Essay: Hierarchy and Power in Australia’s Healthcare System Analysis

This essay provides a comprehensive analysis of the hierarchy and power dynamics inherent in Australia's healthcare system. It begins by highlighting the country's generally well-regarded healthcare model and introduces the argument that power and status influence the quality of care received. The essay explores sociological perspectives like symbolic interactionism, functionalism, and conflict theory, and their relevance to healthcare. It then delves into the biomedical model, discussing its advantages and disadvantages, and how it can be influenced by those in positions of power. The paper examines the concept of hierarchy in both social and medical contexts, detailing the structure of healthcare organizations and the roles of different practitioners. Finally, it outlines the implications of this hierarchical structure within the Australian healthcare system, including the roles of senior medical officers, visiting medical officers, registrars, and resident medical officers, and how they interact with each other and patients. The essay concludes by analyzing the impact of professional power and its influence on patient care.

Running head: HIERARCHY OF POWER IN AUSTRALIA’S HEALTHCARE SYSTEM 1
Hierarchy of Power in Australia’s HealthCare System
(Author’s name)
(Institutional Affiliation)

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Introduction
A 2017 study by a group of America researchers on the 11 different health care models
that are used by developed countries around the world revealed that Australia’s healthcare
system is one of the best in the world (Hierarchystructure, 2017). Australia’s healthcare system is
regarded as one of the most comprehensive, accessible and affordable systems in the world. The
system is managed by the Commonwealth Department of Health and Ageing whose mandate is
to ensure that all Australians have access to important family and health services.
Health care services in the country are predominantly provided by hospitals that are
either government or private operated and by private medical practitioners. The country also has
Medicare which is a universal health care system that subsidizes most of the medical costs for
Australian citizens in Australia (Hierarchystructure, 2017). The success of the country’s
Medicare system is largely attributed to the advanced nature of its private health insurance
system. Despite the significant level of success achieved by the healthcare system, the country
has witnessed a rise in the number of individuals who believe that hierarchy and power are
intrinsic to the current health care system (Jamieson et al., 2015).
Proponents of this school of thought argue that under the current health care system, the
powerful members of the society obtain better healthcare services than the less powerful
members. They believe that a person’s status in society plays an integral role in determining the
type of health care he/she gets. This objective of this paper is to provide a discussion on the
argument that hierarchy and power are intrinsic in Australia’s healthcare system.
The paper will seek to determine the validity of the argument and its impact on the
Country’s health care system. The paper will also seek to investigate why proponents of this
argument believe it to be so.

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Sociology and the Role of Perspectives
The level of success obtained by Australia’s healthcare system is made possible due to
the social life in the country. A number of studies have made it evident that an individual’s social
life is capable of significantly influencing his/her health. One such study was conducted by the
University of North Carolina and proved that individuals with close supportive relationships
have better physical health outcomes than those without. The study also proved that individuals
with positive social life respond better to health care than those without.
To obtain a better understanding of how society influences individuals, it is important to
review the primary theoretical perspectives as they provide a paradigm view of the society. The
perspectives are symbolic interactionism, functionalism and conflict theory. Symbolic
interactionism requires health care practitioners to regard the symbols and details of a person’s
everyday life when providing the individual with care.
The functionalist perspective holds that all societal aspects are interdependent and they
contribute to the functionality of the society as a whole. The conflict perspective holds that
society is in a state of constant competition for scarce resources and that the wealthy in society
are able to control the weak. The conflict perspective covers the concept of hierarchy and power
in determining the type of health care afforded to individuals. Under this perspective, individuals
who are wealthy in society obtain better health care than those who are not.
Biomedical Model
The biomedical model is a medical perspective that is used by health care providers in the
diagnosis of disease and the delivery of care. Under the biomedical model health care is provided
to an individual based primarily on the person’s biological processes. The model does not
consider an individual’s living conditions or lifestyle but instead focusing on the illness with the

HIERARCHY OF POWER IN AUSTRALIA’S HEALTHCARE SYSTEM 4
objective of returning the individual’s physical health to its re illness state. The cause of the
illness is not placed at the center of the model thereby eliminating the concept of hierarchy and
power in the delivery of health care.
The biomedical model of health care has a number of advantages and disadvantages. Some
of its major advantages include the creation of advances in research and technology, provides for
the treatment of a number of common problems, extends life expectancy, and improves life
quality. Some of the disadvantages associated with the biomedical model include it is costly due
to the fact that it relies on technology and professional health care workers, not all medical
conditions can be treated through this model, it does not always promote the health of the person.
Individuals who argue that Australia’s health care system is integrated with hierarchy and power
cite the fact that the country’s health care system is based on biomedical model which costly
makes it susceptible to influence by those who are in power.
Hierarchy and Power
The term hierarchy and power can be used both in a social context and in a medical context.
Under the social context, the term hierarchy and power refers to how the wealthy members of
society are able to acquire better health care services than the disadvantaged members of the
society. This concept of hierarchy and power is greatly supported by the conflict social
perspective discussed above.
Elements of this form of hierarchy and power are evident within the Australian health care
context where individuals who are of a higher economic and social standing are able to afford
better health insurance coverage and as a result of this obtain better health care services. The
second context of health care and power that this paper will focus on is that found within
healthcare setting which focuses greatly on the structure of healthcare organizations. The term

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hierarchy and power is usually associated with a medical practitioner’s status, ego, position
within the organization and in some context financial means.
Under thus context the term refers to the gap that exists between different levels in the
health care system. A number of Australian health care workers have complained that the
concept of hierarchy and power is largely evident in the one sided movement of communication
within the sector. The countries health care system is faulted for focusing only on the following
of orders and established protocols with less emphasis on identifying solutions jointly as a team.
Under the concept of hierarchy and power in the health care system, health care practitioners and
patients are leveled based on their respective role in the organizations.
The hierarchical structure is laced in a such a manner that the opinions if the healthcare
provider who is regarded as the expert in the medical sector are provided with more importance
than the opinions of the patient. This system is criticized for being oppressive of patients who
occupy the lowest position within the hierarchy.
Opposition to the system of health care is largely due to the fact that it does not provide
for patient participation in the treatment process. Under the medical context power is also used to
refer to professional power which is the expertise and capability of a medical practitioner to
perform a particular task in a manner that is appropriate It is argued in most quarters that
professional power for medical practitioners stems from the health care organization that they
belong to, their personal influence, self presentation and their personal identity.
Professional Power in the health care sector is generated from both outside and within the
system. The medical practitioner’s responsibilities, roles, skills and knowledge account for the
amount of power he has (Griscti et al., 2017). This implies that the more skills, knowledge,
responsibilities and roles ascribed to a particular medical practitioner, the more powerful he/she

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is. The more powerful a medical practitioner is, the higher up he/she is within the health care
systems hierarchical tree.
This model of health care is criticized by most practitioners as it Places service users at
a great disadvantage. This is in the sense that the health care practitioner utilizes his expertise in
the matter in alleviating the health statues of the service user. Number of Players within the
health care sector argue for the empowerment of service users to provide them with
responsibility in the decision making process of their medical care.
The context of Power within the health care system is covered under two theories namely
expert Power theory and legitimate Power theory. The expert Power theory holds that Power is
obtained from having specialist skills and knowledge in a particular field (Griscti et al., 2017).
The legitimate Power theory holds that a Person in authority is able to influence people who are
not in authority (Griscti et al., 2017).
IMPLICATIONS (Connections to Australian Health Care System)
As indicated in the introduction section of the paper, Australia has one of the greatest
health care systems in the world. The medical facilities in the country are not only highly
professional but also well organized and managed. The Australian medical system abides by a
stringent hierarchical structure with regards to the placement of medical staff and the provision
of medical care to patients.
The medical staff does not consist only of doctors and nursing but also members of the
administrative staff and executives who occupy the lower levels of the organization. The highest
level in Australia’s medical hierarchy system is that of the senior medical officer which consists
of the general practitioners who are followed by staff practitioners and the career hospital doctors

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(The tyranny of excessive medical hierarchy, 2017). Under the senior medical officers are the
visiting medical officers.
The visiting medical officers supersede the registrars who in turn supersede the principle
house officers who supersede the residential medical officers. The residential medical officers
consist of the senior house officers, junior house officers and the intern respectively (The tyranny
of excessive medical hierarchy, 2017). The senior medical officers occupy the top most level of
Australia’s health care system in under the hospital context. The SMO’s are either appointed as
non specialist or general officers in the staff grade positions.
The non-specialists officers refer to those individuals who may not have the qualifications
to work in a specific field but operate in any specialist under specialist supervision. The SMO’s
who operate under the staff grade position are individuals who maybe qualified in different
medical fields or jurisdictions (The tyranny of excessive medical hierarchy, 2017). This title is
largely occupied by international medical graduates who maintain the title under their fellowship
that is conferred upon them by the relevant Australian Specialty University of the medical
college.
The major sub divisions under this SMO category are the general practitioners, staff
practitioners and the career hospital doctors. The visiting medical occupy the second tier of the
hospitals hierarchy system. They are specialists who operate their own private hospitals or act as
general practitioners who provide consultation services at either public or private hospitals. The
third tier of the hierarchical ladder is occupied by registrars.
These are doctors who have been gained acceptance into a specialists training program that
is accredited with a particular nominated college in a specific clinical specialty. The principle

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house officers occupy the next level of the hierarchical structure and consist of individuals who
are in the fourth year of their post graduation studies.
The PHO’s are also given minor responsibilities in the hospitals with regards to the
treatment patients. Based on this the PHO can be described as a medical practitioner who isn’t
going through an accredited study course that will result in him or her obtaining a higher medical
degree (The Hidden Power Within the Healthcare Hierarchy, 2016). In some hospitals in
Australia, the position is seen to be equivalent to that of the registrar. The final step in the
hierarchical ladder is the resident medical officers.
They include the senior house officer who is a medical practitioner in his 3rd year of post
graduate education (Hierarchystructure, 2017). The junior house officer is a medical practitioner
in his/her 2nd year of post graduate education (The Hidden Power Within the Healthcare
Hierarchy, 2016). The intern is the last level of the hierarchy within the Australian hospital
organization. He/she is a medical practitioner in his/her first year of post graduate education.
The hospital hierarchical system is integrated seamlessly with the entire health sectors
ladder system where the patients are placed below the interns with regards to the provision of
care (Hierarchystructure, 2017). The lowest tier in the ladder is the patient’s family who in most
instances do not play any role in the patient’s treatment process.
A number of debates have been held as to whether or not the stringent heirarchial system
within the country’s health care system is the major contributor to its success or not. Individuals
who argue for the system hold that through the stringent heirarchail system, medical practitioners
are empowered to effectively execute the task assigned to tem therefore enhancing the quality of
health care provided (Crowe, Clarke, & Brugha, 2017). Those who argue against these systems

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indicate that the patient is unable to participate effectively in the treatment process thereby
hurting the effectiveness of the process (Kuokkanen, & Leino‐Kilpi, 2000).
In a study conducted on Australia’s health care system, it was raveled that a significant
percentage of patients confessed to being part of a number of experiences where their
contributions are not taken into account due to the fact that the country’s current health care
system does not provide for it and advice of the health care provider who is the expert prevails
over the voice of the patient.
The study also found that the hospitals hierarchical structure worked to support this
dynamic as nurses where privileged as gate keepers of the service and excluded the patients input
when creating the nursing notes or either through self –regulation (Gardner et al., 2017).
However, the study concluded that the a significant percentage of the patients who underwent
through this experience indicate that even though they found it distasteful, the received quality
service from the health care provider.
Overall Critical Depth
In summary it is logical to conclude that the hierarchy and power are intrinsic elements of
Australia’s medical system and that the success of the system lies in the elements. By stringently
regulating the health care system, the country has been able to control the quality of service
provided by the hospital thereby ensuring increased welfare. Hierarchy and power within the
health care system can also be categorized in two (The Hidden Power Within the Healthcare
Hierarchy, 2016). The first category is that within the hospital and represents the statues of the
medical practitioners and the second category is that of the relationship between medical
practitioners and patients.

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The heirarchail system of the hospital has also served to make it easier for the allocation
of responsibilities within the hospital and the provision of pay (Liberatore, & Nydick, 2008). The
nurses also play a significant role in managing the hierarchy system as they play a gate keeper
role in ensuring that communication flow is unidirectional (The Hidden Power Within the
Healthcare Hierarchy, 2016). Despite its numerous advantages, one of the key disadvantages of
sticking to a stringent hierarchical system, the Australian health care system has served to
eliminate patient participation in the treatment process (Liberatore, & Nydick, 2008).
This has led to a rise in the number of readmissions as more and more patients are unable to
continue with care after leaving the hospital either due to unclear instructions or failure to
understand the instructions. Another major disadvantage of the system is that it has resulted in
internal conflict between hospital staff and those who occupy the lower tiers of the hierarchical
ladder feel that their input into matters affecting health care are not taken into consideration
when making decisions. In conclusion the hierarchical and power elements of Australia’s health
care have both positive and negative sides.

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