would be better spent on the health of its citizens rather than tying into the debate of ‘greenhouse emissions’. Within America almost 50,000,000 (U.S census bureau, 2011) people have no form of health insurance and are left with the very real prospect of being ‘bankrupt’ when they visit a health service. While in Australia, situations are not quite as grim, however funds could be further redirected to other programs which intend to fix health inequalities, like for example the shortened life expectancy of Indigenous Australians (Australian Bureau of Statistics, 2011). So while i agree that the greens political ideals are valiant, and whilst i agree with them, I am left feeling that funds would be better spent achieving better health outcomes for the immediate population, not the future one.


 * __References__**

Australian Bureau of Statistics (2011). Australian Social Trends, Mar 2011. Retrieved from []

Australian Bureau of Statistics (2011). Population Clock. Retrieved from []

U.S census bureau (2011). Health Insurance; Highlights 2010. Retrieved from []