Student Number: n8584575
Tutor: Abbey Diaz


The Artefact:


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(Leahy, 2012)


This piece of artwork was presented by an Australian political cartoonist, Sean Leahy who works for the Courier Mail. On 17th August 2012, this piece of artwork was released together with a newspaper article, “Coalition is being reckless on Private Health Insurance”, revealing a negative point of view towards the change in Private Health (Leahy, 2012). As it is shown in the cartoon, Leahy criticizes that a large proportion of tax paid by the nation is taken up by the 30% rebate policy of Private Health funds, and further questions the efficiency of Private Health funds.


The Public Health Issue:

The artefact represents the public health issue that the Australian government is wasting tax on the policies of Private Health funds. In more detail, the purpose of Private Health Insurance (PHI) is to reduce the demand and cost on public health facilities, avoid public hospital waiting lists and allow choice of own doctor and hospital (Colombo, Tapay, 2003). However, strong evidence convinces that it did not achieve its goals, and therefore the 30% rebate policy is unnecessary, since it significantly increases government expenditure. The Wiki presentation will focus on the government’s inefficient use of tax on the Private Health System, and why it is health reform is necessary.



Literature review:

In the past decade, there has been much debate in addition to the 30% premium rebate policy of the Private Health care system (Colombo, Tapay, 2003; Martins, 2009; Segal, 2003; Segal, 2004; Lokuge, Denniss & Faunce, 2005). This is a crucial issue because strong evidence suggests that PHI did not effectively decrease the demand and cost on public health facilities, avoid public hospital waiting lists, and provide equal health service (Poullier, Hernandez, Kawabata & Savedoff, 2002; AIHW, 2008; Martins, 2009; Lokuge, Denniss & Faunce, 2005). Thus, why is the government wasting so much tax on it?

EFFICIENCY OF PHI:

The efficiency of PHI has been questioned by numerous organizations and researchers recently. Literatures state that although PHI covers 53% of the national population, it only accounts for 7.1% of total health expenditure (ABS, 2009; Colombo, Tapay, 2003). Despite the $2.5 billion that the government spent on the rebate on PHI premium per year, PHI has not effectively reduced the cost on the public health system, but posed pressure on the public health system, while this tax resource could have been used alternatively to benefit the public (DoHA, 2009; Colombo, Tapay, 2003).

HOSPITAL WAITING LIST:

Furthermore, many literatures have pointed out that the amount of money that the Australian government has spent on PHI is not worthwhile due to the increasing hospital waiting list, and decreasing available beds in hospitals (Martins, 2009; AIHW, 2008; OECD, 2011).


Figure 1: Waiting Time of Four Weeks or more for a Specialist Appointment
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(OECD, 2011)



Figure 2 Hospitals and available beds, 1995-96 to 2005-06


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(AIHW, 2008)

According to the graphs shown above, it is clear that PHI did not successfully reduce hospital waiting lists and increase available beds in hospitals. Although the Australian government has spent a large amount of money on PHI, the waiting time for four weeks or more for a specialist appointment still remains the third highest in all OECD countries (OECD, 2011). Furthermore, figure 2 depicts that the available beds per 1, 000 population has gradually decreased from 4.5 to 4.0 in the recent years (AIHW, 2008). In addition, a report released by the Australian government stated that the waiting time across elective surgery has increased from 28 day to 34 days in the past few years (DoHA, 2009). Looking into these evidences gathered from reliable sources, it is totally suitable for people to question the appropriateness of the 30% premium rebate policy and the efficiency of the PHI (Colombo, Tapay, 2003).

EQUITY:

The inefficiency of PHI is only one of the factors that determine the suitableness for the rebate policy. Several literatures have also revealed that the inequity of PHI, and the rebate policy in addition to both lower income and regional population is also a major issue of the Private Health System (Martins, 2009; Colombo, Tapay, 2003).


Lower income-
Figure 3 Percentage of Australians with Private Health Insurance, by Household Income, 2004
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(Denniss, 2005)

According to figure 3, lower income households have lower PHI coverage; higher income households have higher PHI coverage. In other words, the percentage of Australians with PHI coverage is simultaneous to household income. Additionally, it was found that only 23% of the lowest income had PHI coverage, while 76% of the highest income group was covered (Martins, 2009). These evidences highlight the fact that income is one of the strongest influencing factors of PHI coverage, and explains why the majority of people gave affordability as the reason for not having PHI coverage.

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(Leahy, 2012)

It was criticized that the majority of federal subsidy for PHI were received by the higher income population, and this did not benefit the lower income population who could not afford PHI coverage (Segal, 2003; Segal, 2004; Martins, 2009; Poullier, Hernandenz, Kawabata & Saredoff, 2002; Colombo, Tapay, 2003). Literatures state that higher income households purchase more expensive health insurance, and thus receive more rebates. As a result, 69% of the premium rebate accrues to high income households, whereas the lower income households only receive 31% (Denniss, 2005; Paoluccim, Ergas & Paolucci, 2011). Consequently, the lower income population remained without PHI coverage is now more heavily subsidized by public funds. Therefore it was argued that if the government had the money to give the rich rebates, why not use this money to reform the health system?

Regional Areas:


Figure 4: Percentage of population with PHI coverage in Different States
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(Source: PHIAC, 2009)

According to figure 4, in rural areas such as New South Wales, Victoria, Queensland, Southern Australia, Western Australia and Tasmania all had similar coverage rates, around 45%. However, in the regional area, Northern Territory, only 34.3% of the population was covered by PHI (PHIAC, 2009). Figure 4 clearly shows that in remote areas, the PHI coverage rate is 10.7% lower than urban areas. This result could be explained by the lack of convenience, timely access and affordability for Australians who live in remote areas (AIHW, 2008).

For instance, it was revealed that outside major cities, private facilities only take up 16% of the hospitals (Lokuge, Denniss & Faunce, 2005) .As a consequence of the inadequacy of private health facilities in regional areas, it becomes inconvenient and time consuming for people to attend health care settings. This makes PHI less appealing to the remote area residents, thus the PHI coverage rate in these areas are substantially lower than rural areas. As a result, people living in regional areas rely on public health facilities, and this increases the demand and pressure on public health funds.

LIMITATIONS:

The majority of the methodologies used by researchers and the government were surveys, however there are various limitations of this method that may draw to misleading conclusions. These statistics can be used or revealed in ways that may mislead the population. Commonly, mistakes that occurred relate to non-response in surveys and survey sample size (ABS, 2010). Non-response, which means not answering the question, is an issue that imposes a limitation on the statistics provided by the Government and researchers. It may lead to underestimation of the actual percentage. On the other hand, many data collected from journal articles or government websites/report do not state the survey sample size (ABS, 2010). This makes the accuracy of the information questionable, because the survey could be only conducted by only few people. As a result, this data may be inaccurate and may draw to misrepresentative conclusions.

CONCLUSION:

In conclusion, it is clear that many recent and reliable journal articles and government sources have provided strong evidence revealing the inefficiency and inequity of PHI and the premium rebate policy. Considering the significant amount of government expenditure on the policy, hospital waiting lists are still increasing, the pressure on the public health system still remains, and also lower income and regional Australians continue to receive unequal health care. Thus, it is evident that the Australian government should reconsider the use of tax on PHI. To put it another way, strong evidence suggests the government to reform the health system and policies with the tax wasted on the inefficient rebate policy, in order to provide equal health service (Weyden, 2008).


Cultural and Social Analysis:

Who Benefits from health reform?

The government’s use of tax on health care systems has always been a controversial issue in Australia. Indeed, different tax uses can cause serious impacts on the national population. If the government reforms the rebate policy, that is to distribute the rebate to the lower income population, and increase the proportion of private health facilities in regional areas, there will be an impact on everyone who has PHI coverage. In addition, evidence suggests that the social groups that are most affected by the inequity of PHI policy are the lower income and regional Australians who are covered by PHI.

Why is this important?

As it was mentioned in the literature review, remote area residents gave lack of convenience as the main reason for not having PHI coverage, while the lower income Australians stated that they did not purchase PHI dues to the lack of affordability. As a result, these two groups rely more heavily on private funds, this ultimately places a significant burden on the public health (Ansari, 2008; Colombo, Tapay, 2003; Paolucci, Butler & Van, 2008; Lokuge, Denniss & Faunce, 2005). Therefore, literatures suggest that it is crucial for the government to reform the health system and policy, to make PHI affordable and convenient for these disadvantaged groups (Segal, 2004; Lokuge, Denniss & Faunce, 2005). Furthermore, it was highlighted that if the government successfully achieves this goal, the people who were heavily subsidized by public funds will be able to access private health facilities, and hence PHI coverage will experience a substantial increase. Finally, PHI will be able to reach its aim, which is to reduce the demand on the public health system, avoid public hospital waiting lists, and provide equal health service.

Rich Against Poor?

There was no evidence revealing why society and culture are important to consider when the government is trying to redress the inequity of PHI found, yet it was found that the higher income individuals were against health reform. The results of a study that surveyed a great, national sample of adults show that high income society are less willing to pay for health reform (Brady, Kessler, 2010). To explain this behavior, a research-based analysis convinces that income has a strong association with ethical behaviors.


The results showed that social class “positively predicted unethical decision-making tendencies…” (Curtis, 2012).

It was said that the richer the person is, the less helpful, compassionate, generous and charitable they are toward other people, while lower income individuals generally behave more ethically. It is hard to say whether wealth leads to unethical behaviors, or whether some high income people get to the top because of these behaviors. However, these behaviors have formed a negative culture of the rich, and have great effects on the public society (Curtis, 2012). The analysis states that


“Increased resources and independence from others cause people (in higher classes) to prioritize self-interest over others” (Curtis, 2012).

It was found that higher socio economic class individuals view greed in a more positive light. As a result of this greed and selfishness, the higher income population is unwilling to support health reform to help lower income and regional populations. This research-based theory helps us understand why the richer social groups are against health reform.


Analysis of the Artefact and your own Learning Reflections:

The artefact clearly represents the public health issue that the government is wasting the nation’s money by giving the richer population rebate, rather than helping the poorer and regional population who does not receive equal healthcare. After reading numerous literatures based on the issue represented by the artefact, it is shocking to see the inequity and inefficiency of private health care system. Especially after developing an understanding of the unfair distribution of the premium rebate, I felt disappointed about the government’s use of tax and lack of efficiency. As a casual worker and a future public health practitioner, I currently pay tax to the government myself, therefore I have expected the government to use this tax resource to benefit the general public’s health. Unfortunately, this is not the case.

In writing this piece, I now realize how the inequity of the government’s policy can cause negative impacts on the population, and especially the disadvantaged. I acknowledge that this will influence my future learning. During the first year of my university studies, I have always considered public health related units uninteresting. However, now I have established a deeper knowledge about the public health issues, and how this may disadvantage the population. Hence, as a future practitioner and a student, I will now take public health related units seriously, and try to develop a deep understanding of the consequences that may be caused by public health issues.


Learning Engagement and Reflection Task:

http://pub209healthcultureandsociety.wikispaces.com/Bogan+culture+and+health+outcomes

Great job! I have found this WIKI piece very interesting and enjoyable to read. It has shown the strong association between the bogan culture and negative health outcomes by gathering useful information from numerous reliable sources such as the Australian Bureau Statistics and the Australian Institute of Health and Welfare. It is fantastic that this WIKI piece not only discusses the stereotype bogans- low socio-economic group, but also provides an insight of the cash-up bogans. As it was recommended to use education as a tool to promote health to bogans, I have done some research on the effectiveness of health promotion through education. Fortunately, the Australia National Public Health and Community Nutrition Interest Group stated that case studies and research around the world have provided convincing evidence that health promotion through education can effectively improve health, and cause an impact on the economic, environmental and social conditions that determine health (Dietetics Association of Australia, 2008). Hence, I am looking forward to see how health promotion will contribute to an improvement in health outcomes of bogans a few years later!

Link of article here:

http://onlinelibrary.wiley.com.ezp01.library.qut.edu.au/doi/10.1111/j.1747-0080.2007.00242.x/pdf


Honestly, this WIKI is fascinating. I totally agree with the viewpoint, that tax should be used to benefit the general public. This WIKI piece has done a wonderful job by applying the Subcultural Theory and the importance of positive social recognition to personal identity and well-being, to explain the behaviors of prisoners. Hence, now I realize how the general public’s view towards ex-offenders is putting pressure on them, and this impact on their behavior. Also, it is interesting to know that the government has found job offers as an important implication that can be used to decrease recidivism rate in older criminals.

https://pub209healthcultureandsociety.wikispaces.com/Branded+For+Life%3F



Reference List

Ansari, H. (2008). Inequities in Access to Health Care by Income and Private Insurance Coverage: A Longitudinal Analysis. ProQuest Dissertations and Theses. Retrieved from http://search.proquest.com.ezp01.library.qut.edu.au/docview/304349775

Australian Bureau of Statistics. (2009). National Health Survey: Summary of Results, 2007-2008 (Reissue). Retrieved from the Australian Bureau of Statistics website
http://abs.gov.au/ausstats/abs@.nsf/Latestproducts/4364.0Main%20Features52007-2008%20(Reissue)?opendocument&tabname=Summary&prodno=4364.0&issue=2007-2008%20(Reissue)&num=&view=

Australian Bureau of Statistics. Using ABS Statistics: Telling the Right Story. Retrieved from the Australian Bureau of Statistics website
http://www.abs.gov.au/websitedbs/d3310114.nsf/home/using+abs+statistics:+telling+the+right+story#Anchor2

Australian Institute of Health and Welfare. (2008). Australian’s Health 2008- The eleventh biennial health report of theAustralian Institute of Health and Welfare. Retrieved from the Australian Institute of Health and Welfare website http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442453674

Australian Institute of Health and Welfare. (2010). Health Expenditure Australia 2008-09. Retrieved from Australian Institute of Health and Welfare website http://www.aihw.gov.au/publication-detail/?id=6442472450

Brady, W., Kessler, P. (2010). Who Supports Health Reform? PS: Political Science and Politics, 43(1), 1-6. doi:10.1017/S1049096510990720

Colombo, F., Tapay, N. (2003). Private Health Insurance in Australia- A Case Study. Retrieved from the Organization for Economic Co-operation and Development website https://www1.oecd.org/australia/22364106.pdf

Curtis, V. (2012). Are the Rich more Ethical and Greedy? Strategic Finance, 93(11), 15-17. Retrieved from http://search.proquest.com.ezp01.library.qut.edu.au/docview/1016745164

Denniss, R. (2005). Who Benefits from Private Health Insurance in Australia. New Doctor, 83, 23-24. Retrieved from http://search.informit.com.au.ezp01.library.qut.edu.au/documentSummary;dn=071550016844653;res=IELFSC

Department of Health and Ageing. (2009) Tackling Major Access and Equity Issues that Affect Health Outcomes for People Now. Retrieved from the Australian Government-Department of Health and Ageing website
http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/1AFDEAF1FB76A1D8CA257600000B5BE2/$File/CHAPTER%203.pdf

Martins, JM. (2009). Private Health Insurance and Hospital Services in Australia. Asia Pacific Journal of Health Management, 4(2), 15-24. Retrieved from http://search.informit.com.au.ezp01.library.qut.edu.au/documentSummary;dn=463235280064131;res=IELHEA

Leahy, S. (2012). Coalition is being Reckless on Private Health Insurance. Retrieved from The Punch website http://www.thepunch.com.au/articles/coalition-is-being-reckless-on-private-health-insurance/

Lokuge, B., Denniss, R., & Faunce. (2005). Private Health Insurance and Regional Australia. Medical Journal of Australia, 182(6), 290-293. Retrieved from http://search.proquest.com.ezp01.library.qut.edu.au/docview/235704585

Organization for Economic Co-operation and Development. (2011). Health at a Glance 2011. Retrieved from the Organization for Economic Co-operation and Development website www.oecd.org/dataoecd/6/28/49105858.pdf

Paoluccim F., Ergas, H., & Robson, A. (2011). The Analytics of the Australian Private Health Insurance Rebate and the Medicare Levy Surcharge. A Journal of Policy Analysis and Reform, 18(2), 27-47. Retrieved from http://search.informit.com.au.ezp01.library.qut.edu.au/documentSummary;dn=663701731640970;res=IELHSS

Paolucci, F., Butler, J., & Van, W. (2008). Subsidizing Private Health Insurance in Australia: Why, How, and How to Proceed? Retrieved from the Australian Centre for Economic Research on Health website www.acerh.edu.au/publications/ACERH_WP2.pdf

Poullier, J., Hernandez, P., Kawabata, K., & Savedoff. (2002). Pattern of Global Health Expenditures Results for 191 Countries. Retrieved from World Health Organization website www.who.int/healthinfo/paper51.pdf

Private Health Insurance Administration Council. (2009). Hospital Treatment. Retrieved from the Australian Government Private Health Insurance Administration Council website
http://www.phiac.gov.au/for-industry/industry-statistics/membership-statistics/introduction/

Private Health Insurance Administration Council. (2012). Hospital Treatment Coverage. Retrieved from the Australian Government- Private Health Insurance Administration Council website
http://www.phiac.gov.au/resources/file/120827%20Coverage%20Chart%20Website(1).pdf

Segal, L. (2004). Why it is Time to Review the Role of Private Health Insurance in Australia. Australian Health Review, 27(1), 3-15. doi: 10.1071/AH042710003

Segal, L. (2003). Why Support Private Health Insurance in Australia?. New Doctor, 79, 10. Retrieved from http://search.informit.com.au.ezp01.library.qut.edu.au/documentSummary;dn=774782670824852;res=IELFSC