Introduction
There is a global consensus on the importance of universal healthcare (UHC), however each country’s interpretation of the concept is slightly different due to diverse perspectives. This creates an emergence of various definitions, goals and outcomes which raise questions about how the progress and its long-term sustainability can be measured on a whole (Abiiro & De Allegri, 2015). This essay will aim to explore and compare the UHC systems in Australia and Thailand, and the practice and implementation challenges they both face. Furthermore, referencing the National Health Performance Framework, Australia’s and Thailand’s neonatal population will be explored and compared to understand the outcomes of different UHC systems.
Universal Healthcare
UHC is a multi-dimensional concept, that allows all populations to have access to health services without the risk of financial hardship (WHO, 2017). It provides universal financial protection, and access to healthcare services such as for treatment, rehabilitation, palliative care, health prevention and promotion (WHO, 2017).
According to the World Health Organisation (WHO), for a country to achieve UHC, several factors must be met (WHO, 2017). A country must have a strong, efficient and well-run health system in place, that meets individual’s health needs (WHO, 2017). This system should integrate person-centred care through health promotion and prevention and, having the capacity and capability to early diagnose, treat and manage diseases and, also ensuring palliative care is available (WHO, 2017). The health system must be affordable with a financial system in place to support individuals who are at risk of financial hardship (WHO, 2017). Moreover, well-trained, motivated healthcare workers should provide optimal care, and have the availability to access essential medicines and technologies (WHO, 2017). Additionally, actions should be taken to address social determinants of health such as education, living conditions and gross income as it will affect people’s health and their access to services (WHO, 2017).
Universal Healthcare in Australia: Affordability and Availability
In Australia, Medibank (1975-1981) and Medicare (1984-present) have provided universal access to medical and pharmaceutical services (Laba, Essue & Jan, 2015). It provides free access to public hospitals for inpatient admissions and outpatient services and, subsidised primary and specialist care to all residents regardless of income (Perkovic, Turnbull & Wilson, 2014). However, research has indicated a growing number of the population have been experiencing large out-of-pocket expenses and are at risk of financial hardship (Laba et al., 2015).
In Australia, healthcare is becoming progressively complex due to a surge in chronic disease sufferers (Perkovic et al., 2014). The Medicare Benefits Schedule (MBS) was introduced to subsidised specialised and innovative medicine and technology services (Perkovic et al., 2014). There are over 5000 MBS items as Medicare is still a fee-for-service-based scheme (Perkovic et al., 2014). However, there is still a growing number of medicines and technologies that are not government-funded, and becoming a financial burden for individuals (Perkovic et al., 2014). The government has tried to minimise gap payment expenditures for heavy users by introducing the Medicare Safety Net (Perkovic et al., 2014). However, it has been debated that Medicare has moved away from bringing equity to health care costs, to becoming a system of affordability for the government (Perkovic et al., 2014). The 2014-15 Budget proposed a mandatory $7 co-payment for general practitioner visits, pathology and radiology services (Perkovic et al., 2014). This proposal caused outrage as it was viewed that the government did not recognise the substantial co-payments individuals were already paying (Perkovic et al., 2014). The increasing costs to accessing healthcare services will become a barrier to achieving optimal health for Australians (Laba et al., 2015).
Universal Healthcare in Thailand: Affordability and Availability
Thailand is a developing nation that has made significant social and economic progress, advancing from a low-income country to a middle-income country (Nonkhuntod & Yu, 2018). In 2002, Thailand achieved UHC through the implementation of their Universal Coverage Scheme (UCS) (Nonkhuntod & Yu, 2018). The introduction of UCS, increased the overall population coverage from 71% in 2001 to 99.9% in 2012 (Nonkhuntod & Yu, 2018). It is comprised of three public health schemes: Social Security Scheme (SSS), Civil Servant Medical Benefit Scheme (CSMBS), and the UCS. The UCS provides coverage for those that are not eligible for SSS or CSMBS (Nonkhuntod & Yu, 2018).
SSS was introduced to cover private sector employees and their family members (16% of the population) (Nonkhuntod & Yu, 2018). Individuals are entitled to comprehensive outpatient and inpatient treatments, accident and emergency (Paek et al., 2016). These healthcare services are paid via inclusive capitation method (Paek et al., 2016). In terms of healthcare funding, financing for SSS comes from government tax and tripartite contribution of 1.5% equally by the employer, employee and government (Paek et al., 2016). On the other hand, public sector employees and their family members are covered by the CSMBS (8% of the population) (Nonkhuntod & Yu, 2018). These individuals have free choice of public health providers, and service payment method is fee-for-service (Paek et al., 2016). In terms of healthcare funding, CSMBS is fully funded by government tax (Nonkhuntod & Yu, 2018).
The UCS scheme covers up to 75% of Thailand’s population (Paek et al., 2016). UCS provides comprehensive cover like SSS, but including disease prevention and health promotion, annual health examination and rehabilitation services (Nonkhuntod & Yu, 2018). Individuals under the UCS must go to healthcare services within their district, but if individuals decide to avoid their district without a referral, they are liable for 100% of all costs (Nonkhuntod & Yu, 2018). Capitation payments are made for outpatient services, and global budget with diagnosis-related groups is the main payment method for inpatient services (Paek et al., 2016). In terms of healthcare funding, the UCS is fully funded by government tax (Nonkhuntod & Yu, 2018).
The overall implementation and impact of the UCS has been successful (Paek et al., 2016). Studies have shown a significant increase in outpatient visits and inpatient admissions in designated facilities (Paek et al., 2016). This change minimised the out-of-pocket health expenses for individuals (Paek et al., 2016). However, despite the positive results, inadequate infrastructure and skilled healthcare workers moving from public to private sectors are threatening the quality of the UCS (Paek et al., 2016). These issues contribute to longer waiting periods, limited service access and the availability of required medicine and technology (Paek et al., 2016). The Thailand government recognised the growing issue and intervened by expanding the benefits to more costly services and introducing traditional Thai medicines and treatments (Paek et al., 2016).
Health Status Comparison of Australia and Thailand
The National Health Performance Framework (NHPF) is used to comprehend and evaluate Australian’s health and the health system (AIHW, 2017). The NHPF has three domains: health status, determinants of health and health system performance, and among them is 14 health dimensions (AIHW, 2017). The health status domain determines the healthiness of the population (AIHW, 2017). The domain can help to identify areas for improvement to increase the overall health status of Australians (AIHW, 2017). The health dimensions within this domain includes: health conditions, human function, wellbeing and deaths (AIHW, 2017). This domain will be used to explore the neonatal mortality rate due to neonatal sepsis in Australia and Thailand.
Globally, neonatal sepsis is a leading cause of neonatal morbidity and mortality (Shane, Sanchez & Stoll, 2017). Neonatal death is when a baby dies in the first 28 days of life (AIHW, 2018). Neonatal death from sepsis involve bacterial, viral, fungal or other sources that alters the body’s structure (Shane et al., 2017. The burden of the disease has been reported higher in low-income and middle-income countries, and lower in high-income countries (Shane et al., 2017). In Thailand, neonatal death rate is not high, but its rate of decline has not been substantial since 2000 (IHME, 2016). In 2013, more than 17,000 neonates were diagnosed with neonatal sepsis and 7.1% were fatal (Kiatchoosakun, Jirapradittha, Areemitr, Sutra & Thepsuthammarat, 2013). In contrast, Australia reported 4.8% of neonates died from sepsis in 2013-2014 (AIHW, 2018). In the same year, the neonatal mortality rate was 2.6 per 1,000 births, with the neonatal mortality rate showing a slow decline in numbers since (IHME, 2016).
Health interventions to lower neonatal sepsis rates should involve the care throughout the pregnancy, childbirth and into the early neonatal period (Kiatchoosakun et al., 2013). For Thailand, the greatest challenge is to educate healthcare workers to recognise and start appropriate management and treatments during these periods (Kiatchoosakun et al., 2013). This ranges from providing education to referring more advanced issues to appropriate facilities (Kiatchoosakun et al., 2013). Furthermore, health promotion of maternal and newborn services must be improved within the districts (Kiatchoosakun et al., 2013).
On paper, Thailand’s three public health schemes provides total coverage to 99.9% of the population (Nonkhuntod & Yu, 2018). However, the reliability of Thailand’s UHC has shown inconsistencies as there is a larger focus on maternal health and children over five years of age, compared to neonatal health (Kiatchoosakun et al., 2012). This supports the data findings of neonatal death from sepsis (Kiatchoosakun et al., 2012). On the other hand, Australia’s trends have shown neonatal sepsis death is more common with low birthweight for gestational age, babies of women who are of Aboriginal and/or Torres Strait Islander status, and those who have poor attendance or access to antenatal/neonatal care (AIHW, 2018). However, according to AIHW, Australia has not formally reported on neonatal death from sepsis and its factors (AIHW, 2018).
Conclusion
UHC is an important concept that allows equity amongst all citizens of a country. It is with access to services, that a country can strive for a healthier population. However, due to different perspectives and circumstances, countries can have varying definitions and implementation strategies of UHC. Whilst both Australia and Thailand have a well-founded UHC system in place, due to different social determinants, the neonatal mortality rates vary. Continues efforts to reform the UHC systems will minimise such variances, and lead to better health outcomes for individuals.