The Healthcare System, Change and Health Promotion

This topic covers the other three content groups of Health in an Australian and global context. It suits "assess" and "evaluate" questions, so learn the facts and also practise making judgements.

• The healthcare system: its role and effectiveness; equity of access; shared responsibility between the federal, state and territory and local governments and the non-government sector (private and not-for-profit); collaboration to deliver person-centred care.
• Health expenditure: treatment versus prevention; sustainability, access and equity; Medicare, private health insurance and Commonwealth-funded programs.
• Complementary healthcare and the importance of being a critical health consumer.
• Changes and challenges: technology and health; new technologies and treatments; digital health; how health data and artificial intelligence are shaping health, including privacy and confidentiality.
• Actions to promote health: the key features of the Sustainable Development Goals (SDGs) 3, 4, 10 and 11, and how they can inform strategies to improve a community's health.

Shared responsibility in action: public hospitals are jointly funded. The Australian Government pays a large share of the costs under national health reform agreements, and the states run them. Medicare Urgent Care Clinics (from 2023) are funded federally and delivered with states, primary health networks and local clinics.

Person-centred care

Care organised around the person's needs, values and goals, with providers working together. Example: a GP chronic disease management plan that brings in a dietitian, a physiotherapist and a diabetes educator, with the patient involved in setting goals. Benefits: better coordination, fewer duplicated tests, better adherence to treatment and better outcomes.

• Medicare (since 1984) is universal public health insurance funded from general taxation, including the Medicare levy (2% of taxable income for most taxpayers). It subsidises services on the Medicare Benefits Schedule and provides free treatment as a public patient in public hospitals. Bulk billing means the doctor accepts the Medicare benefit as full payment, so the patient pays nothing.
• The PBS subsidises listed medicines. Patients pay a capped co-payment: the general co-payment was cut to $25 from 1 January 2026, and concession card holders pay less.
• Private health insurance is optional. _Hospital cover_ allows treatment as a private patient with a choice of doctor and often shorter waits for elective surgery; _extras cover_ contributes to dental, optical and physiotherapy. Private insurance cannot cover out-of-hospital Medicare services such as GP visits.
• Incentives to take out private hospital cover: the income-tested private health insurance rebate; the Medicare Levy Surcharge (an extra 1–1.5% for higher-income earners without hospital cover); and Lifetime Health Cover (a loading of 2% of the premium for each year over age 30 that a person delays taking out hospital cover, up to 70%, removed after 10 continuous years of cover).

Worked example: Lifetime Health Cover

Sam first takes out hospital cover at age 41. His loading is $(41-30)\times 2\%=22\%$ so a base premium of $2000 a year would cost him $2000\times 1.22=\$2440$ until the loading is removed after 10 years of continuous cover.

• Size: $270.5 billion in 2023–24, about 10% of GDP, or about $10 000 per person (AIHW, 2025). Governments funded about 70%: the Australian Government $106.2 billion and state and territory governments $82.0 billion. The rest came from individuals, private health insurers and other non-government sources.
• Drivers of rising costs: an ageing population, more chronic disease, new technologies and expensive medicines, and greater use of services.
• Treatment versus prevention: most spending goes on hospitals, primary care and medicines. Only a small share, a few per cent, goes on public health and prevention, even though about a third of the burden of disease is linked to preventable risk factors.
• Arguments for more prevention: cost-effective in the long run (tobacco control and screening have saved many lives), reduces future demand, improves quality of life.
• Why treatment dominates: people who are already sick need care now; prevention takes years to show results; demand from ageing is growing.
• Sustainability, access and equity: out-of-pocket costs (specialists, dental, gaps) are a barrier for low-income people; rural people face distance; public hospital waiting lists are longer for people without insurance.

Complementary healthcare is used alongside conventional medicine (alternative medicine is used instead of it). Examples include acupuncture, chiropractic, massage, naturopathy, and herbal and vitamin products. They can be preventative products and services, or treatments used together with medical care.

• Possible benefits: symptom relief (for example massage for muscle tension), a holistic approach, a sense of control.
• Risks: limited evidence for many products; interactions between herbal products and medicines; cost (often not covered by Medicare); delaying effective treatment.

Being a critical health consumer

A critical health consumer evaluates information, products and services before acting on them.

1. Who is saying it? Qualifications, motives and conflicts of interest (is the influencer paid or selling the product?).
2. What is the evidence? Peer-reviewed research and reputable sources (healthdirect, government and major not-for-profit sites) rather than testimonials.
3. How is it regulated? The Therapeutic Goods Administration (TGA): an AUST R (registered) medicine has been assessed for quality, safety and efficacy; an AUST L (listed) lower-risk medicine may only contain approved low-risk ingredients and must meet quality and safety requirements, but the TGA does not evaluate the evidence for its claims before listing.
4. Ask a professional (GP or pharmacist), especially about interactions.
5. Know your rights: complaints can go to the provider, then to state health complaints bodies or the Australian Health Practitioner Regulation Agency (Ahpra).

Red flags include "miracle cure", "secret ingredient", claims that a product works for everything, and pressure to buy now.

• New technologies and treatments: robotic-assisted surgery, immunotherapy and targeted cancer drugs, genomic testing, mRNA vaccines, AI-assisted reading of scans. They usually improve outcomes but are expensive, which is one of the main drivers of rising spending; some save money through shorter hospital stays or earlier diagnosis.
• Digital health means using digital technology to deliver and coordinate care. Examples include telehealth, My Health Record, electronic prescriptions, health apps and remote monitoring.
• Telehealth: phone and video consultations, which expanded during COVID-19 and are now a permanent part of Medicare.
• My Health Record: an online summary of a person's medicines, allergies, test results and discharge summaries that authorised providers can see. People can set access controls or opt out.
• Electronic prescriptions, health apps and remote monitoring devices.
• Evaluating digital health. Benefits: access for rural people, convenience, better coordination, fewer errors and duplicated tests. Challenges: the digital divide (older people, remote communities and people on low incomes), privacy and security, and care that still needs a hands-on examination.
• Health data and AI: data show trends and at-risk groups, help plan services, track outbreaks and evaluate programs; AI can detect some diseases earlier and reduce waste. Risks: privacy breaches and bias (an AI trained on data that under-represents some groups works less well for them). Protections: the Privacy Act 1988 and the Australian Privacy Principles, consent, de-identified data and secure systems.

The United Nations adopted 17 SDGs in 2015, to be achieved by 2030. The syllabus focuses on four.

Applying the SDGs to a community

Choose a community you know (a suburb, a regional town, your school community) and work through these steps.

1. Major health issues, with data if possible (for example high rates of obesity and type 2 diabetes, low physical activity).
2. How each goal informs a strategy: SDG 3, a bulk-billing clinic with screening; SDG 4, health literacy programs in schools; SDG 10, culturally appropriate programs for groups experiencing inequity; SDG 11, safe walking and cycling paths and green spaces.
3. Lessons from elsewhere: how cities overseas have used the goals, for example by building active transport networks.
4. Advocacy: working with councils, schools and health organisations; using local data to make the case.
5. Will it work? Judge each strategy against criteria: based on evidence, developed with the community, built on partnerships across sectors, sustainable, and with measurable outcomes and evaluation.

• Saying the federal government "runs public hospitals". It funds a large share; the states run them.
• Saying private health insurance covers GP visits. It cannot.
• Confusing complementary (alongside) with alternative (instead of) medicine.
• Treating AUST L as proof that a product works.
• Describing the healthcare system when the question asks you to assess or evaluate it. Without a judgement you cannot reach the top band.
• Listing SDGs without applying them to a specific community.

• For "assess" or "evaluate", state your judgement in the first sentence, support it with strengths and limitations, and restate it at the end.
• Quote expenditure figures with the year (for example $270.5 billion in 2023–24).
• Use specific named examples: Medicare, the PBS, ACCHOs, Medicare Urgent Care Clinics, My Health Record, Cancer Council, Heart Foundation.
• In 6–8 mark questions, aim for 3–4 well-developed points rather than many short ones.

• How healthy are Australians? (HMS-H1): the health status and inequities that the system and the SDG-based strategies are trying to improve.
• Training for improved performance (HMS-T2): sports technology and supplements raise the same critical-consumer questions about evidence and regulation.