Universal Healthcare In Australia & Bangladesh

Universal healthcare can be defined as striving for accessible, sufficient, and effective health services with a particular emphasis on the provision to all. This approach has become increasingly eminent worldwide as it is identifiable as a world health goal in pursuit of attaining collective health reform. Essentially, the objective of universal health care embodies three main objectives; equity in access, quality service and financial risk protection. This notion is epitomized by an excerpt within the World Health Organization’s Constitution which states that “The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition”. (WHO, 2017a) This exemplifies the philosophy reinforcing universal healthcare which surrounds the prioritization of equitable healthcare provision.

There are five factors essential for universal healthcare to exist; an efficient, well-run health system, affordability, availability of medicine and technology, health workers and finally, actions to address social determinants of health (World Health Organisation, 2018). The first factor refers to a health system being logical, functional and organised which reflects the primary goal of restoring, maintaining or improving general health via methods of prevention, promotion, treatment, rehabilitation or palliation. The second factor denotes the necessity for an effective financing system alongside adequate funding in achieving affordability; by alleviating the stress of potential financial hardship, healthcare becomes substantially more accessible to all persons. Next, factor three addresses the presence of a reliable supply of essential medicines and technologies required to adequately diagnose and treat medical conditions. Without which, a healthcare system is redundant. Similarly, factor four concerns the abundance of well-trained, motivated health workers who possess the capacity to ethically, competently, and compassionately deliver integrated person-centred care. Finally, factor five entails the evidence of strong health plans and policies crafted to address social determinants of health personal to each specific community such as education, lifestyle, income, housing etc.

Australian healthcare is renowned for providing safe, effective and equitable services and to a moderate extent be considered reasonably affordable. The Medicare program, a Commonwealth-funded health insurance scheme, was introduced in 1984 in an attempt to lessen the financial burden which previously coexisted with accessing health services by providing free or subsidized health care services to citizens and permanent residents. Despite this, many individuals struggle with out-of-pocket costs which may arise for non-hospitalized services, private hospital treatment, and other services outside the safety net arrangements. Nonetheless, there are actions set in place to improve affordability to the majority of people. Since the introduction of the Pharmaceutical Benefits Scheme, prescription medications have become increasingly affordable for life-saving and disease-preventing medicines. This scheme entails government co-payment by the subsidy of selected prescription medication, such that patients pay only a portion of the price for the medicine. Not only does this subsidy apply to Australian citizens and permanent residents, but also may be accessed by those who are visiting from a country with which Australia has a reciprocal health care agreement. Whilst this program substantially contributes to more affordable medicines, it does not subsidize the cost of private or non-prescription medication. Additionally, some patients with chronic illnesses, financial hardship, repatriation cards, pension cards or other selected circumstances can access medicines at a further subsidy, at concession prices. Every dispensing of medicine at concession price contributes toward their safety net, and once the safety net is reached, subsidized medicines become free for that individual and/or family for the remainder of the year. In summation, Australia is a publicly funded health care system which is underpinned by a ‘universal access’ principle however, in order to fully achieve this sentiment there are improvements that need to be implemented.

A major issue which plagues the Bangladeshi health care system is the severe shortage of health professionals. A geographical breakdown of the Bangladeshi population indicated only 30% reside in urban areas whereas the remainder live rurally; this is incredibly problematic as the vast concentration of health workers are located in urban areas. (GHWA, 2008). The World Health Organisation provides a recommendation of the ideal nurse-doctor ratio to cater a well-functioning health care system, this ratio is three nurses per doctor though, in Bangladesh it is the other way around with only one nurse per doctor. This demonstrates the staggering shortage of almost 140,000 nurses and 60,000 doctors (Health Systems and Policy Research, n.d)

Some of the challenges Bangladesh faces in solving this issue include sufficiently training health workers – the health problems in Bangladesh reflect social determinants of health individual to them. Therefore, health professionals trained elsewhere are likely to not be experienced or equipped with the knowledge to provide such care. Additionally, due to the low rates of higher education undertaken in Bangladesh, it would be exceedingly difficult to ensure those who do pursue tertiary education to study a health profession, complete the entirety of studies and continue to practice.

The Nation Health Performance Framework (NHPF) is a conceptual framework resource designed to assist in the evaluation of general health as the health system in Australia. One of the key domains by which evaluation is performed is by health status which is comprised of four main indicators; health conditions, human function, wellbeing and deaths. The indicator ‘health condition’ explores the prevalence of disease, disorder, injury or trauma within the population. Similarly, human function explores alterations to body structure or function (impairment), activity limitations and restrictions in participation. Wellbeing, however, is more grafted to the general measure of physical, mental and social wellness of individuals. Finally, the category ‘deaths’ refers to the mortality rates and measures of life expectancy.

Australia is a wealthy nation boasting a strong economy, vast resources, sturdy government so naturally, the general health status is quite strong. Bangladesh however, is densely populated and has been identified as one of the poorest in the world as it continually faces socio-economic challenges such as poverty, corruption, and overpopulation. Having experienced a severe political climate and struggling for independence, the rate of development was stunted, resulting in a slower rate of societal development. Consequently, the standard of its healthcare system is comparatively low.

In Australia, the leading cause of ill-health is chronic disease/conditions which affect approximately half the population. Interestingly though, negative lifestyle behaviours such as insufficient physical activity, tobacco smoking, alcohol consumption and obesity are among the largest contributors to the degradation of health. (AIWH, 209) Contrastingly, in Bangladesh a significant amount of causes of ill-health stem from socio-economic challenges such as poverty, crowding, sanitation, unclean water access and unsafe working conditions.

The infant mortality rate is determined by the number of deaths under one year of age in reference to the number of live births that year (OECD, 2019). High infant mortality rates are generally indicative of unmet human health needs in sanitation, access to clean water, inadequate medical care, malnourishment and education (Britannica). Currently, Bangladesh’s infant mortality rate is 25.788 death per 1000 live births which indicates a 3.94% decline from 2018. (Macrotrends, 2019) According to the Australian Bureau of Statistics, Australia’s is 3.1% infant deaths per 1,000 live births compared with 3.3% in the previous year.

Life expectancy is a hypothetical estimate of the average number of years an individual is anticipated to live. Factors such as sex, age, race, health status and geographic location affect this measure significantly however, it may be considered as a direct reflection of an individuals’ local conditions. Bangladesh’s life expectancy is 72.43 years which is an 0.39% increase from 2018. Comparatively, the Australian life expectancy is 83.35 years which is an 0.18% increase from 2018.

Conclusion

Ultimately, the manifestation of universal healthcare in society represents an intrinsic ambition to achieve equitable, quality healthcare to all irrespective of economic consequence. It perceives humanity as a priority which signifies an enormous step forward in the progression of modern healthcare.