Discuss about the Importance of Equity, Quality, Efficiency and Acceptability in the Healthcare Service System.
The midwifery is popularly known as “with women” healthcare services where the midwives help service users in maternity situations like pregnancy, labours, post-birth services etc. The midwifery is kind of nursing and emergency services in maternity situation (Kirkham, 2010). Although being a small part of healthcare scenario the effectual and functional midwifery services play a very importance role in overall healthcare process because they are directly connect with birth and death situations. There are more than 23,000 midwives employed in Australian midwifery services (Gaskin, 2010).
In this study, learner has analysed the importance of equity, quality, efficiency and acceptability in the Australian midwifery service delivery system. The study will detail the importance of evaluating midwifery healthcare services on the basis of quality, quality, efficiency and acceptability.
Wiliam (2010) studied an overall Australian Healthcare system considered to be a mixed healthcare system with providers from both public and private sector. The Australian healthcare system is a collaboration of different healthcare activities and processes whose aim is to support, promote, maintain, restore and deliver health to living organisms. This healthcare system is influenced by various internal and external environmental factors that form its overall structure, functionality, and outcomes.
The Australian healthcare system follows “The Beveridge Model” where government or public finances the healthcare system via tax payment. Australia holds 3rd position for life expectancy, after Iceland and Switzerland in the International Life expectancy Data (Gaskin, 2010). The Rankings of healthcare, Australian healthcare system is best in effective care, safe care, patient-centred care, efficiency and productivity. Generally, the Australian populations holds a good health status as well as life expectancy of 84 for female and 80 for males (Starfield, 2012). The burdens of chronic heart diseases are only issue that create a high mortality rate of Australian (Kirkham, 2010).
Figure1: Structural presentation of Australian Healthcare system
(Source: Australia’s health system (AIHW), 2016)
The midwifery and nursing services being a very important part of primary healthcare where they work to deliver quality healthcare irrespective of the user’s case, creed, colour and other external identifications. In last few years, Country made a significant improvement in its maternity safety and quality services. The maternity services that include antenatal, intrapartum and postnatal care play a very important role in this improvement in healthcare services. Australia is considered to be one of the best paternity services providing country at the global context (Gaskin, 2010).
The performance of healthcare system is analysed by specific healthcare assessment or evaluation process that determines the effectiveness of service delivery process. The multidimensional healthcare depends on various factors that work to deliver personal health care and services. Therefore, achievement of healthcare performance requires analysis in a multidimensional manner where the outcomes are analysed on the basis of specific evaluation criteria (Kirkham, 2010).
According to Regan & Wong (2010) any healthcare system whether it be midwifery or clinical care is evaluated as per their equity, quality, efficiency and acceptability. The performance evaluation is determined as per user perspective rather them providers perspective in healthcare. Therefore, equity, quality, efficiency and acceptability work as outcome indicators in evaluation process that are sufficient to describe the users perspective in healthcare. Further, Buykx et al. (2012) indicated that systematic healthcare system framework involves inputs, outputs and outcomes. The inputs occur at provider level but the outcomes and output are individual or user specific. Hence, patient-centred performance evaluation frameworks are designed in a manner where healthcare system is evaluated as per its impact on quality, equity, efficiency and acceptability. Gardner et al. (2011) studied that in midwifery healthcare evaluation a systematic approach where processes, outputs and outcomes are evaluated to determine the achievement.
There are models that simplify the structure of healthcare environment. Joumard, Andre & Nicq (2010) indicated that Australian healthcare system including the primary healthcare (nursing and midwifery) is best presented using input, outputs, and outcomes model. World Health Organization (WHO) as an evaluation framework for its healthcare system is, also used this framework of Australian Healthcare System.
The below-provided structure demonstrates a general view on system framework of Australian Healthcare
Figure 2: Model of Australian Healthcare System
(Source: Joumard, Andre & Nicq, 2010)
There are a number of evaluation frameworks that are proposed by different authors to evaluate healthcare systems. For example- The American Public Health Association (APHA) framework evaluate healthcare on the basis of continuity, quality, accessibility and efficiency (American Nurses Association, 2010). Further, Armstrong & Kendall (2010) indicated that main criteria for evaluation should be efficiency, effectiveness and equity. But, the Australian healthcare system follows a specific framework of evaluation (RoGs framework) whose major goal is to determine the equity, efficiency, quality and acceptability of outputs and outcomes described in the healthcare system. The importance of these four evaluation criteria to determine the effectiveness of Australian healthcare system is described below: –
Equity in healthcare is fairness or equals establishment for the achievement of equality based healthcare services. Any region or country persist a variety of cast, culture, creed, language and people having some specific individuality. The equity determined the equality in healthcare services for a different variety of individuals. The equity assessment involves ethnic and socio-economic equity (Gaskin, 2010).
Equity determines the performance of healthcare services for fulfilling the healthcare necessities of a particular group in society. This measures the equity in access to healthcare services and outcomes. The equity is of two types, ‘horizontal equity’ where equal healthcare is provided equally to all groups and ‘vertical equity’ where equitable (fair) unequal healthcare is provided to the unequal group (Fineberg, 2012).
Equity indicator measures the differences in class, race, origin, gender, geography and other factors in the outcomes of healthcare services in order to minimise these differences. Equity measurement helps to achieve equality and stability in healthcare inputs (Kirkham, 2010). However, Frenz & Vega (2010) indicated that efficiency and quality are dependant on equity measurement. The equity versus efficiency issue depends on one’s value position. Kringos et al. (2010) indicate that equity assessment or determining differences in healthcare are critically important to get the overall care processes acceptability, outputs effect. The equity assessment is very much essential but more difficult to achieve in healthcare scenario. Equity can be considered as the second dimension of acceptability and quality but still it is different from other evaluation criteria due to its specific objective that relates only to user satisfaction.
This criterion of evaluation helps to determine the healthcare accessibility to disadvantageous groups like indigenous Australian who are under privileged in terms of health as well as wealth in Australia. Equity is the assessment criteria that focus on disadvantages groups in term of healthcare service delivery (Guindo et al. 2012). According to Starfield (2012), equity helps to determine the overall health states of disadvantageous women in midwifery healthcare. The fulfilment of sexual and reproductive healthcare is assessed for disadvantageous women that make equity an essential assessment criterion in midwifery services.
The efficiency describes the potential of the healthcare system in the technical, productive and allocative field. The technical efficiency indicates the cost of service delivery that is required to be maintained minimum that involves the input in the healthcare system. The productive efficiency optimal health services and care in all healthcare scenarios including primary, acute and post-acute care (Gaskin, 2010).
The technical efficiency in assessment is determined by the patient treatment output and reflects on care management output. However, productive efficiency clearly determines the effect of inputs as per attained outcomes in patient services. Lastly, the allocative efficiency is the service provision at the level of expected standards that is focussed on outcomes (Guindo et al. 2012). Therefore, allocative efficiency can be manipulated as per the technical and productive efficiencies (minimising input as per outcomes or increasing outcome as per input).
Wiliam (2010) indicated that efficiency assessment involves clinical outcomes measurement that can be quality of life, specific disease, illness or condition. This can be performed using clinical equipment’s like scales, genetic measures, quality measures etc. The efficiency being a part of productive effectiveness assesses the capability of healthcare program or strategy (output) to reach the ideal state (effective outcomes).
According to Guindo et al. (2012) efficiency provides data in clinical terminologies that involves sufficient information regarding the defects in the input system of healthcare. By determining the efficiency of outcomes it is easy to adjust the requirements of its input. For example- A tuberculosis control program is not able to provide expected efficiency outcomes than either the program is eliminated from input system or modified to generate required outcome efficiency. In this manner, efficiency assessment is another important criteria that help to determine the overall impact of clinical services.
Quality is determining the level of outcomes as per expected criteria on the basis of health services provided to individual patient. Quality involves assessment of professional skills, knowledge, technique, environment and competency in healthcare scenario (Levett-Jones & Bourgeois, 2010). Basically, quality determines the input criteria of healthcare services, as per studies of Spaeth-Rublee et al. (2010) the stakeholders, components, and service providers in healthcare form the assessment criteria for analysing the quality. These form the major portion of input in healthcare system. Quality determines that weather safe healthcare services are provided to users and the service outcomes are as per expectations. For example- clinical quality involves determination of care outcomes as per patient perspective. Raven et al. (2012) indicated that overall suitable healthcare quality involves social solidarity, sense of equality, high quality healthcare, and care effectiveness.
Spaeth-Rublee et al. (2010) indicated that quality is considered to outcome of medical knowledge, practice and good intentions of service providers. The aspects like ethical certainty, trust and professionalism dominates the quality assessment criteria. In healthcare system of Australia, quality is influenced by various input and output factors, therefore, quality assessment works as a tool to analyse the overall functionality of organisation. According to Buykx et al. (2012) quality indicator involves the structure, process and outcome evaluation that has improved focus on quality improvement in last few years. Quality assessment is performed to assure “complete quality management”, “quality assurance and incessant quality improvement” in healthcare system. The quality assessment is essential to confirm healthcare achievement in complex dynamics of internal and external environmental factors that influences the functionality of healthcare.
Raven et al. (2012) indicated that midwifery healthcare deals with maternity nursing services provided to women where the major focus is on nursing services rather than clinical treatments. The quality analysis specifically determines the effectiveness of healthcare services. Therefore, quality assessment forms a major component of midwifery healthcare assessment framework. The quality assessment determines the impact of policies, regulations, diseases programs, medical facilities, staff, infrastructure and medical procedures. Spaeth-Rublee et al. (2010) indicated that quality assessment is one of the most important component of almost 80% health assessment frameworks at the global level.
Acceptability determines the effectiveness of system safety, equity, quality and ethnicity as per patients, providers and communities perspective. This involves determining the level of satisfaction attained after healthcare service use (Levett-Jones & Bourgeois, 2010). Wiliam (2010) indicated that being a major assessment goal of health outcomes, acceptability assessment is critically essential in public healthcare system evaluation where social and political support determines the resourcing level. The change if not accepted can widely affect the political environment; therefore, acceptability assessment is essential for publicly funded systems of healthcare. This makes acceptability assessment as an essential analysis criterion in Australian healthcare system because it is also a publically funded system highly under the social and political influence.
Buykx et al. (2012) indicated that acceptability assessment works to determine the fairness and ethical environment practices in the healthcare system. The acceptability assessment revolves around four ethical principles of healthcare that are autonomy, beneficence, non-maleficence, and justice. These ethical principles work in a contradictory manner where acceptance of one principle can harm the aspects of others. For example- if care providers protect the autonomy of patient for not taking medication than provider simultaneously harms his duty of care involving beneficence. Therefore, the acceptability of any healthcare system highly depends on its ethical equilibrium. By determining the acceptability the ethical functionality in healthcare system can be predicted, hence, acceptability assessment becomes another important assessment criteria due to its specificity towards ethical environment analysis approach.
Conclusion
The above essay clearly explains that healthcare service assessment critically and essentially depends on analysing the equity, quality, efficiency and acceptability. However, there are other criteria of evaluation that are adopted in different frameworks but for the Australian healthcare system framework evaluation criteria, these four factors completely describe the overall functionality of health system in an effective manner. Through this study, the overall identification and importance of equity, efficiency, quality and acceptability are clearly understood in the Australian healthcare system evaluation process.
References
American Nurses Association. (2010). Nursing’s social policy statement: The essence of the profession. Nursesbooks. org.
Gaskin, I. M. (2010). Spiritual midwifery. Book Publishing Company.
Kirkham, M. (Ed.). (2010). The midwife-mother relationship. Palgrave Macmillan.
Levett-Jones, T., & Bourgeois, S. (2010). The clinical placement: An essential guide for nursing students. Elsevier Health Sciences.
Armstrong, K., & Kendall, E. (2010). Translating knowledge into practice and policy: the role of knowledge networks in primary health care. Health Information Management Journal, 39(2), 9-17.
Buykx, P., Humphreys, J. S., Tham, R., Kinsman, L., Wakerman, J., Asaid, A., & Tuohey, K. (2012). How do small rural primary health care services sustain themselves in a constantly changing health system environment?. BMC Health Services Research, 12(1), 1.
Fineberg, H. V. (2012). A successful and sustainable health system—how to get there from here. New England Journal of Medicine, 366(11), 1020-1027.
Frenz, P., & Vega, J. (2010). Universal health coverage with equity: what we know, don’t know and need to know. Montreux: Global Symposium on Health Systems Research.
Gardner, K., Bailie, R., Si, D., O’Donoghue, L., Kennedy, C., Liddle, H., … & Dowden, M. (2011). Reorienting primary health care for addressing chronic conditions in remote Australia and the South Pacific: Review of evidence and lessons from an innovative quality improvement process. Australian Journal of Rural Health, 19(3), 111-117.
Guindo, L. A., Wagner, M., Baltussen, R., Rindress, D., van Til, J., Kind, P., & Goetghebeur, M. M. (2012). From efficacy to equity: Literature review of decision criteria for resource allocation and healthcare decisionmaking. Cost Effectiveness and Resource Allocation, 10(1), 1.
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Kringos, D. S., Boerma, W. G., Hutchinson, A., van der Zee, J., & Groenewegen, P. P. (2010). The breadth of primary care: a systematic literature review of its core dimensions. BMC health services research, 10(1), 1.
Raven, J. H., Tolhurst, R. J., Tang, S., & Van Den Broek, N. (2012). What is quality in maternal and neonatal health care?. Midwifery, 28(5), e676-e683.
Regan, S., & Wong, S. T. (2010). Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency (Doctoral dissertation, University of British Columbia).
Spaeth-Rublee, B., Pincus, H. A., Huynh, P. T., & IIMHL Clinical Leaders Group. (2010). Measuring quality of mental health care: a review of initiatives and programs in selected countries. The Canadian Journal of Psychiatry,55(9), 539-548.
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Wiliam, D. (2010). What counts as evidence of educational achievement? The role of constructs in the pursuit of equity in assessment. Review of Research in Education, 34(1), 254-284.
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