A Literature Review on Health Care Inequality within Australia

This literature review examines health care inequality in Australia, focusing on the discriminatory attitudes of healthcare professionals and their impact on patient care. The review identifies racial, socioeconomic, gender, and age-based discrimination within the Australian healthcare system. It aims to identify inequalities, determine their causes and affected populations, and suggest system changes. The methodology includes a systematic literature review using the PRISMA flow chart for article selection from databases like CINAHL, with inclusion criteria focusing on articles published within the last five years in English. The review synthesizes findings from various studies, highlighting the negative impacts of socio-economic structures, gender inequality, and low health literacy, particularly among Indigenous populations and those from lower socioeconomic groups. The review emphasizes the need for healthcare reform to reduce discrimination, address geographical barriers, and improve health outcomes for all Australians, with a focus on universal healthcare and the reduction of catastrophic healthcare expenditure.

Running head: LITERATURE REVIEW
LITERATURE REVIEW: INEQUALITY IN HEALTH CARE IN AUSTRALIA
Name of the Student
Name of the University
Author Note

1
LITERATURE REVIEW
Introduction
Health care system should be focused on providing care to everyone with the
consideration of the care providence with patient centred approach. However, it has been seen
that the health care system of the Australia has been seen to be affected with the discriminative
attitudes of the health care professionals. In this context, the racial, socio-economic, gender and
age based discrimination can be found. Thus, the factor of the inequality is prominent in the
Australian health care system. Based on this context, the factorisation of the process of the health
care should be done and the identification of the negative impact of this discriminative behaviour
would be important. In the following section, the aspects of the inequality in health care of
Australia would be identified and discussed with the help of literature review.
Aim
The aim of this paper is to identify the inequality in health care system of Australia
through a thorough literature search.
Objectives
 To understand the negative aspect of inequality in health care system of Australia.
 To determine the causes and the people affected by this practice.
 To demonstrate the changes required in the system of health care.
Method
The paper will be developed with the focus on the literature review process. Hence, it is a
qualitative method and descriptive study which will identify the negative approaches of health
care based on previous works of authors. Thus, the systematic literature review will be

2
Records identified
through CINAHL
database searching
(n = 291)
Records after duplicates removed
(n = 200)
Records screened
(n = 200)
Records screened
(n = 198)
Records excluded
(n = 170)
Records excluded
(n = 186)
Full-text articles assessed
for eligibility
(n = 30)
Full text articles excluded,
with reasons
(n = 20)
Full-text articles excluded,
with reasons
(n = 6)
Included studies in this
investigation for
qualitative synthesis
(n = 10)
Included
Screening
Eligibility
Identification
LITERATURE REVIEW
conducted. PRISMA flow chart will be developed for the inclusion and exclusion process of the
articles searched and selected for the review process.

3
LITERATURE REVIEW
Figure: PRISMA Flow Chart
Inclusion Criteria
 The articles should be from recognised source database (e,g., CINAHL).
 Articles should be published within 5 years.
 Articles should focus on the topic of inequality and its effects critically.
 Articles should be published in English language.
Exclusion Criteria
 The articles are not published in any recognised source database (e,g., CINAHL).
 Articles published before 5 years.
 Articles deviating from the topic of inequality.
 Articles published in language other than English.
Literature Review
Methods and design
Callander, Fox and Lindsay (2019), conducted and longitudinal analysis of the national
dataset of health care. Hyun et al. (2017), conducted a medical health record assessment and data
collection. Martinson and Reichman (2016), assessed the national health record and derived the
data. Bastos, Harnois and Paradies (2018), conducted a literature review. Schuch et al. (2017),
conducted a quantitative survey. Jamieson et al. (2016), conducted national health data based
quantitative survey. Callander (2019), conducted literature review and descriptive study to
identify the factors. Wade and Stocks (2017), conducted a descriptive literature review. Baade,
Dasgupta, Youl, Pyke and Aitken (2016), conducted a cohort study. Jiang et al. (2019),
conducted an epidemiological modelling study.

4
LITERATURE REVIEW
Result and Findings
Callander, Fox and Lindsay (2019), highlighted that the negative impact of the socio-
economic structure is present in terms of inequality in health care system of Australia. Based on
this finding, the effects of the inequality can also be identified as the negative health outcome for
the people from the lower socio-economic group.
According to Hyun et al. (2017), the gender inequality has been prominent and also the
factor of the gender inequality affects the quality care as well. Based on this context, the
conclusion of the authors highlighted that the process of the care should be provided without any
discrimination and also the gender inequity should be eliminated in the health care sector with
higher priority.
Based on the views of Martinson and Reichman (2016), the health literacy rate among the
lower socio-economic group are found to be very low. The health acre access is also lower
among these people as the remote location and also the discrimination affects the health
condition of the people. In this context, the authors found that the low birth weight among the
infants of this group of people is prominent as well.
It can be stated that the negative practice of the discrimination is present. Based on this
context, it can be found that the process of the care should be provided without any kind of
discrimination. Thus, the elimination of the inequality in the health care processes can reduce the
negative impact on the care facility and the health outcome of the people form the socially
unprivileged people (Bastos, Harnois & Paradies, 2018).
The discrimination towards the people from the Indigenous group can affect the care
quality of the Australian health care system. On the other hand, it has been seen that the socio-

5
LITERATURE REVIEW
economic imbalance and the racial discrimination towards the people from the Indigenous group
leads to the lower health literacy and also lower health care access (Schuch et al., 2017).
Jamieson et al. (2016), highlighted that there is a distinct difference among the people
from the non-Indigenous people and the people from the Indigenous group regarding the health
outcome. The authors stated that the health care quality is affected in Australia as the personnel
responsible for the health care have a problem of racial or other kind of discriminative behaviour.
It can be found that the health care is subsidised to the people from the lower income
group. However, the discriminative behaviour of the health care professionals affect the health
care procedures. Thus, it can be stated that the government should seek the effective change of
the situation and reduce the health care cost and the negative health outcomes of the country
(Callander, 2019).
Wade and Stocks (2017), found that the cardiovascular diseases are the primary causes of
the negative health situation and the large amount of mortality rate of the Australian context. It
has been seen that the health situation of the Indigenous people is worst. However, this negative
situation developed due to the discriminative behaviour towards the people from the Indigenous
group and also the people from the lower socio-economic group.
The factor of the negative impact of the geographical context is reduced as the health care
access is developed in the distant islands and other places. Thus, it can be stated that the process
of the health care should be reformed and the inequality in terms of the discrimination and
natural barriers should be assessed and reduced as well (Baade, Dasgupta, Youl, Pyke & Aitken,
2016).
According to Jiang et al. (2019), health care is affected by many different aspects. One of
the most prominent factors which is affecting the health care is the increasing rate of the health

6
LITERATURE REVIEW
issues due to the alcohol or substance abuse cases. Thus, it can be found that the Australian
government is focusing on the reduction of the negative impacts of the health conditions of the
country population.
Discussion
According to Callander, Fox and Lindsay (2019), health care should be provided to
everyone equally. It has been documented that the increasing amount of poor health is associated
with the negative impact of poverty increase. The factor of the universal health is focusing on the
reduction of health care cost and providing appropriate care to the patients despite of the socio-
economic structure of the patient. The process of the health care and the discriminative
behaviour of health care professionals have been affecting the health condition of these people.
Based on the views of Hyun et al. (2017), cardiovascular risks are prominent among the
people of Australia. However, the study of the authors shoed that the women population of the
country is less likely to have the risks as the rate of cardiovascular issue are lower among the
patients from female gender. The women population are less likely to be provided with higher
rate of care with high importance than that of the male population.
Martinson and Reichman (2016), highlighted that the socio-economic status affects the
health condition of the people. The factor of the inequality regarding the socio-economic status is
quite common among all the developed countries. Australia is one of the well known country for
the health care infrastructure. However, it has been seen that the lower socio-economic people
are affected with the negative health issues.
Bastos, Harnois and Paradies (2018), opined that the possibility of the direct connection
is very much prominent between the partial racial discrimination and the health care quality.
Thus, it can be stated that the racial discrimination is one of the most dominant factors that affect

7
LITERATURE REVIEW
the health care quality. The factor of the care delivery is affected with the discrimination in the
Australian context. However, the authors could not specify the discriminative approach of the
care professionals towards the race or socio-economic structure of people or gender or on any
other aspect.
As per the views of Schuch et al. (2017), health condition of the Indigenous Australians
is affected. The factor of the health care quality is affected with the negative discriminative
behaviour of the health care personnel affect the health care quality. Thus, it can be stated that
the elimination of the discrimination can reduce the inequality of the care providence. Moreover,
it can be stated that the process of the health care and the health outcome of the patients are
proportionally relative.
Jamieson et al. (2016), highlighted that it can be seen that the oral health condition of the
people from the Indigenous group are in negative condition than the people from the non-
Indigenous counterpart. Thus, it can be seen that the inequality in the health care sector of the
country is prominent and it is mostly common in case of the Indigenous people. Thus, the
improvement should be considered with higher priority and situation should be revised to the
positive direction.
According to Callander (2019), catastrophic health care expenditure is increasing with
time. The authors also stated that the increase of this negative situation is affecting the health
outcome of the lower income group of people. It has been seen that the health care cost is one of
the factors for the government which should be implemented for the effective care delivery to
every person of the country. However, the health condition of the lower income people is more
severe than the people from the higher or middle income group.

8
LITERATURE REVIEW
Wade and Stocks (2017), suggested that the reduction of the negative condition can be
achieved through the implementation of the telehealth procedure. This procedure can improve
the timely care delivery process and also the discriminative approach of the health care
professionals. Hence, the reduction of the negative health situation for the patients and also the
reduction in the inequal health care delivery can be achieved from this process.
Based on the views of Baade, Dasgupta, Youl, Pyke and Aitken (2016), the geographical
barriers are present in the process of the health care delivery to the people. It has been seen that
the remote area people are affected with the health care inequality as the health care access is
less in the remote areas. Thus, it can be stated that the health care inequality can be induced by
the barriers such as the geographical remoteness.
The factor of the taxation and the pricing of alcohol and other substances can reduce the
health quality of people as the consumption of these substances if get costly then the reduction of
the consumption can be achieved. Thus, the inequality in the health care sector can also be
reduced by the financial improvement for the health care sector. Thus, as per the authors view it
can be an effective process to reduce the negative factors of health care sector including
inequality (Jiang et al., 2019).
Limitation and Conclusion
Based on the above discussion it can be concluded that the process of the health care in
Australia is affected with inequality due to the racial or other kinds of discriminative behaviours
of the health care professionals. However, this paper has a limitation of not having any present
and practical data as this is a literature review of previous works. On the other hand, the factor of
the financial imbalance, health literacy, health care access and also the geographical contexts are
the factors that affect the health care quality through the development of the health care

9
LITERATURE REVIEW
inequality. In this context, it can be found that the reformation of the health care sector,
telehealth adaptation and also subsidising the health care with the help of the extra revenue from
the alcohol or other industry can induce the health care.

10
LITERATURE REVIEW
References
Baade, P. D., Dasgupta, P., Youl, P. H., Pyke, C., & Aitken, J. F. (2016). Geographical
inequalities in surgical treatment for localized female breast cancer, Queensland,
Australia 1997–2011: improvements over time but inequalities remain. International
journal of environmental research and public health, 13(7), 729.
DOI:10.3390/ijerph13070729
Bastos, J. L., Harnois, C. E., & Paradies, Y. C. (2018). Health care barriers, racism, and
intersectionality in Australia. Social Science & Medicine, 199, 209-218. Retrieved from
https://doi.org/10.1016/j.socscimed.2017.05.010
Callander, E. J. (2019). Out-of-pocket health spending in Australia: inequalities identified.
PharmacoEconomics & Outcomes News, 824, 21-23. Retrieved from
https://doi.org/10.1007/s40274-019-5749-1
Callander, E. J., Fox, H., & Lindsay, D. (2019). Out-of-pocket healthcare expenditure in
Australia: trends, inequalities and the impact on household living standards in a high-
income country with a universal health care system. Health economics review, 9(1), 10.
Retrieved from https://doi.org/10.1186/s13561-019-0227-9
Hyun, K. K., Redfern, J., Patel, A., Peiris, D., Brieger, D., Sullivan, D., ... & Woodward, M.
(2017). Gender inequalities in cardiovascular risk factor assessment and management in
primary healthcare. Heart, 103(7), 492-498. Retrieved from
https://ora.ox.ac.uk/objects/uuid:09b919d4-e885-4024-8f40-93b7ce000217/
download_file?safe_filename=Hyun_et_al_2017.pdf&file_format=application
%2Fpdf&type_of_work=Journal+article

11
LITERATURE REVIEW
Jamieson, L. M., Elani, H. W., Mejia, G. C., Ju, X., Kawachi, I., Harper, S., ... & Kaufman, J. S.
(2016). Inequalities in indigenous oral health: findings from Australia, New Zealand, and
Canada. Journal of dental research, 95(12), 1375-1380. Retrieved from
https://doi.org/10.1177%2F0022034516658233
Jiang, H., Room, R., Livingston, M., Callinan, S., Brennan, A., Doran, C., & Thorn, M. (2019).
The effects of alcohol pricing policies on consumption, health, social and economic
outcomes, and health inequality in Australia: a protocol of an epidemiological modelling
study. BMJ open, 9(6), e029918. DOI:10.1136/bmjopen-2019-029918
Martinson, M. L., & Reichman, N. E. (2016). Socioeconomic inequalities in low birth weight in
the United States, the United Kingdom, Canada, and Australia. American journal of
public health, 106(4), 748-754. Retrieved from
https://dx.doi.org/10.2105%2FAJPH.2015.303007
Schuch, H. S., Haag, D. G., Kapellas, K., Arantes, R., Peres, M. A., Thomson, W. M., &
Jamieson, L. M. (2017). The magnitude of Indigenous and non‐Indigenous oral health
inequalities in Brazil, New Zealand and Australia. Community dentistry and oral
epidemiology, 45(5), 434-441. Retrieved from https://doi.org/10.1111/cdoe.12307
Wade, V., & Stocks, N. (2017). The use of telehealth to reduce inequalities in cardiovascular
outcomes in Australia and New Zealand: A critical review. Heart, Lung and Circulation,
26(4), 331-337. Retrieved from https://doi.org/10.1016/j.hlc.2016.10.013