Discuss about the Health Care and Delivery Reform for Clinical Governance.
Proper health care facilities should be developed in all countries, with the aim in provision of universal health services irrespective of the financial backgrounds of its citizens. This paper compares and contrasts the health care systems of UK, US and Australia using the analytical framework which includes efficiency, effectiveness and equity. Additionally it mentions the reforms that is being implemented for betterment of the health care system in the respective countries.
The clinical governance in Australia has been seen to vary across the jurisdictions of the Commonwealth and states of the country. This in turn reflects the system of fragmented health in terms of funding and service responsibilities since Australia has a federal parliamentary system. The mechanism of governance varies in order to protect and provide the customers living in the different parts of the country (Allin & Rudoler, 2014). There is also a variation in the information related to the quality and safety aspects of clinical governance.
The organizational structure of the health care system in Australia is quite complex which consists of many types of providers and services and a variety of funding and mechanisms of regulations. The major bulk of the health care system is funded by the commonwealth funds which subsidizes the pharmaceuticals and the care of the aged in terms of residential care. There is also a large private sector which plays a role involving many stakeholders. There is an overlap between the commonwealth and the state governments (Abubakar, 2015).
The function of the health care system in Australia is carried out both by the private and the public health providers. The private sector is mainly involved in delivering the primary as well as the specialist care, which is provided through the private hospitals. The state and the territories run the public hospitals which is mainly concerned with providing public health programmes and delivering a much smaller amount of primary health care as compared to the private health care (Delaney, 2015).
The united states possess a federal system of government, having a significant amount of authority shared by its regional governments; hence the clinical governance is regulated both by the federal and the state or local governments. Having the largest economy in the world, the health care system in the US has mainly developed through the private sector, with the combination of high levels of funding. There is a deficit of government engagement in the health care system (Duckett & Willcox, 2015).
The organizational structure of the health care system of the United States comprises of a system that is multiple in nature. It tends to operate with independence, or at times work in collaboration with each other. The state funding and the funding received from the public heath functions pay the cost of the Medicaid and lay down the rules for the health insurance policies. While on the other hand, the federal system mainly oversees the pharmaceutical and the medical devices (Jee & Kim, 2013).
The health care system functions on decentralization and centralization that operated by federalism. The private stakeholders in the US, has the strongest role in the health care system. The establishment of the health insurance system was initiated in the early 1930s by the private sector, while the major federal government health insurance programmes, Medicare and Medicaid was developed only in the mid-1960s. Medicare scheme provided coverage for senior citizens and some of the disabled individuals and Medicaid covers health-care services for the financially challenged citizens (McGorry, Bates & Birchwood, 2013).
The health care system in the United Kingdom was established in the year 1948, which aimed at providing to all its residents. The system is funded through taxation where health service is provided through the publicly owned hospitals mainly and which is free at the point of use. The clinical governance of the health system in UK has regulations which oversee the health professional groups as well as the quality of the care providers (Papanicolas & Smith, 2013).
The organizational structure of the health system comprises of the United Kingdom government at the top which determines the budget of the health and other social services in this field. The ministry of health oversee the financial control and the performance delivery in the health care sector, which is controlled by the National health services (NHS). This an executive body which is non departmental with a wide range of defined duties that is accountable to the government as well to the public (Schoen et al., 2013).
The health system functions to provide care to all its residents which is free at the point of service. It aims to provide services that are safe, effective in function as well as in cost, maintain equity in care provision and is of high quality. The NHS systems across the United Kingdom are making a continuous attempt to indulge in more effective allocation of the human resources and the finances. They are also aiming to to find new ways of engaging with the public on order to operate improvement in the responsiveness of the health system (Spigelman & Rendalls, 2015).
The health care system of United Kingdom possess the characteristics of a nationalized and a centrally driven system. The Labour government illustrates the pro-active role in the setting benchmarks for the effectiveness and efficiency while changing the factors of the internal market which was established earlier, which led to the transition to a partnership rather than competition (Stoddart & Evans, 2017).
The health care system of the United States is in stark contrast to the National Health Service (NHS) in the United Kingdom. In US, the health care system is a sequence of systems with the insurance benefits which is variable. It is influenced by the regulations designed by the federal and state government levels together. The system is majorly private sector-driven which is combined with a market-based aspect focusing on the implementation of data of performance by the health-care consumers. The performance enhancement is catalysed through the procedure of selection and decision making (Zimlichman et al., 2013).
However Australia stands in between these two approaches which projects a intermingling of the unique features of both the systems. The health system of Australia has developed a system that is universally accessible, accompanied by the use of market-like financing rewards and incentives along with the activation of the private sector. Australia has a federal government structure hence retains overlapping responsibilities of the national and state government for the funding, regulation and health care delivery. There exists a collaboration between the governments and the professional institutes that is important for the effectiveness of the system-wide transformation (Stoddart & Evans, 2017).
Medical treatment is broadly available free of cost and its use fairly unlimited. The treatment that is provided to the general citizens to is made free at the point of delivery. The treatment provided by the general medical practitioners is also made free while the pharmaceutical are subsidized. For the items on the Pharmaceutical Benefits Schedule, the pharmaceuticals are also given at subsidized rates (Duckett & Willcox 2015). For the list on the Medical Benefit Schedule, the medical consults and the treatment is also subsidized. Individuals receiving pensions are entitled to receiving significant amount of concessions. There is no such limit imposed on the medical services that an individual is entitled to. There is no ration on the health care benefits and there exists a very little debate on the fact that whether ration services should be provided or not and how it should be provided (Squires & Anderson, 2015).
The health system efficiency in the United Kingdom have been measured in terms of allocative efficiency and technical efficiency. There have been a change in the United Kingdom over the favour for primary care as compared to the secondary care. It can be hoped that the primary care will be more cost effective at treating people before the conditions degrade. However there is a disparity among the money that is tied up with the health care services provided by the primary and the community care (Spigelman & Rendalls 2015). This needs to be addressed if the efficiency needs to be enhanced. Although the United Kingdom does not face the problems of transparency in matters of financing of the health such as events of informal taxations. Transparency is achieved through the participation of the public. The data of performance for the providers are made available to the public in order to inform the patients about the performance in respect to the standards (McGorry, Bates & Birchwood 2013). In the United Kingdom, not only the service improvement can be driven by the patient but also financial decisions by exercising the choice of the patients. However, the public does not have a strong hold in raising their voices in case of major service transition propositions. This meant that there are existence of issues which are in relation to the reality of accountability, where there is involvement of the common mass in the decision making process (McGorry, Bates & Birchwood 2013).
Within the United States, there is a variation in terms of socioeconomics and geography with respect to the technical efficiency. The technical efficacy illustrates the extent to which the expenditure of health care is directed to the patient care more than the administration. If the resources are being expended towards the patient care then it can be said that it is working in a technically efficient manner. The private insurers work in a manner that is based on profit and they try to obtain returns from the investors. There is a process of marketing through advertisements, which helps in determining whether a person should be able to purchase process claims and coverage that is private (Zimlichman et al., 2013). After obtaining the payment from the public and the private insurers, that involves a significant administrative effort. A substantial amount of labour and capital resources is required by the hospitals and the groups of physicians for engaging with the multiple private insurers as well as the government programmes, particularly Medicare and Medicaid (Allin & Rudoler 2014). The allocative efficiency on the other hand, relates to whether the resources of the society are that being spent in the manner that is useful to the benefit of the society. This can be related to the health care system in a way that can be operated effectively for the overall health and the well-being of its residents. Although no health care system can perform flawlessly but it must strive to move forward according to the ideal objectives that has been laid down. This allocative efficiency generally comprises of the following components such as technical efficiency and to oversee that whether the right products and services is being provided. The last component is to see that how the goods are being distributed (Abubakar, 2015).
The key factors of the public health in UK that contributes to the effectiveness of the health care system comprises of the health protection programmes, the health improvement programmes and the reduction of health inequities. The main three roles of the primary health care is firstly the point of contact when the individual first suffers a health concern. Secondly it aims at providing long term care for the conditions and injuries and finally it acts as a gatekeeper to the specialized care that is offered by the health care system. The secondary care that is provided by NHS is provided through the services of the doctors who are specialized and who work in the state-run hospitals. The tertiary level of health care is provided by is more specialized system that provided care in case of more complex case histories of disease (Burwell, 2015). The priorities that the public health system of UK has includes the alcohol harm reduction, reducing child obesity, removing health equalities, reduction in infant mortality, response to sexual violence, awareness of sexual health and teenage pregnancy, tobacco control, introduction of vaccinations and immunizations and the mental health and well-being of the residents. Certain interventions have also been developed like smoking bans in public places and making eighteen the minimum age limit for consuming tobacco (Williams et al., 2014).
The key factors which contribute to the effectiveness of the health care system in US includes defining public health by the IOM, the policy developments and the assurance (Delaney, 2015). The public agencies majorly promote public health which is primarily at the state level. Although sometimes the private agencies also play a role. At the federal level of health services, it is directed by the United States Public Health Service (USPHS), which is a division of the HHS. The services provided by the public health includes control of communicable diseases, control of environmental hazards, preparedness for emergency and terrorism, promoting occupational health, population health and well-being surveillance, promotion of health and prevention and other public health screening programmes (Moses et al., 2013).
The effectiveness of the Australian health system is dependent largely on the general medicine practise which form a bulk of the medical care. In order to strengthen the health care system, a partnership was introduced which took place between the Australian Institute of Health and Welfare and the National Health and Medical Research Council. The six different arenas of national health priority of Australia includes the special attention for cardiovascular diseases, cancers, injuries, psychological problems, diabetes and finally asthma. The wide aim of the National Public Health Partnership is to bring harmony to the public health legislation, to strengthen the infrastructure of public health, better information development, funding of research and development, examination of the issues suffered by the workforce and establishing a framework for national planning (Spigelman & Rendalls 2015).
In Australia the 40% of the total population is covered by insurance that is private, which only covers 30% of the health care payments. This is in sharp contrast to the systems in UK where private insurance is only received by the population which are better-offs and only covers the payments partly. In case of US, there is a large amount of out-of-pocket payment system and private insurance.
In the Medicare system that exists in Australia, direct payments are made, therefore the direct pays are expanded and become regressive. The health system of Australia is less equitable as compared to UK and Australia in terms of health delivery. The better-off population receives more benefits of the public and private health care system. In the US and UK the intermingling of the public and private system favours the finances of the health care services although which is becoming less progressive with time (Stoddart & Evans 2017).
In order to measure performance and address the improvement initiatives which are to be taken the United States in terms of its health care system, it needs to recognize the multiple stakeholders and the responsible parties. Although several activities has been observed in US, still there remains problems with the quality of care that remain evident. Therefore implementation of potential change in strategies of reforms remain essential (Boulware et al., 2016).
In the context of reforms in the United States, it is evident that most of the performance enhancement management strategies that have been implemented were operational rather than of national policy level. Therefore the importance of the national initiatives must be highlighted in order to bring strategic reforms in the health care system which can be long lasting. Recently, four important contributions have been made in this field which includes the president’s commission for ensuring consumer protection and quality in health care, the institute of medicine: quality and safety reports, enhanced federal government leadership and leverage and lastly the national forum for the quality measurement and reporting (Burwell, 2015).
United Kingdom unlike the US and Australia, has a history of reasonable national approach in providing of health services. The national health system of UK is a universally accessible system that is funded by taxations and was managed like a single unit, until recently.
The major factors of the quality assurance in UK consisted of hospital morbidity and mortality committees and the local clinical audits, the national confidential enquiries and the licencing of the doctors through the general medical body. After a number of failures in context of the health care systems and the concerns of the public about the quality of health care provided, the NHS developed certain objectives which consisted of different components. These included the development of national standards through the implementation of national service frameworks, the national institute for clinical excellence (NICE),, development of a definition of a defined duty for clinical governance, the creation of a new national identity to ensure the quality standards (commission for health improvements) and a performance assessment framework (Drummond et al., 2015).
The funding for the public hospital services is implemented by framework that has a five-year agreement (Australian Health Care Agreements), which plays a role in performance reporting and quality improvement requirements. The Australian health care system has a universal fee-for-service payment service which enhances the robustness of the national data collection procedures. After a health care study was conducted for quality in Australian health care, there was creation of two national bodies which were consecutive, that made suggestions to the health ministry regarding the directions for development and improvement of the performance indicators according to the public and incident reporting systems. The national bodies were namely Australian council for safety and quality in health care (safety and quality control), the national institute of clinical studies (NICS), the national health priority action council (NHPAC) and the national health performance committee (Mossialos et al., 2016).
Conclusion
From the above discussions it can be concluded that there are a several differences that exist between these three countries, along with several similarities. The United States is more invested in public sector providing more private insurances to the well-off citizens. The health system of United Kingdom involves both private and public sectors, which grants service which is free at the point of access of the service. In case of Australian health care system, it is made universally available to its citizens although insurance is available majorly to the well-off citizens.
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