Module 1
Healthcare Systems Handout
Group Agendas
Health Professionals: You got into health to help people. However, as an owner and operator of a multidisciplinary practice, you need to see many patients to cover the cost of equipment, technology, office and consumables, and pay your staff. The Medicare benefit doesn’t cover the rising cost of operations, so you pass on that expense to the patient in the form of a gap-payment. You also know that know many patients avoid going to the doctor because this out-of-pocket cost is getting too much.
As a member of the health profession, your priority is to have a healthcare system where staff and hospitals still get paid a fair amount, but you also want to focus on caring for people, not worrying about billing.
Middle to upper socioeconomic class: You represent the rich people of Australia. You can get access to care under the current public healthcare system like everyone else. You also have high‐quality private health insurance coverage that gives you access to additional services. You can cover out‐of‐pocket expenditures as needed and are able to implement the advice for your health and medical professionals.
You ask the questions about what any future changes would mean for your current level of living. You already pay a high rate of income tax. You advocate for a healthcare system that fixes a few of the current problems, but without going too far. You want to make sure the system is responsible and doesn’t waste resources.
Low socioeconomic and chronically unwell people: You or your family need a lot of medical care, a lot more than most. You are the person that will go to and wait in A&E for hours to speak to someone about “non-urgent” care because you can’t afford the GP this week. You’re on the receiving end of a fragmented health care system. You live in fear that the current access to health and medications you need to survive will become harder to afford. You want a healthcare system where nobody ever goes without because of their health or finances.
State Government: Congratulations! There was a recent election and you have recently been appointed your state’s Health Minister with a panel of advisors. You are now responsible for creating a health system that sufficiently meets the needs of stakeholders – note this covers patients / carers, health care workers, organisations eg hospitals (public & private) / insurance /
pharmaceutical / imaging companies etc. Health is a state responsibility but there is a large reliance upon the federal government to provide top up funding.
Instructions: Read and annotate this handout to show what you like about each
country’s healthcare system. Which country’s system is best, according to your team’s
agenda?
Healthcare systems in the U.S., Switzerland, Canada, and the U.K. are set up very differently in terms of who pays for the care and how care is provided. Broadly, the U.K. government pays for and runs all medical care; Canada pays for all medical care but does not run it; Switzerland requires all citizens to buy insurance but subsidizes the cost; and the U.S. uses a mishmash of all the above.
The U.S. (Individualistic model of health) has many different systems to pay for healthcare.
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About half of people have private insurance through jobs, while some buy private insurance themselves.
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The Affordable Care Act (Obamacare) provides subsidies to help lower income people purchase their own private insurance plans.
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Many private insurance plans have high deductibles in addition to monthly premiums, forcing people to pay for care out of pocket until the deductible is met. Many people skip care because they can’t afford to pay this money.
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About one‐third of the population is on some kind of government health insurance plan, including Medicare (for people over 65 and the disabled), Medicaid (for low income people), and military care.
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15% percent of the population is uninsured and must pay for care directly – or else go without care.
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This complexity makes medical billing particularly expensive in the U.S.
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Hospitals are privately run, except for those for military veterans (VA hospitals) which are run by the government.
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U.S. medical care is the most technologically advanced and innovative in the world, and its doctors are the best paid.
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But the U.S. leaves more people uninsured than any other industrialized country, and health outcomes (like infant mortality and longevity) are not as good.
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The overall cost of U.S. healthcare is far higher than in any other country.
Switzerland (Bismarck model – also referred as “Social Health Insurance Model”) requires everyone to buy private health insurance on healthcare exchanges.
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Insurance companies are non‐profit organizations but compete for customers.
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Jobs do not provide insurance, and no one is allowed to go without insurance. As a
result, the overall cost of private insurance goes down because the cost of medical care is spread over more people.
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Thirty percent of people get subsidies based on their income to help them buy insurance. Hospitals are privately run.
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The government negotiates drug prices and regulates fees for medical services to control costs.
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Swiss health outcomes are excellent, but costs are higher than many other countries (though still lower than in the U.S.).
In Canada (National health insurance model or Hybrid model), the government uses taxes to pay for health insurance for everyone.
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This “single‐payer” system (meaning that the government is the single payer of health insurance) greatly reduces costs for medical billing compared to Switzerland and the U.S.
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Everyone in the country has health insurance and can go to any doctor or clinic and get care.
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Hospitals are privately owned, not run by the government.
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Canadian health insurance covers basic care but does not cover things like prescriptions, dentistry, and vision care. Sixty percent of Canadians get private insurance, usually through their jobs, to cover those things.
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Canadians have longer wait times to see doctors than many other countries, but when they have an urgent issue, they move to the top of the wait list.
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Their health outcomes are better than in the U.S.
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The country spends half what the U.S. spends on healthcare.
In the U.K. (Beveridge model of health), the National Health Service uses taxes to pay for almost all medical care (meaning it is single‐payer) and also employs almost all doctors (meaning it is socialized).
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All U.K. citizens are covered for any medically necessary care including free prescriptions, dentistry, and mental health care.
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Co-pays are generally not required except for dentistry, and those are less than $15.
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About 10 percent of Brits get private insurance, usually through their jobs, to cover medical care that their doctor decides is “elective” (optional).
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U.K. hospitals can be overcrowded and not as fancy as U.S. hospitals, without the latest tech. But overall costs are among the lowest in the industrialized world, and health outcomes are better than in the U.S.
Costs, Access, and Health Data
For more information: Australia’s health expenditure: an international comparison
Reference:
AIHW. (2019). Australia’s health expenditure: an international comparison. https://www.aihw.gov.au/getmedia/ba3f6a4c-3059-4340-b1ca-b4ddd5630e4f/aihw-hwe-75.pdf?v=20230605180149&inline=true
Collins, S. & Gupta, A. (2024, Nov 21). The State of Health Insurance Coverage in the U.S. Commonwealth Fund. https://www.commonwealthfund.org/publications/surveys/2024/nov/state-health-insurance-coverage-us-2024-biennial-survey?utm_campaign=Achieving%20Universal%20Coverage&utm_medium=email&_hsenc=p2ANqtz-8cfduPqMm81prbuXmzUzKrAAdYKdmLWkL6op9nrueit0EHZFZ7Du42ba8ttmLmqOlozF3GnXOzbnu2y-dWs2cJYMpU3A&_hsmi=335044667&utm_source=alert
Blumenthal, D. et al., (2024). Mirror, Mirror— A Portrait of the Failing U.S. Health System. Commonwealth Fund. https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024?utm_campaign=The%20Connection&utm_medium=email&_hsenc=p2ANqtz-9a-AJLZA0Jhq9kKgPeZUHgI6tvFOIcylZVjq8PkHrtkkc526P7PjQ-0QHOCDb5CITfixveIMSMv_ZWqztr0aWLy3zGfA&_hsmi=327207685&utm_content=327207685&utm_source=hs_email
Tikkanen, R., Osborn, R. Mossialos, E. Djordjevic, E. & Wharton, G. (Eds.), (2020). International Profiles of Health Care Systems. The Commonwealth Fund. https://www.commonwealthfund.org/sites/default/files/2020-12/International_Profiles_of_Health_Care_Systems_Dec2020.pdf

Module 4Current challenges in global health
Module overview
Welcome to Module 4. This module explores global health risks and what is being done to
protect us against future public health threats. This is an interesting topic on the back of Covid
pandemic and extends to other important areas of global need. It links directly to learning
outcome #4: Examine the current and future directions of healthcare within the context of
health technologies and global health issues.
The live online workshop will discuss Assessment 2 and provide a guide to begin.
Self-access and class learning will take approximately 10 hours of time this week, and includes:
Reviewing module content
3 hours
Completing self-access learning resources
2 hours
Completing self-access learning activities
3 hours
Tutorial and workshop preparation
0 hours
Tutorial attendance
2 hours
Workshop attendance
1 hour
Module purpose
By the end of this module, you will be able to:
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reflect on the current challenges to global health
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identify and discuss global strategies to protect and promotion public health.
Introduction
Disease outbreaks and other public health crises are happening more frequently and with greater intensity. As future health professionals, it is essential for you to be aware of what is happening outside of Australia and what is being done to reduce the extent of global health crises or the next public health emergency of international concern (Click the link to watch – 43 seconds).
Section 1: Global health security
This section explains and discusses the fundamental ideas behind the Global Health Security Agenda, International Health Regulations, and the Humanitarian-Development-Peacebuilding Nexus.
1.1 International health regulation
International health regulation is a piece of international law that nations abide by; it currently imposes duties on 196 countries, such as the need to report incidents involving public health. International health regulations require countries to detect, assess, report, and respond to public health events. The Regulations also specify the standards to determine whether a specific incident qualifies as a public health emergency of international concern. Please watch the video “What are the World Health Organization and International Health Regulations?” where we are introduced to and learn about the International Health Regulations.
1.2 Global Health Security Agenda
Global health security is the ability of public health systems to detect, prevent, and respond to threats from infectious diseases wherever they may arise. The US Centers for Disease Control and Prevention lists the following as the main global health security risks of the present:
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newly emerging and rapidly spreading infectious illnesses
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Travel and trade are becoming more and more globalised, which helps diseases spread.
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emergence of disease-causing, drug-resistant microbes
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Possibility of unauthorised use, theft, or release of harmful pathogens.
The Global Health Security Agenda (GHSA) is an international initiative to identify and respond to infectious disease threats. The GHSA framework has been endorsed by more than 70 nations, including Australia. The Australian Government’s Indo-Pacific Centre for Health Security is the leading department in progressing the actions of the Indo-Pacific region in meeting the GHSA 2024 targets. Please look through both these links and watch the video “ CDC: Protecting Americans through Global Health ” by the Centers for Disease Control and Prevention where we will learn about how the global population is protected through this work.
1.3 The Humanitarian-Development-Peacebuilding Nexus
In 2018, an estimated 206 million people were in need of humanitarian assistance due to long-term displacement—also known as protracted displacement. The Humanitarian-Development-Peacebuilding Nexus is a three-pronged strategy that brings together humanitarian, development, and peacebuilding stakeholders to address protracted displacement. The strategy promotes integrated and multisectoral actions to prioritise and attend to urgent needs, rebuilding the health system and preventing future catastrophes. Please watch the video “The Humanitarian-Development-Peace Nexus” by the United Nations Development Programme, where we will see the nexus in action.
Section 2: Top threats to global health
Now that we have discussed what actions are taking place to secure the health at the global level, let us consider some of the top threats to global health.
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Climate change
One of the biggest threats to world health in the twenty-first century is climate change, but it is also the best chance to rethink the social and environmental factors that influence health. This 2023 article from the World Economic Forum ‘The UN now focuses on climate change as a health issue too. Here’s why’ concisely outlines the #1 threat to global health.
The Intergovernmental Panel on Climate Change (IPCC) is the leading international body for the assessment of climate change.
Noncommunicable diseases
Noncommunicable diseases (NCDs), including heart disease, stroke, cancer, diabetes and chronic lung disease, are collectively responsible for 74% of all deaths worldwide. Many NCDs can be prevented by reducing common risk factors such as tobacco use, harmful alcohol use, physical inactivity and eating unhealthy diets.
Communicable disease
Communicable diseases constitute a major global health challenge. The major concerns include HIV/AIDS, tuberculosis (TB), malaria, viral hepatitis, sexually transmitted infections and neglected tropical diseases.
Pandemics and epidemic outbreaks
Millions of people have died because of pandemics and widespread epidemics, which have also ravaged civilisations and disrupted economies. In addition to COVID-19, there has also been major Ebola outbreaks in Uganda, Mbandaka, Equateur Province, Democratic Republic of the Congo, and a global Monkeypox outbreak.
Weak primary care
Primary health care is the first point of contact people have with the health care system. Effective primary health care is founded on equity, access, empowerment, community self-determination and intersectoral collaboration. However, many nations lack sufficient primary healthcare infrastructure or people in need do not access due to financial / transport / health knowledge / other reasons.
Vaccine hesitancy
Years of advancement in the global fight against infectious illnesses are at risk because of resistance to or refusal to receive vaccinations. Vaccines prevent 3.5–5 million fatalities yearly from diseases like measles, diphtheria, tetanus, pertussis, influenza, and COVID-19.
Mosquito-borne disease
More than 17% of all infectious diseases are vector-borne, accounting for more than 700,000 annual fatalities. The most frequent viral infection spread by Aedes mosquitoes is dengue. Dengue threatens more than 3.9 billion individuals in 129 countries, with a yearly death toll of 40,000 and 96 million cases.
Drug resistance
Some of the greatest achievements of modern medicine include the creation of antibiotics, antivirals, and antimalarials. However, antimicrobial resistance–or the ability of bacteria, parasites, viruses, and fungi to withstand these drugs–poses a considerable threat to public health. The abuse of antimicrobials in humans and animals, particularly those employed for food production and in the environment, is a significant contributor to drug resistance. A recent article in The Guardian explains this further.
Activity: Planetary health quiz
Section 3: Extreme weather events and health
3.1 Health effects of climate change
Ref: Wellcome. (2023).
Reflect:
Can you think of any other effects?
This is a great starting point for this topic (and Assessment 2).
Activity
Read: The health effects of climate change, explained
The above article reports effects from a population view. Consider the effect of climate change / extreme weather event from a community, family and individual perspectives over short, medium and long term timeframes.
Question: Is it possible to mitigate these effects by forward planning? If so, who would do this?
Answer: Yes! Great answer! The Australian Government has 2 departments working on this.
1.
The Department of Climate Change, Energy, the Environment and Water is currently producing the National Climate Risk Assessment and National Adaptation Plan. This will provide information and a plan for Australia to manage its significant climate risks across braod areas of the economy, infrastructure, health, agriculture, social / culture, biodiversity, etc. Its goals are for ‘everyone’ to be involved to mitigate risk – government, households, community, industry, First Nations Peoples, etc and be locally adapted.
2.
The Department of Health and Aged Care launched the National Health and Climate Strategy in December 2023. This focuses upon the impacts of climate change upon health & wellbeing. Its goals are to ‘build healthy, climate-resilient communities, and a sustainable, resilient, high-quality, net zero health system’. Great that it covers reducing the carbon footprint of our hospitals, etc.
Great resources about planetary health
Assessment 2: potentially helpful resources
Tutorial
Tutorial week 4