Australia

the aussie healthcare system, is it worth working in?

Everyone knows the Australian healthcare system is extremely well regarded. So much so, its gets embarrassing. Sure the right wing press here love to whinge and moan about it but the reality is it is an excellent health system. Doctors get well paid, well supported and even in some services they can work 4 days a week. After you have wiped whatever it was you were sipping off the screen , please read on.

Feedback from OTDs (overseas trained doctors) who have migrated to Australia tends to be extremely positive of the systems, facilities, workforce planning, funding etc.

In the context of working as an OTD in Australia, critics tend to  focus on the process that directs OTD Consultants/Specialist to areas that are short of medical skills rather than the broader health system or specific practicalities. More of this extremely  controversial topic in a future blog post (area of need, district of workforce shortage).

If you transfer over from the NHS in the UK, working in the Australian public health care system as a doctor does tend to mean less hours worked whilst getting paid more. Salaries tend to be higher at all levels, registrar to consultant ratios are good, most facilities are new and well staffed.

I have heard of no instances of doctors returning to their departure countries because of dissatisfaction with the Australian healthcare system specifically. People tend to return for family reasons.

So, let’s get it into it, the fascinating and dangerous world of the Australian health care system. By the way all of this information can be found on the Australian Bureau of Statistics website but its a pain in the arse to research.

Australian healthcare is a hybrid of private and public sector involvement. Simple as that sounds the reality is more complex. Not as complex as brexit negotiations but complex.

The thought of how Australia’s health services are managed and regulated brings out hives in the best of people. Throw in the endless tiers of local and federal government as well as NGOs and you have a potential bunfight of monumental proportions.

The system demands a lot of money to work. In 2014-2015 Health funding cost governments in Australia was AU$108.2billion with the states and territories contributed AU$42 billion (26%) of this, the Australian Government AU$66.2billion whilst other stakeholders such as NGOs, private health insurance etc. contributed the remaining AU$53.4billion.

Health spending has been increasing like every 1st world country -mainly down to an ageing population, chronic conditions, diseases and risk factors etc. etc. So how is healthcare in Australia actually delivered and managed?.

Understanding this will also help you understand the variances in salary levels between the states and territories, job title terminology and the context in which allegations of protectionism (what! I hear you cry! Impossible! Look out for future posts..) towards international medical graduates are made.

Australia is a federation of states and territories. The Federal government – I will term as the Australian government – is based in Canberra where the national parliament sits and hurls abuse at each other. The states and territories are – in no order – West Australia, Northern Territory, South Australia, Tasmania, Australian Capital Territory (ACT – Canberra basically), Victoria, New South Wales, Queensland. Each State and territory has its own local government which provides services to its citizens that reflects the varied logistical, economic and social requirements of this huge continent. Public health care is devolved to each of these state and territory governments.

Yet, the Australian Government continues to have has important financial and policy responsibility for health services including hospitals, mental and public health. Basically, they fund the crap out of it. Approx. 70%.

State and territory governments, local councils and NGOs are mainly responsible for the delivery of these services. Private, “non-salaried medical practitioners” deliver most of the medical, dental and primary care services. FYI in case you’re wondering, as an OTD Consultant/Specialist you cannot work in private practise from the get go. Please read my upcoming blog about where you can work – and the controversy around this – as an OTD consultant/specialist.

The two national services Medicare and the Pharmaceutical Benefits Scheme (PBS)  are funded by the Australian Government. They cover all Australian citizens and permanent residents.

Medicare is Australia’s universal healthcare system giving people access to subsidised services and prescriptions (pharmaceuticals) and free hospital care as a public patient.

Since 1984, Medicare has been funded by a tax of 1% of an individual’s taxable income – regardless if you have private health insurance or not.

The Australian Government also runs the MBS (Medicare Benefits Schedule) which gives rebates for patients using the services of medical practitioners and allied health professionals. The benefits given are based on a schedule of fees, which are put in place by the Government after they have pow wowed with the medical community.

So we know the system is an intricate and confusing web of public and providers, stakeholders and supporting tools. Great, a recipe for disaster I hear you say. It works pretty well though and is fairly well respected by the general population despite the best efforts of the Murdoch media beat up. Sure, we’ve had the odd medical college bullying scandal, dodgy hires, sex discrimination cases and the odd surgeon misrepresenting their backgrounds.

The providers of healthcare are your standard medical practitioners, nurses, allied health professionals, hospitals, clinics, government and NGOs etc. etc.

Private sector providers include private hospitals, radiology clinics, medical practises and chemists (pharmacies).

Public hospitals are funded by the Australian, state and territory governments. However, the management of these is done only by the state and territory government in which the hospital is in unless they are a private institution. There are number of private hospitals that are contracted to government to deliver public services.

Here are some exciting stats.

In 2014–15, there were 10.2 million hospitalisations (2.5 million involving surgery), including 7.4 million presentations to emergency departments.

Public hospitals provide the vast majority (over 90%) of emergency department and outpatient services. Private hospitals account for more than 2 thirds of hospitalisations involving elective surgery.

All tiers of government  contribute to funding and delivering other niche services such as indigenous Australian health services, mental health services etc. Watch out for a future post on indigenous health by the way, its going to be ripper.

The government tries to incentivise people to take out private health insurance by offering tax rebates. In 2012 57% of the adult population had a form of private health insurance.

Some believe this is the main reason why the public health care system in Oz is as well regarded.

Primary care is delivered through traditional methods but the sheer scale of geography – the famous tyranny of distance –  in regional Australia and Indigenous Australian health care issues can make it even more problematic. Platforms of delivery include GP clinics (including ‘GP Super Clinics’), Indigenous Australian and community controlled health services, allied health clinics and community health centres.

When you look at it spending on primary care is close to spending on hospital services.

For more specific GP information and primary health care look out for an upcoming post!

The parent health services and associate acronyms of each State and Territory are:

ACT Health. Australian Capital Territory (ACT) – basically just Canberra. A paradox of a city in itself. Boring yet still fascinating.

NSW Health. New South Wales (NSW). Under this umbrella, lots of Local Health Districts (LHDs)

Queensland Health (QLD).

WA Health. Western Australian Health (WA). Looks after different  Perth metropolitan services and WACHS – West Australian Country Health Service.

SA Health. South Australia (SA).

Vic Health. Victoria (VIC).

Tasmanian Health Service. Tasmania (TAS).

NT Health. Northern Territory. (NT).

Our next post will be about job title terminology in each state.Hopefully.

Picture Credit:

Piron Guillaume

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