How are health services organized and financed?
Primary care: In 2010, there were 44,600 GPs and 29,300 specialists employed in health occupations (AIHW 2012). Most GPs are self-employed and work in multi-provider practices. Some “corporatization” is under way as 8 percent of GPs are employed under contract with private agencies. GPs are paid fee-for-service (FFS) and the majority bulk-bill Medicare. In addition, general practices receive incentive payments for being accredited against the Royal Australian College of General Practitioners (RACGP) practice standards, meeting certain benchmarks for health information technology, providing appropriate care for some chronic diseases, teaching students, and performing some other activities. Individuals are not required to register with a primary care physician and are free to consult any GP, to seek a second opinion, or to shift to another GP practice at any time. Doctors with busy practices, however, may decide not to accept new patients. GPs play an important gatekeeping role as Medicare will reimburse specialists the schedule fee payment only for consultations referred by GPs. Nurses play an important role in the majority of practices, where they are funded by practice earnings and some nurse-specific Medicare benefits and practice incentive payments.
Outpatient specialist care: Medicare allows individuals to choose their specialist for out-of-hospital care-although their GP must provide a referral letter to the specialist. Specialists are paid FFS with benefit levels set by the Commonwealth and patient copayments set between the doctor and the patient. Specialists practice in both the private and the public sector; many work in both sectors.
After-hours care: GP clinics vary considerably in the extent to which they provide after-hours care; it is often provided by a private company through arrangements with GP practices. For example, doctors in Canberra set up a nonprofit company in 1971 (CALMS Ltd), now also supported by the Australian Capital Territory government, where each member doctor agrees to participate on a roster to provide appropriate after-hours medical care to people in the territory. The Australian government also has offered grants to GPs to provide after-hours services. Medicare Locals (described below) also are contracted to improve access to after-hours care and this is now leading to improved arrangements in some regions.
Hospitals: There is a mix of public, private, and not-for-profit hospitals. In 2010–11 there were 735 public acute hospitals, 17 public psychiatric hospitals, 303 private day hospitals, and 285 other private hospitals. Public hospitals are funded jointly by the Australian government and state/territory governments in addition to receiving funds from treating private patients. Private hospitals (including freestanding ambulatory day centers) can be either for-profit or nonprofit, and their income is derived chiefly from patients with private health insurance. Under the 2011 National Health Reform Agreement, 136 local hospital networks have been formed, each consisting of one to four public hospitals, run by boards with local clinician input. State health departments continue to be the overall managers of their public hospitals and state governments have been funding hospitals largely on a prospective, capped activity-based formula from the past 20 years, using Diagnosis Related Groups. Through the National Hospital Funding Authority, the Australian government now pays state governments a percentage (rising from 40% in 2011 to 50% after 2016–17) of the “efficient” cost, as calculated by the Independent Hospital Pricing Authority, for each service provided to public patients. The remaining costs will continue to be paid by state governments. Transition arrangements toward retrospective, open-ended activity based funding for hospitals have now also been set in place for the Commonwealth’s share of public hospital funding, provided to the states through the Council of Australian Governments Health Reform Agreement (August 2011). The Commonwealth plus the state funding covers the whole episode of care for each occasion of hospitalization, as public hospital services are free to public patients under the Commonwealth–state arrangements.
Physicians in public hospitals either are salaried (but may also have private practices and additional FFS income, of which they usually contribute a portion from the fees to the hospital), or are private specialist physicians
who do some work in public hospitals, where they are paid on a per-session or FFS basis for treating public patients. Australia also has many specialist physicians who work purely in private practice, with admitting rights at several private hospitals. For private hospital coverage, private insurers list their preferred providers and doctors, with whom the patient will not face high out-of-pocket costs. Rural general practitioners often have admitting rights at their local public hospital, but this is rare for urban general practitioners.
Long-term care: The majority of care for older people with long-term health conditions is provided by relatives and friends, although there is an allowance available to other caregivers in some cases. For people assessed as having a high level of dependency, the Australian government subsidizes assistance through either community care services or residential aged care homes. The Australian government subsidy for aged residential care is means-tested, and the amount of subsidy is based on the extent of a person’s dependency (low, medium, high) and total assessable income. As of July 2013, under the current funding formula, the maximum income-tested fee for standard care for a single resident was AUS$48.21 (US$45.95) per day. In 2010–11, 60 percent of residential aged care providers were not-for-profit (such as religious and community organizations), 30 percent were private for-profit, and the remaining 10 percent were state and local government facilities.
The Home and Community Care (HACC) program, previously an intergovernmental program, subsidizes services that aim to support people in their own homes. Following the 2011 National Health Reform Agreement, the Australian government fully funds Home and Community Care services (except in Victoria and Western Australia, which did not sign up to the agreement) from July 1, 2012. The program includes individual budgets that allow patients to tailor services to their needs. The Health and Community Care program is complemented by several smaller Commonwealth and state programs.
Palliative care services are provided by government and nongovernment providers to people in their own homes, in community-based settings such as nursing homes, in palliative care units, and in hospitals. The National Palliative Care program also funds initiatives to ensure palliative care quality and access.
Mental health care: A variety of public and private health care providers deliver mental health services. Nonspecialized services are offered through GPs, and specialized services are provided through psychiatrists, psychologists, community-based mental health services, psychiatric hospitals, psychiatric units within general acute hospitals, and residential care facilities. Mental health–related GP and specialist consultations are reimbursed by Medicare. Inpatient admissions to public hospitals for mental health problems are free to the patient and funded through intergovernmental hospital funding agreements. There are nearly 20 remaining public psychiatric hospitals that treat and care for admitted patients with psychiatric, mental, or behavior disorders. Private insurers subsidize admissions to private hospitals. Community services include crisis, mobile assessment and treatment services, day programs, outreach services, and consultation services. Nongovernmental organizations also provide information, treatment, and advocacy services for mental health care.
การจัดบริการสุขภาพระเบียบ และเงินหลัก: ใน 2010 มี 44,600 GPs และ 29,300 ผู้เชี่ยวชาญที่ทำงานในอาชีพสุขภาพ (AIHW 2012) จีพีเอสส่วนใหญ่เป็นเจ้าของธุรกิจ และทำงานในทางปฏิบัติผู้ให้บริการหลาย บาง "corporatization" จะเดินทางเป็น 8 เปอร์เซ็นต์ของ GPs ว่าจ้างภายใต้สัญญากับหน่วยงานเอกชน จีพีเอสจะจ่ายค่าธรรมเนียมสำหรับบริการ (FFS) และส่วนใหญ่จำนวนมากตั๋วเมดิแคร์ ปฏิบัติทั่วไปรับเงินจูงใจในการได้รับการรับรองจากออสเตรเลียราชวิทยาลัยมาตรฐานปฏิบัติผู้ทั่วไป (RACGP) ประชุมกำหนดเกณฑ์มาตรฐานสำหรับเทคโนโลยีสารสนเทศสุขภาพ ให้การดูแลที่เหมาะสมสำหรับบางโรคเรื้อรัง สอนนักเรียน และทำกิจกรรมอื่น ๆ บุคคลไม่จำเป็นต้องลงทะเบียนกับแพทย์ที่ดูแล และสามารถปรึกษาใด ๆ GP แสวงหาความเห็นที่สอง หรือกะฝึก GP อีกตลอดเวลา แพทย์กับปฏิบัติไม่ว่าง อย่างไรก็ตาม อาจจะไม่ยอมรับผู้ป่วย จีพีเอสมีบทบาทสำคัญ gatekeeping เป็นเมดิแคร์จะชำระเงินคืนชำระเงินค่าธรรมเนียมตารางสำหรับอ้างอิง โดย GPs การพยาบาลให้คำปรึกษากับบทบาทสำคัญส่วนใหญ่ปฏิบัติ ผู้เชี่ยวชาญที่พวกเขาจะสนับสนุนปฏิบัติรายได้ และประโยชน์เฉพาะพยาบาลเมดิแคร์ และชำระเงินจูงใจปฏิบัติบางOutpatient specialist care: Medicare allows individuals to choose their specialist for out-of-hospital care-although their GP must provide a referral letter to the specialist. Specialists are paid FFS with benefit levels set by the Commonwealth and patient copayments set between the doctor and the patient. Specialists practice in both the private and the public sector; many work in both sectors.After-hours care: GP clinics vary considerably in the extent to which they provide after-hours care; it is often provided by a private company through arrangements with GP practices. For example, doctors in Canberra set up a nonprofit company in 1971 (CALMS Ltd), now also supported by the Australian Capital Territory government, where each member doctor agrees to participate on a roster to provide appropriate after-hours medical care to people in the territory. The Australian government also has offered grants to GPs to provide after-hours services. Medicare Locals (described below) also are contracted to improve access to after-hours care and this is now leading to improved arrangements in some regions.Hospitals: There is a mix of public, private, and not-for-profit hospitals. In 2010–11 there were 735 public acute hospitals, 17 public psychiatric hospitals, 303 private day hospitals, and 285 other private hospitals. Public hospitals are funded jointly by the Australian government and state/territory governments in addition to receiving funds from treating private patients. Private hospitals (including freestanding ambulatory day centers) can be either for-profit or nonprofit, and their income is derived chiefly from patients with private health insurance. Under the 2011 National Health Reform Agreement, 136 local hospital networks have been formed, each consisting of one to four public hospitals, run by boards with local clinician input. State health departments continue to be the overall managers of their public hospitals and state governments have been funding hospitals largely on a prospective, capped activity-based formula from the past 20 years, using Diagnosis Related Groups. Through the National Hospital Funding Authority, the Australian government now pays state governments a percentage (rising from 40% in 2011 to 50% after 2016–17) of the “efficient” cost, as calculated by the Independent Hospital Pricing Authority, for each service provided to public patients. The remaining costs will continue to be paid by state governments. Transition arrangements toward retrospective, open-ended activity based funding for hospitals have now also been set in place for the Commonwealth’s share of public hospital funding, provided to the states through the Council of Australian Governments Health Reform Agreement (August 2011). The Commonwealth plus the state funding covers the whole episode of care for each occasion of hospitalization, as public hospital services are free to public patients under the Commonwealth–state arrangements.Physicians in public hospitals either are salaried (but may also have private practices and additional FFS income, of which they usually contribute a portion from the fees to the hospital), or are private specialist physicianswho do some work in public hospitals, where they are paid on a per-session or FFS basis for treating public patients. Australia also has many specialist physicians who work purely in private practice, with admitting rights at several private hospitals. For private hospital coverage, private insurers list their preferred providers and doctors, with whom the patient will not face high out-of-pocket costs. Rural general practitioners often have admitting rights at their local public hospital, but this is rare for urban general practitioners.Long-term care: The majority of care for older people with long-term health conditions is provided by relatives and friends, although there is an allowance available to other caregivers in some cases. For people assessed as having a high level of dependency, the Australian government subsidizes assistance through either community care services or residential aged care homes. The Australian government subsidy for aged residential care is means-tested, and the amount of subsidy is based on the extent of a person’s dependency (low, medium, high) and total assessable income. As of July 2013, under the current funding formula, the maximum income-tested fee for standard care for a single resident was AUS$48.21 (US$45.95) per day. In 2010–11, 60 percent of residential aged care providers were not-for-profit (such as religious and community organizations), 30 percent were private for-profit, and the remaining 10 percent were state and local government facilities.
The Home and Community Care (HACC) program, previously an intergovernmental program, subsidizes services that aim to support people in their own homes. Following the 2011 National Health Reform Agreement, the Australian government fully funds Home and Community Care services (except in Victoria and Western Australia, which did not sign up to the agreement) from July 1, 2012. The program includes individual budgets that allow patients to tailor services to their needs. The Health and Community Care program is complemented by several smaller Commonwealth and state programs.
Palliative care services are provided by government and nongovernment providers to people in their own homes, in community-based settings such as nursing homes, in palliative care units, and in hospitals. The National Palliative Care program also funds initiatives to ensure palliative care quality and access.
Mental health care: A variety of public and private health care providers deliver mental health services. Nonspecialized services are offered through GPs, and specialized services are provided through psychiatrists, psychologists, community-based mental health services, psychiatric hospitals, psychiatric units within general acute hospitals, and residential care facilities. Mental health–related GP and specialist consultations are reimbursed by Medicare. Inpatient admissions to public hospitals for mental health problems are free to the patient and funded through intergovernmental hospital funding agreements. There are nearly 20 remaining public psychiatric hospitals that treat and care for admitted patients with psychiatric, mental, or behavior disorders. Private insurers subsidize admissions to private hospitals. Community services include crisis, mobile assessment and treatment services, day programs, outreach services, and consultation services. Nongovernmental organizations also provide information, treatment, and advocacy services for mental health care.
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