By Dr Grainne Ahern*
When the option was given to me recently to tajke up a medical placement abroad, I was aware that this might be one of my last chances for a while to dip my toe in the medical system of another country before the reality as life as a junior doctor in Ireland set in.
With this in mind, I was lucky enough to be put in contact with a GP in New South Wales, Australia, who was willing to accept me for a month-long placement in his medical centre.
The health systems in Ireland and Australia are quite different from each other. The major differences are in the regulatory and financial system under which the medical profession acts in both countries. In my opinion, this offers Australian citizens a more equitable and accessible healthcare system than that currently available in Ireland.
The Australian healthcare system is built around a programme called 'Medicare'. In light of my clinical experiences, I feel that Medicare represents a middle ground between the publicly-funded NHS in the UK and the public versus private situation we have in Ireland.
It aims to provide accessible and affordable healthcare to all Australians. The system is funded by a 1.5% health tax levy, with an exemption for low income earners, with those on higher salaries (over $70,000-€46,000) being encouraged to take out private insurance by the imposition of a further 1% levy should they fail to do so.
It provides free or subsidised treatment by GPs, as well as assisting with the cost of access to public hospitals, dental care or prescription medicine.
There are two main options available to GPs when deciding how to charge their patients for services rendered.
Firstly, a practice may opt to allow a group of patients to be 'bulk billed' to Medicare, in which case the practitioner accepts the Medicare rebate as full payment.
A benefit schedule exists under which a rebate level for every procedure is set, ranging from a repeat visit to a GP for a prescription to more invasive procedures such as the removal of skin lesions.
At the time of writing, the Medicare rebate for a consultation lasting less than twenty minutes was AuS$36.30 (€23.76).
In this situation, the GP agrees to treat for the cost of the rebate with the practice then billing the government directly with no patient charge.
Typically, most GPs opt to confer this option on the elderly, those with chronic illnesses and often children but it is entirely at the discretion of each doctor. Around 74% of all medical visits were 'bulk-billed' in this way.
In theory, this is similar to the situation of old in Ireland where-by services provided to medical card holders could be charged to the State on a per visit basis as opposed to a flat annual fee per patient as is now the case.
However, where the two systems diverge sharply is in relation to the financial benefits conferred on those who fall outside the remit of the state systems.
In Ireland as we are only too well aware, no financial assistance is available for the cost of attending a GP to those above the income threshold for medical cards, unless the patient has a health insurance policy offering some reimbursement for GP costs.
As a result, we have reached a critical point in Ireland whereby many people are now postponing necessary and sometimes crucial appointments with their GP and consequently presenting at a later stage in their illness.
In contrast to this lack of intervention, in Australia the rebates listed in the benefits schedule are paid to the GP for all patients regardless of income status.
Some GPs in Australia choose to charge more to patients outside the 'bulk billing' system for a service than that listed under the schedule, thus creating a gap between what the patient is expected to pay and what will be refunded by the State. This excess is paid by the patient.
The existence of a 'safety net' provision in Australia, whereby once a threshold of expenses has been reached in a calendar year for those outside the 'bulk billing' system, the State then accepts the entire cost of medical visits, procedures etc, ensures that the out-of-pocket expenses to the population as a whole are kept as low as possible.
So, while both systems lack the universal coverage seen in the UK under the NHS, the extent of the financial burden on patients in Australia is much lower than that currently accepted in Ireland. Personally, I would welcome a change whereby 1% of my income was specifically diverted to the provision of health services in a manner similar to that in Australia.
But the Australian system is not without its problems; particularly with equality of access to care related to geographic disadvantage, given that is is a huge land-mass with a sparsely distributed population.
The Australian population has an average life expectancy on par with the rest of the Western World. However, men and women from Aboriginal communities live for, on average, almost 20 years less than other groups of society.
These communities have a high incidence of serious diseases such as diabetes, cancer and heart diseases, which can be improved with consistent and accurate monitoring, so the corollary of this reduced access to to health professionals by these communities is evident.
It is also important to highlight that the detrimental effect of this geographical dilemma is not limited to those of Aboriginal descent. Increased early mortality has also been identified in those of Caucasian race who live inremote areas.
There is an urgent need for more health professionals in rural areas of Australia and it has been suggested that the only way to adequately redress the unequal distribution of access in such a vast territory is financial compensation for those doctors willing to consider a rural-based career.
An interesting comparison can be drawn with the Travelling Community in Ireland, which also has significantly higher death rates among their younger population than the national average.
The issues facing the two population groups were similar, but the Irish system had the distinct advantage of the patients being within a much closer proximity to health services of all forms than many of the Aboriginal population in rural Australia.
The training and dedication of the doctors and medical staff are of the highest standard in both Ireland and Australia, but the difference regarding the regulation of both systems struck me most.
* Gráinne Ahern currently works as a GP intern in Galway.
(This article appears in the latest edition of Forum, journal of the Irish College of General Practitioners, published by MedMedia.)
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