Question

Compare and contrast nursing in the United States and Australia.

Answer 1

Australia has a 2-tier system: public and private. All citizens, permanent residents and certain visa holders are eligible to receive high quality free public inpatient and outpatient hospital care, including free emergency department visits through Medicare. However, many people also pay an out of pocket fee to see a doctor in the community setting (GP or other private specialists) as the patient’s Medicare rebate for these services has failed to increase with rising health costs. Approx 57% of Australians also choose to have private cover, which can supplement allied health services, optometry and dental and enable access to private hospitals with your choice of healthcare provider and reduced waiting times for elective procedures. The government also provides a subsidy for private insurance costs to families using a sliding scale based on income to encourage uptake of private insurance. As well as being funded through general taxation, all Australians pay a 2% Medicare income tax levy. An additional levy of 1% is applied to high-income earners who choose not to take out private cover.

Compared this to the US system, in the 1960s, Medicare and Medicaid were introduced in America, funded by US payroll taxes. They provide coverage to very low-income earners and the elderly. However, the majority of Americans are not included in this small cohort and are therefore responsible for almost all of their healthcare costs. Most families obtain private insurance coverage through their employer, but often this is only if they are employed full time. Insurance policies also vary widely in their level of cover, co-payments and deductibles so most patients are still subjected to out of pocket costs. The self-employed and many part-time employees are left to self-fund their own insurance completely, which is often beyond their means. The Affordable Care Act was introduced in 2010, with the aim of increasing insurance uptake and increasing employer-sponsored cover. For the first time, it also ensured that pre-existing conditions would be covered. A penalty was introduced for all the uninsured in an attempt to mandate insurance coverage. Despite all this, an estimated 26 million people remain without health insurance in the US.

The funding of medications also differs. While Australia has a Pharmaceutical Benefits Scheme (PBS) that caps the out of pocket cost of most medications for all Australians, patients in the USA rely on medications being covered by their private insurance. What is eligible for coverage again varies widely amongst insurers and many can find themselves being responsible for the full cost of essential medication, which in some cases can be financially crippling.