Healthcare System | Assignment

Running head: HEALTHCARE SYSTEM
HEALTHCARE SYSTEM
Name of the Student:
Name of the University:
Author Note:

1HEALTHCARE SYSTEM
Answer 1:
Medicare is the federal health insurance program (Marmor 2017). It plays a vital role
in providing financial security towards older individuals above old age and younger
individuals with a disability. Medicare beneficiaries with HIV has evolved in many years.
Approximately one-quarter of people with HIV in care get their health insurance coverage
through Medicare. This program is the single largest source of federal financing for HIV care
and treatment. Most of the people with HIV on Medicare are under age 65 and however,
younger individuals qualify because of a disability (Friedman & Duffus, 2016). The majority
of Medicare beneficiaries with HIV are dually eligible for Medicare and Medicaid and
receive low-income subsidies.
Medicare has been Australia’s universal health care scheme. Medical services, public
hospitals, along with medicines, are the key part of Medicare. It is made accessible to the
Australian and New Zealand nation or citizen that is permanent residents in Australia. If from
outside or born overseas, than reciprocal agreement is required. Medicare covers the rate of
community hospital services. This cost can be of physiotherapy, basic dental services for
children, GPs, medical specialists, community nurses and many others. Pharmaceutical
Benefits Scheme (PBS) is a crucial part of Medicare. The major role of PBS is to makes some
prescription medicines cheaper. If a person is enrolled with Medicare, then he or she needs to
pay for some amount of cost and the rest will be paid by Australian governments.
Antiretroviral therapy for HIV infection is made accessible in PBS by the use of section 100
under highly specialised drugs program (health.gov.au, 2019). For treating chronic
conditions, these drugs are made available. It is also controlled and the supply can be done
only in public hospitals along with the private hospitals having access to suitable specialists’
services (health.gov.au, 2019). The PBS is broadly known both in Australia and overseas as

2HEALTHCARE SYSTEM
being the topmost systems in the globe for patients as well as taxpayers. This perception is
built on the basis of structure, equity, access as well as funding arrangements, along with
health outcomes. PBS has a national program that certifies a steady and reliable approach
towards the availability of essential medicines, pricing of the treatment along with the
evaluation of these medicines. Therefore, these programs result in adding an important
strength to PBS.
ANSWER 2:
Australian federal, as well as State/Territory governments, share accountability in
funding, regulation, service distributions along with policy developers. Australian federal
government sets national policies to be followed by the health system. The main
responsibility of the Australian government is Medicare. It comprises subsidence medical
facilities along with the funding with the states or territory governments (health.qld.gov.au,
2019). The federal government equally funds in pharmaceuticals through the pharmaceutical
benefits schemes (PBS).
Additionally, it also delivers support to retrieving in primary health care, controls
private health insurance besides establishes health facilities for veterans. Federal government
correspondingly funds in community-controlled as well as primary health care. They are also
the foremost funder of health along with medical research that includes the National Health
as well as the Medical Research Council. All the medicines and medical equipment are
regulated with the help of the Australian federal government. However, State government
along with the territory governments, accomplish public hospitals. Their role is to give
license and permits private hospitals. They are also accountable and responsible for the public
community based as well as primary health services. The services in primary health care
comprise of mental health, alcohol along with the drug services, and dental health. Multiple

3HEALTHCARE SYSTEM
preventive services such as immunization programs as well as cancer screening are delivered
with the governance of State/Territory governments (Dalziel et al., 2018). Apart from
preventive services, emergency services are also governance by state along with the territory
governments. All the health-related complains and feedback are regulated with the help of
state along with the territory governance. They fund public health programs as well as
services. Moreover, state, as well as territory government, also funds in Aboriginal and
Torres Strait Islander health deliveries (Duckett & Willcox, 2015).
ANSWER 3:
For eliminating HIV effectively, it is necessary to make the availability of treatment
for temporary residence as well. To avail the treatment of HIV, a person should have the
Medicare card that is only be given to the permanent citizen of Australia. Therefore,
temporary residency does not have approval for opting for Medicare card as well as free
treatment. Western Australia and the Australian capital territory have given free treatment to
an HIV positive person (napwha.org.au, 2019). The state and territory government has made
limited legislation to give a permit for temporary residence to access treatment of HIV at free
of cost. For instance, the cost of ARV is paid by dispensary hospital or any insurance
schemes where applicable in Western Australia. Another illustration can be of the Northern
Territory, although there is no single legislation however, there is a facility of providing free
treatment for people with HIV (napwha.org.au, 2019). There is a substantial burden on
recommending clinicians by the current system as significant clinic time is spent in access
through individual association with pharmaceutical concerns.
The current system is not promoted widely; this is leading unawareness of the
campaign. The campaign includes early diagnosis along with the immediate encouragement
diagnosis as well as treatment. The ability of the Australian HIV initiative to end the

4HEALTHCARE SYSTEM
transmission is being hindered due to this unawareness. This also led to late diagnosis as well
as late treatment. Additionally, late diagnosis also increases the chances of risks and further
can result in health complications. Retrieving ARVs from oversees possess serious concerns
for recommending clinicians. Cost effects the person’s choice of medication. Most of the
ARVs presently measured optimum are not accessible in generic form. Ordering from
overseas frequently affects treatment disruptions due to stock source issues or late order
leading to additional recurrent unscheduled treatment.
Healthcare providers might feel the challenge in providing continuity of care. These
schemes of the free cost may have a rapid transition towards alternative state-based access
arrangements. However, due to these schemes of free cost, HIV has drastically been reduced
and availability and accessibility have made it easier. Overseas patients can get access to
healthcare with this current governance of the health system. Access to ARV is not
distributed equally. In some jurisdictions, access is available only in Pharmaceutical Benefits
schemes. Additionally in some jurisdictions, only two pharmaceutical companies are
providing ARVs and thus leading to complex issues in choosing the right drugs in any critical
cases. This scenario also results in limited access to frontline care (napwha.org.au, 2019).
ANSWER 4:
The Australian health system is constantly growing and expanding to deliver
maximum outcomes towards the quality of care. The system is efficiently and effectively
integrating every level of healthcare in Australia. Nurse navigator has evolved to provide and
assist patients in their journey of receiving health care. Complex needs and complex health
systems affect the patient to make difficult decisions or choices. The objective of this essay is
to deliver a clear understanding of nurse navigators and their role in different levels of the

5HEALTHCARE SYSTEM
health system. The main goal of the nurse navigator is to reduce the barrier to access health
care and educating patients in the coordination of care.
Nurse Navigators comprises of an advanced registered nurse. These senior nurses
provide dynamic services for every patient facing complexity in health conditions. They have
a thorough knowledge and are highly experienced with a comprehensive critical degree of
patients. Nurse navigators practice a multi-disciplinary method to screen high requirements
patients, ascertain activities required to accomplish their health care as well as direct patients
to the right service, at the right time and in the right place. It also delivers a central view of
statement and engagement to certify optimal care as well as coordination of services for a
complete healthcare journey. They also educate and create awareness to understand the health
condition of a particular or individual patient. They participate in the decision making of the
patient to ensure the improvement in their health outcomes (health.qld.gov.au, 2019).
The nurse navigator focuses on the entire journey of healthcare including all the needs
of a patient. Whereas, other nursing roles focus only on clinical outcomes such as special
disease or any specific conditions. Nurses work closely with the general physicians to support
the clinical approach and on the other hand, the nurse navigator works closely with a general
physician to focus on the critical needs of patients. They fulfilled the gap between the patients
and the health system. Nurse navigator services are based on patient needs of complex
medication, difficult in an understanding of the system, lack of knowledge of the procedures
or any issues in coordination of appointments and many more.
Primary healthcare is the first contact point for a patient. It is generally referred to as
frontline care. Here, a patient can access this level of the health system by visiting a general
physician (GP). The primary healthcare main objective is to provide efficient and effective
healthcare delivery. In the same manner, the role of nursing navigator is also similar to

6HEALTHCARE SYSTEM
enhance the quality of healthcare. Many nurse navigators are in association with a specific
secondary like hospital services. The services can be pediatrics, maternal care, cancer service
or any other disease-specific care and services (McMurray et al., 2018). In most of the
scenario, patient visits secondary health care if they are referred by the primary health care.
This sector of services is provided by local or state governments and the federal government.
This service is being delivered to meet the need for critical care patients. Nurse
navigator has knowledge of clinical procedures and outcomes, along with it they also have
knowledge of different Australian healthcare delivery systems. For instance, a cancer patient
can take guidance from a nurse navigator. Myelosuppression is the most critical case of
cancer. Anemia is one of the specific types of Myelosuppression that involves the use of
transfusion, repletion of vitamins as well as a growth factor of erythropoietin. The patient
needs education regarding the necessity of correcting the Anemia. All the strategies and
procedures for minimizing the Anemia need to be properly guided with the help of a nurse
navigator. Properly addressing the complication and possibilities in the entire treatment will
lead to reducing the pain of patients effectively. The nurse navigator is present in different
levels of the Australian healthcare delivery system. However, every hospital of Queensland,
as well as health service, has a nurse navigator (Hudson et al., 2019). Nurse navigator has
made accessible to every patient who has high needs. They receive an additional integrated
approach towards their health and quality of care.
This service is made available for patients for smooth and seamless evolution. This
service creates awareness in the mind of patients and thus, a patient can understand better
about their situation and accordingly take a decision for them. The service of nurse navigator
complements along with intensifies the services provided by the other nursing role and
healthcare professionals. The major key element is playing a role in providing end-to-end
care to the patient. These nurse navigators are well experienced and thus, they will associate

7HEALTHCARE SYSTEM
patients with accurate health professionals. The nurse navigator follows the nurse navigator
model. This model makes use of trained nurses to help patients among complex conditions as
well as needs to progress more easily throughout the healthcare system, in addition to
between hospitals as well as community settings (McMurray & Cooper, 2017). This model
intends to provide synchronization of patient care, generate partnerships between hospitals
along with community settings, advance patient outcomes, and incorporate a system of care.
The intensity of service is very flexible, and it generally depends on the requirements of the
patients.
From the above discussion, it can be concluded that the nurse navigator plays an
important key element in providing health care to patients. This nurse navigator works at
every level of the Australian health system. They work closely with the patient to make their
journey of accessing health smooth and effortless. They generate awareness and educate
every patient to help in decision making by the patients. Based on the needs of patients such
as complex medical disease, coordination with an appointment or holistic assessment, nurse
navigator plays their role in providing the needs of every patient.

8HEALTHCARE SYSTEM
References
Dalziel, K. M., Huang, L., Hiscock, H., & Clarke, P. M. (2018). Born equal? The distribution
of government Medicare spending for children. Social Science & Medicine, 208, 50-
54.
Duckett, S., & Willcox, S. (2015). The Australian health care system (No. Ed. 5). Oxford
University Press.
Friedman, E. E., & Duffus, W. A. (2016). Chronic health conditions in Medicare
beneficiaries 65 years and older with HIV infection. AIDS (London, England), 30(16),
2529.
health.gov.au. (2019). The Australian health system. Retrieved 29 January 2020, from
https://www.health.gov.au/about-us/the-australian-health-system
health.qld.gov.au. (2019). Nurse Navigators | Queensland Health. Retrieved 29 January 2020,
from https://www.health.qld.gov.au/ocnmo/nursing/nurse-navigators
Hudson, A. P., Spooner, A. J., Booth, N., Penny, R. A., Gordon, L. G., Downer, T. R., ... &
O’Donnell, C. (2019). Qualitative insights of patients and carers under the care of
nurse navigators. Collegian, 26(1), 110-117.
Marmor, T. R. (2017). The politics of Medicare. Routledge.

9HEALTHCARE SYSTEM
McMurray, A., & Cooper, H. (2017). The nurse navigator: An evolving model of
care. Collegian, 24(2), 205-212.
McMurray, A., Ward, L., Johnston, K., Yang, L., & Connor, M. (2018). The primary health
care nurse of the future: Preliminary evaluation of the Nurse Navigator role in
integrated care. Collegian, 25(5), 517-524.
napwha.org.au. (2019). Medicare ineligible PLHIV in Australia (pp. 1-20). napwha.org.au.
Retrieved from
https://napwha.org.au/wp-content/uploads/2019/07/2019_NAPWHA_MedicareIneligi
blesPLHIVinAustralia_Analysis.pdf