Healthcare System Levels and Governance

• Illustrates the ways in which consumers interact with the healthcare system to meet individual needs

Levels of Healthcare

• Tertiary: Highly specialized care in a hospital, referred from primary and secondary levels, including cancer management and cardiac surgery
• Secondary: Medical specialist care, referred from primary doctor (dermatologist, cardiologist, urologist)
• Primary: First line of healthcare service including GPs, midwives, dentists, and pharmacists with a focus on health promotion and communication

Healthcare Governance Levels

• Australian government sets national policies and is responsible for Medicare (subsidizing medical services), funds pharmaceuticals through the Pharmaceuticals Benefits Scheme, funds community-controlled Aboriginal and Torres Strait Islander primary health care

• States manage and license public/private hospitals, deliver preventive and ambulance services, and handle health complaints

• Local governments provide environmental health services (waste disposal, water fluoridation, food safety monitoring), community/home-based support, and public health activities

• Federal funding of Medicare is through a 2% levy on income tax, providing free treatment to all citizens

• The Pharmaceutical Benefits Scheme (PBS) subsidizes prescription medications

• Private insurance covers medical and hospital services

• Appraises contemporary developments in global, national, and regional health and wellbeing and the role of nurses

Challenges in Healthcare

• Decreasing revenue and increased healthcare expenses
• Increased burden of disease
• Aging population
• Increased demand for services across all demographics
• Advances in treatment techniques and technology
• Lack of workforce

Roles of Nurses

• Nurses and midwives can help shape health policy/provide holistic, human, and culturally appropriate care
• Nurses are recognized as the largest body of healthcare providers and should drive policy change/provide care
• Many strategies are available to remain informed and contribute to nursing's future

Available Services

• Health promotion and protection, improving health and preventing root causes of ill health (immunizations, cancer screenings)
• Includes primary care, specialists, and hospitals

Challenges

• Digital health technologies are used to improve healthcare delivery, but not everyone has access

• Gaps exist in good health data, which limits the capacity for population health monitoring, research and planning, creating an imbalance in understanding

• The aging population and rising chronic conditions create challenges

• Medicare reimburses up to 85% of scheduled fees, and the patient pays the remainder

• Bulk billing allows patients to pay nothing, with the practitioner billing Medicare directly

• Covers surgery, allied health rebates, Indigenous healthcare, some medications, testing/diagnostics (imaging), optometry, anaesthesia, and GP visits

• Private insurance is additional to Medicare

Social Determinants of Health

• Social determinants are non-medical factors that influence health outcomes including socioeconomic status, education, housing, transportation, food security
• Psychosocial risk factors, social/support networks, community/civic engagement, trust, and the physical environment

Five Domains of Social Determinants

• Concerned with: economic stability, education access/quality, healthcare access/quality, neighbourhoods/built environments, and social/community context
• Lower socioeconomic positions worsen health
• Polluted air/water, unsafe housing/transportation/neighbourhoods, racism/discrimination/violence, lack of education/job opportunities/access to nutritious foods/physical activity opportunities/language/literacy skills

Individual Determinants of Health

• Individual determinants of health include: diet, physical activity, alcohol/cigarette/drug use, and hand washing

• Social groups that suffered during COVID include poorer populations, disadvantaged ethnic groups, healthcare workers, the elderly, prisoners, and the homeless

• Colonization caused intergenerational trauma with a fundamental impact on Indigenous health

• Protective factors for Indigenous health include cultural activities, access to traditional lands, and connection to family and kinship

Socioeconomic and Environmental Factors

• Education, employment, and income: Higher education can improve health understanding and access
• Housing: Overcrowded housing increases the risk of infectious diseases

Health Risk Factors

• Overweight and obesity, often due to affordable poor diets

• Alcohol consumption

• Tobacco smoking

• Social determinants affect health greatly, including social connectedness

• Climate change influences daily living conditions

• Intergenerational disadvantage includes: groups needing welfare, entrenched disadvantage and worse health, public housing, unemployed, single parents, education below year 11, and a higher chance of passing on disadvantage

• Health is related to an individual's environment and circumstances, including where they live, education, income, and access to health services

• Nurses should address both individual and social determinants of health

• Worsening of rural healthcare access and quality, not as many resources causing wait for appointments

• There maybe be reduced quality healthcare, hesitant patients, and limited medications

• Positives to rural health include: greater sense of belonging, restorative environment, shorter commutes, greater psychological resilience/support, and lower financial stress

• Food insecurity is when someone can't afford healthy food/nutrients and lacks education on good food

• Leads to a lack of economic security and can cause illness

• Solutions involve charities and food banks, and providing education on good food/cost-effective nutrients

Disability and Healthcare

• Considers attitudes, social structures, environment, and processes for people with disabilities and how this can affect access to healthcare

• Social model: individuals experience disability due to environmental barriers, attitudes, and social structures

• A result of interaction with impairments and an environment filled with barriers which implies that the environment must change

• Responsibility lies on society

• Reasonable adjustments include environmental adjustments, alternative waiting spaces, health literacy support, longer appointments, and practice centred around family

• Individual model: disability is a health condition dealt with by medical practitioners

• In need of being fixed/cured with diagnosis based language

• Can be seen as tragedy

• Medical model seeks to change the person with impairment to function in society

Benefits of the Social Model

• Provided voice for people and improved supports
• Led to denationalization
• Influenced human rights
• Rejects thinking that people cant participate

Benefits of the Medical Model

• Increased understanding on causes of impairment

• Can contribute to survival rates of certain conditions/disorders

• Helped healthcare professionals treat impairments

• ICF MODEL: International classification of functioning, disability and health. Combines individual and social perspectives. Aims to use different lenses to consider interventions framework

Inclusive Language

• Person-first vs. identity-first language. Avoid stereotypical language. Do not ignore impairment
• People with a disability vs. disabled people. Zhang has a chronic health condition Nurses can make reasonable adjustments in practice to better support consumers with disabilities