The Australian and Norwegian Healthcare System

Introduction

Australian healthcare has a mixed public-private model, while Norway relies on taxes to fund its universal healthcare system (Australian Institute of Health and Welfare (AIHW), 2022; OECD/European Observatory on Health Systems and Policies, 2019). This leads to varying degrees of quality care accessibility for citizens (AIHW, 2022; OECD, 2019). As a result, healthcare affordability and availability differ significantly between these two countries (AIHW, 2022; OECD, 2019).

Australia’s Model of Healthcare 

Over time, the Australian healthcare system has experienced funding changes and operates through a Beveridge model (Australian Institute of Health and Welfare (AIHW), 2020). Universal public insurance is offered by the government for health services which allows individuals to purchase private health insurance (AIHW, 2020). Over the last two decades, health expenditure has been markedly rising in Australia. Actual spending has reached $185.4 billion, and individual spending has reached $7,485 (AIHW, 2020). The proportion of GDP allocated to healthcare spending has increased and currently stands at 10% (AIHW, 2020). Two performance measures…

Australian Health Performance Measures 

Mortality

Australian fatalities reached 161,300 in 2020, with 84,588 male deaths and 76,712 female deaths (AIHW, 2022). Elderly individuals aged 75 years or older accounted for 66% of all fatalities (AIHW, 2022). Coronary heart disease was the primary cause of 12% of male deaths, whereas 12% of females were affected mainly by dementia and Alzheimer's. Additionally, cerebral vascular illness, lung cancer, breast cancer and prostate cancer ranked among the top five causes of mortality for both men and women (AIHW, 2022). 

Life Expectancy

Life expectancy estimates the average lifespan of a person based on their age and gender-specific death rates. Life expectancy is the projected number of years an individual will live from birth (AIHW, 2022). The average lifespan of both men and women in Australia has risen in the last four decades, particularly among older individuals (ABS, 2019). Male babies born between 2018 and 2020 are predicted to live up to 81.2 years, and female babies up to 85.3 years (AIHW, 2022). Men aged 65 and 85 saw a 50% and 40% rise, respectively, while women experienced less dramatic but still noteworthy increases (ABS, 2019). 

Norway’s Model of Healthcare

The healthcare system in Norway follows the Beveridge model and is partially decentralised. (Ringard et al., 2013). In theory, everyone in Norway is covered by this system, mainly financed through various levels of taxation. Furthermore, a small group of individuals comprising 5-10% of the populace have the choice to obtain coverage from private insurance providers, which is frequently given as a job benefit. This allows for faster treatment and more options in selecting medical care (Mossialos et al., 2016). Public sources contribute over 85% towards total healthcare spending, while private funding mainly involves households paying out-of-pocket expenses (Ringard et al., 2013). "Health care expenditure accounted for 10.4% of GDP in 2017 – the fifth highest in the WHO European Region. With Norway's per capita GDP being one of the highest in the world, the country's per capita health expenditure is also much higher than in most countries" (Sagan et al., 2020, p xxi). 

Norway Health Performance Measures 

Mortality

Mortality rates spanning from 2000 through 2016, with figures reaching 51.7 per 100,000 Norwegians, lung cancer continues to be the most prevalent cause of death by cancer throughout the country. Alzheimer's disease mortality rates have experienced a sharp rise since 2000 (OECD, 2019). Ischaemic heart disease accounts for roughly 10% of all deaths in Norway. Additionally, fatalities linked to tobacco usage continue to pose a significant threat to public health within Norway (OECD, 2019). 

Life Expectancy

In 2017, the average lifespan in Norway reached 82.7 years, with the primary reasons for death being cardiovascular diseases and cancers (Sagan et al., 2020). Nevertheless, among the younger generation, the leading death factors were self-harm and substance abuse disorders (Sagan et al., 2020).

Compare and Contrast Healthcare Models and Funding 

Compare

Norway and Australia offer citizens universal healthcare coverage but differ in funding mechanisms and cost-sharing arrangements (AIHW, 2020; OECD, 2019). Norway's system is publicly funded through taxation, while Australia has a mixed public-private system with Medicare and private health insurance options. Norway typically requires small co-payments for certain services, while Australia charges higher out-of-pocket costs for some procedures and medications (Mossialos et al., 2016; AIHW, 2020). Both countries prioritise equitable access to quality care and invest heavily in preventative health measures. Norway follows a pure Beveridge model, while Australia has adopted a hybrid model combining elements of the Beveridge model (Mossialos et al., 2016).

Contrast

The government's funding of healthcare services in Australia is accomplished through a combination of support from both the public and private sectors, which is made possible through collecting taxes and providing private health insurance (AIHW, 2020). Conversely, Norway operates under a universal healthcare system funded by taxes (Kasper et al., 2017). Despite these differences in funding mechanisms, both countries have consistently demonstrated exceptional performance in inaccessibility to healthcare services and the quality of care provided (OECD, 2019; AIHW, 2020). 

Quality and Safety Healthcare in Australia 

The ultimate goal for quality and safety healthcare in Australia is to protect individuals from adverse experiences and to ensure healthcare services are of highest possible standards (Australian Commission on Safety and Quality in Health Care, 2017). Organisations have implemented safety and quality systems into their governance procedures (ACSQHC, 2017). By doing so, they can effectively manage and enhance healthcare safety and quality for patients (ACSQHC, 2017). 

Quality and Safety Healthcare in Norway

In recent years, there has been a shift in the approach to regulating healthcare quality and safety in Norway, this involves an increased emphasis on leadership and enhancing quality (Saunes et al., 2020). The Action Plan for Patient Safety and Quality Improvement 2019-2023 is designed to support these new regulations, focusing on four key areas: competence, national initiatives for quality and safety, system and structures, and leadership and culture (Saunes et al., 2020). Every year since 2013, the government has submitted a white paper to parliament titled "Quality and Patient Safety," highlighting efforts towards improving patient safety and quality improvement (Saunes et al., 2020). Norway's performance in most indicators reported in the OECD Health briefly database is commendable; however, some challenges still exist (Saunes et al., 2020).

Similarities and/or Differences 

Patients, consumers and the community trust clinicians and health service organisations to provide safe, high-quality health care, and most Australians have access to such care (Australian Commission on Safety and Quality in Health Care. (2017b).National model clinical governance framework)

References

Australian bureau of statistics regulator performance framework assessment report, 2019-20. (n.d.). Gov.au. Retrieved March 31, 2023, from https://www.abs.gov.au/about/our-organisation/corporate-reporting/historical-regulator-performance-reporting/ABS%20Regulator%20Performance%20Framework%20Assessment%20Report%202019-20.pdf

Australian Institute of Health and Welfare. (2020). Australia’s health 2020. https://doi.org/10.25816/5F05371C539F3

Deaths in Australia. (2022). Gov.au. Retrieved March 30, 2023, from https://www.aihw.gov.au/getmedia/743dd325-7e96-4674-bb87-9f77420a7ef5/Deaths-in-Australia.pdf.aspx?inline=true

Kasper, J., Lager, A. R., Rumpsfeld, M., Kienlin, S., Smestad, K. H., Bråthen, T., Ankell, H., Knutsen, T., Kløvtveit, R., Gulbrandsen, P., Vandvik, P. O., Heen, A. F., Flottorp, S., Tollåli, G., & Eiring, Ø. (2017). Status report from Norway: Implementation of patient involvement in Norwegian health care. Zeitschrift Für Evidenz, Fortbildung Und Qualitat Im Gesundheitswesen, 123–124, 75–80. https://doi.org/10.1016/j.zefq.2017.05.015

Mossialos, E., Wenzl, M., Osborn, R., & Sarnak, D. (2016). Approby.com. https://da7648.approby.com/m/679d3f31e43c2e4e.pdf

OECD/European Observatory on Health Systems and Policies (2019), Norway: https://www.euro.who.int/__data/assets/pdf_file/0006/419469/Country-Health-Profile-2019-Norway.pdf

Ringard, Å., Sagan, A., Sperre Saunes, I., & Lindahl, A. K. (2013). Norway: a health system review. Health Systems in Transition, 15(8), 1–162. https://pubmed.ncbi.nlm.nih.gov/24434287/

Sagan, A., Karanikolos, M., Busse, R., Quentin, W., Spranger, A., Winkelmann, J., Alvarez-Dardet, C., Lin, V., Marchildon, G., Menabde, N., & Zatonski, W. (n.d.). Who. int. Retrieved March 30, 2023, from https://apps.who.int/iris/bitstream/handle/10665/331786/HiT-22-1-2020-eng.pdf?sequence=1&isAllowed=y

Swanson, J. O., Vogt, V., Sundmacher, L., Hagen, T. P., & Moger, T. A. (2018). Continuity of care and its effect on readmissions for COPD patients: A comparative study of Norway and Germany. Health Policy (Amsterdam, Netherlands), 122(7), 737–745. https://doi.org/10.1016/j.healthpol.2018.05.013

Appendix A: Concept Grid for Search Strategy

Appendix B: Search Strategy: Record of Literature Review