Making Decisions in Public Health


The medical care in Australia has undergone frequent changes with disruptions during its gradual transition from distinct interest groups. The deciding factor for all of these interventions is mainly attributable to the concept of sovereignty. The core elements underlying this concept are the insistence for authority, autonomy and boundary maintenance which are monitored by the physicians in general. According to Paul Starr, since physicians maintain the overall cultural as well as emotional authority over the patients, the patient-doctor relationship becomes the deciding factor in the health care scenario, even if the authorities enforce stipulations (Starr 1984). In most of the cases the patients are ignorant about the causes of illnesses and remedies which put the physicians on the vantage point of authority thereby enabling them to retain the decision factor. In the current prospective health care market, the provision of materials and services is a matter of profitability and as such the conditions that prevail in the medical care industry regarding supply and services seem to depart from all conventional theories by virtue of licensing that restricts competition which in turn increases the medical care expenditure (Arrow 1963).

In this context, it is worthy to note that the licensing laws cannot fulfill all of the needs of advanced medical care though such norms are designed to inculcate quality in the professionals. The licensing has provided filtering for identifying quality professionals which may reduce the chances of their entry, and in net effect it proves to be improper that it thwarts the consumer choices causing increase in the costs of medical care (Young, 2002). Therefore, through instituting guaranteed systematic output of medical services, Australia needs to apply the free market concept which enhances competition and equity. It is practically impossible to extend unlimited health care to anyone as it is an economic good which demands profit. The free market is capable to deliver more care to most of the people irrespective of whether they belong to middle, upper or low income group. The Australian medical care system with its free market provision can be successful even if it applies case specific policies. It is evident that every reform in the health care market envisages healthy competition, and unwanted regulations may torpedo the aim in its entirety (Makridis, 2011) for, Australian health care is committed to increase life expectancies of the people by lessening the infliction of infectious diseases and making health care readily available when required (Podger & Hagan, 1999), and it can happen only if there is explicit opportunities for curative as well as people interventions and trade-offs added by quantity, quality and capability driven by equity and cost effectiveness based on cultural values (Ross et al. 1999).

Health care is a composition of personal care added by health promotion, disease eradication and development of community interlinking equity, access and collaboration of the various elements of the social set up with empowerment, founded on socioeconomic and cultural factors of health (Keleher, 2001). Equity translates fairness backed by equality, compassion and empathy. According to Braverman and Gruskin (2003),

Equity in health reflects a concern to reduce unequal opportunities to be healthy [which are] associated with membership in less privileged social groups, such as poor people; disenfranchised racial, ethnic or religious groups; women and rural residents.

That means equity extends to more dimensions. In Australia the life expectancy of the indigenous people is shorter when compared to the non-Indigenous Australians and that reflects the inequality represented as inequity. Equity is ethically value oriented and as such different individuals require healthcare services on the basis of their medical condition and social status. Australians are connected to their social and cultural values, and they are equally bonded to the medical causes. Therefore, they need something more than the provision of equitable health care (Mathews, 2003) and that is “equal access to equal care for equal need” (Mooney, 2003).

Main body

The objectives of Australian health system are designed mainly to promote health and welfare of the people by means of effective consumption of health care services. It is focused on the maintenance of general health and wellbeing of the community and at the same time targets the equal distribution of medical care to all. Earlier, the performance and accountability of the Australian health schemes were of poor level which lacked consideration of the above objectives due to the complicated funding and delivery system inherent in the State and Federal forms of governmental machineries (Peacock and Segal, 1999).

To overcome such situations the funding mechanisms have been improved to provide strong and effective incentives for the participants of the system for achieving the policy goals. The progress achieved is evidenced by the present funding model including the departmentalization of services, emergence of private sector in meeting the demands of the indigenous people, and the adherence to the rural elements (Peacock and Segal, 1999).

Previously, the Medicare benefits were extended only to those services given by the medical practitioners. But now they are made available to the practice based nursing professionals in all of the fields of health service sector. After 1948, subsidized medicine supply began as per the Commonwealth Pharmaceutical Benefits Scheme (PBS) by Medicare Australia under the patronage of Department of Health and Ageing, thereby providing some sorts of safety net, to cut short the cost of medications. Private health insurance coverage is now put across wide segments including private and public hospitals, and allied medical services such as physiotherapists, podiatrists etc., and other aids and appliances like spectacles. The number of insurance coverage is also increased to 43% from the 1984 figure of 32% (Thomas, 2007). In order to achieve and maintain the national objectives of equity in health care, private health insurance is designed for meeting the community needs irrespective of the health status and at the same time based on equal premium. With the same objective the Federal Government has declared a new package to private insurance sector so as to include coverage to outpatient services as well as services which are regarded as out of hospital treatment of diseases like asthma, diabetes etc. As a result of these developments Australians are experiencing good health at present. The life expectancy has increased to become the highest in the world. The mortality rate of the infants has also come down. The 2004-2005 National Health Survey has revealed that 84% of the population aged 15 and above marks excellent health (Hotchin, 2008).

Public policy making is defined as the main determining objectives or societal goals as per Encyclopaedia Britannica (Encyclopaedia Britannica, 2000). Policy making in the health care sector is more than a technical exercise. It is consisted of different activities that aim to achieve certain statuses in the fixed target groups. The Government of Australia formulates national health policies through the Department of Health and Ageing and it encompasses every aspect of the health policies and provides subsidies to various health services extended by the State and territory governments and also by the private sector. The funding schemes and the financial burden pose challenges to Australia due to the technological advancements and increased patient expectations. The policy confirms funding to the universal medical services, the pharmaceutical companies, and public hospitals, and financial assistance to housing, and community care to the aged. Further, it supports training the professionals. While attaining coverage and control of the whole health expenditures, Australia’s health policy focuses on increasing the supply side efficiency. The complexity of the dual system of health care service added by the funding and governmental systems has put more pressure on Australia. The country implemented the Medicare in 1984 so that all of the Australian residents could avail the health care facilities available, regardless of private and public hospitals. Though it is either free or subsidized, the individual’s contribution is wholly based on the income which is collected through taxation called Medicare levy. The patients admitted to the hospitals are not made liable to pay the costs, and the selection of the treatment and the hospital is entirely left at their discretion (Healthcare in Australia).

The cooperation with foreign countries enables Australia to contribute much to the international health scene while it imparts better health care to its people by setting quality health standards. However, there exists confusion and apprehension in the health sector that if the outcomes of the policy implications are not explicit, it would affect the community health concept itself and will put shadows in the political scene and will cut holes in the budget. This situation, hence, demands pro active approach for maintaining positive performance. According to the World Health Organisation,

Community health includes curative, preventive, social support and health promotion activities for, and with, people in a community setting. Community health practice, as a component of primary health care, is underpinned and informed by the values and principles espoused in the Alma Ata Declaration on Primary Health Care (World Health Organisation, 1978).

The services delivered by community health shall therefore, be very diverse viz., (i) one-to-one (categorized as medical or clinical care and counseling services), (ii) group programs such as health education and training to support groups, and (iii) Community development. These functions require multi-disciplinary groups applying strategies to safeguard and promote the targeted communities. The recent reorganization of these systems by the government has resulted in the formation of the services of health, housing and community into Department of Human Services. In order to integrate the programme planning, a new section of Primary Care and Community System is all set to start under the Metropolitan Division (Deth 1999). Thus health service in Australia is in full swing to reach new realms fulfilling the policy objectives.

With the initiation of customer responsiveness and efficiency, from 1980 onwards, innovated techniques on public management were introduced worldwide and it focused more on the outcomes rather than the activities. Performance management was started in lieu of these techniques and to mark the deviation to the market oriented economic reforms, characterized by the separation and shifting of the health care purchaser from that of the provider of services and tendering and contracting of the service provisions. As a result the government lost its direct hold on the regulation of quality of health care which necessitated monitoring of accountability and performance (Shaw 1997). The community health activities in Australia are founded on the principles of reducing the inequities in health condition of the people. As such, inequities are the outcome of social and economic inequalities, employment, ethnicity, age, gender and place. Most of these activities are therefore, centred among the aboriginal communities and the migrants (Jolley, 1999).

As stated earlier, the health care is characterized by the technological developments, organization and funding. The solving of the problems in the development of public policies is marked by a series of processes in which most of the genuine problems are shadowed and allowed to be remained unsolved, till such unsolved problems are replaced by new ones. The success of a policy denotes its adaptability and acceptance by the predecessors thereby making it precedents. According to Culyer (1990), equity and efficiency envisaged in the policies justify government monitoring of the health services and the demands. The efficiency of the supply factor would be made maximal by leaving it to competitive market for strengthening the demand; efforts are made to burden more responsibilities for mediating between consumers and service providers (Scotton, 1991).

. There are enough international similarities in disease patterns and medical know how to rationalize the experiences, historical differences, cultural and political styles etc., and hence much attention is needed in determining the nature of ideas and the policy elements. The remedial measures are often determined by the systemic health care modes along with communites where they operate providing components for structural change. The broad features of the Australian health care system relate to designing of health insurance, funding, and financing of public and private sectors against the rising trend in health care expenditure. The past history of health care policy was distinguished by its sharp and frequent shifts with the change in form of government, funding schemes, and programs that were designed to support and promote the private insurance and service provisions (Scotton, 1991). Public policy should be effective in achieving the goals delivering maximum profit with least cost, and the goals formulated should have long term vision. It must comply and address the current environment and the society’s needs.


An effective public policy invites attention to proceed with the processing at the end users in multiple ways, whereas poorly conceived policies result in unwanted consequences (Scotton, 1991).

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Scotton, R. (1991) National Health Insurance in Australia: New Concepts and New Applications. Centre for Health Programme Evaluation, Working Paper-11, ISBN 1 875677 17 8.

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