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To control costs and keep emergency preparedness in the spotlight, many other aspects of emergency preparation in the City of Los Alamitos depend on multi-agency collaborations and community partnerships. Southland’s contribution provides backpack-style response kits with reporting procedures and essential emergency supplies to facilitate that response. Southland is a committed community partner and is consistently working with the city to enhance community events. Southland Credit Union will be recognized for their contribution in support of Disaster Preparedness Month at the Los Alamitos City Council Meeting on Monday, September 17, at 6 p.m. Even though the city has been fortunate to avoid the destruction experienced in other parts of the country, there remains the looming threat of a massive earthquake or other unforeseen event. It is commonly accepted that the impact of disasters can be mitigated through careful planning and preparation.
Australia's health 2014Understanding health & illness Australia's health system How healthy are we?
This chapter looks at the many components of the Australian health system, how they are organised and funded, and how they are delivered to, and used by, Australians. While for many Australians most of their contact with the health system involves a visit to a GP or pharmacist, these services are part of a much broader and complex network. Complexity is unavoidable in providing a multi-faceted and inclusive approach to meeting the health system needs of Australia's many and varied residents, when those needs are shaped by many and varied factors, including gender, age, health history and behaviours, location, and socioeconomic and cultural background. Behind the scenes of the health system is a network of governance and support mechanisms that enable the policy, legislation, coordination, regulation and funding aspects of delivering quality services. This growth can be attributed in part to societal changes such as population ageing, and to increased prevalence of chronic conditions, diseases and risk factors. For most people their first contact with the Australian health system when they become ill is a visit to a general practitioner (GP). While the configuration of services varies from country to country, common elements include robust funding mechanisms, a trained workforce, reliable information on which to base decisions and policies, and well-maintained facilities and logistics to deliver quality medicines and technologies (WHO 2013a).
Australia's health-care system is a multi-faceted web of public and private providers, settings, participants and supporting mechanisms. Public sector health services are provided by all levels of government: local, state, territory and the Australian Government. Although public hospitals are funded by the state, territory and Australian governments, they are managed by state and territory governments. Navigating your way through the 'maze' of health service providers and responsibilities can be difficult (Consumers Health Forum of Australia 2013).
Note: The inner segments indicate the relative size of expenditure in each of the 3 main sectors of the health system ('hospitals', 'primary health care', and 'other recurrent'). The inner segments show the relative size of the expenditure in each of the main sectors of the health system, being hospitals, primary health care and other recurrent areas of expenditure.
The middle ring indicates the relative expenditure on the specific service types within each sector, and who delivers the service. The outer ring shows the funding source for the different services and the relative size of the funding. For more detailed information about expenditure, see 'How much does Australia spend on health care?' in this chapter. The colour coding in the figure shows whether the service is provided by the private sector, public sector, or both. The health system is used to varying degrees by Australian citizens, overseas visitors, temporary and permanent visa holders and asylum-seekers (Department of Health pers.
Our contact with the health system almost always begins at birth and, for most of us, continues frequently throughout our lives. In Australia, primary health care is typically a person's first point of contact with the health system and is most often provided outside the hospital system (Government of Western Australia Department of Health 2013).
Primary health care is delivered in a variety of settings, including general practices, Aboriginal and Community Controlled Health Services, community health centres and allied health services, as well as within the community, and may incorporate activities such as public health promotion and prevention. Secondary care is medical care provided by a specialist or facility upon referral by a primary care physician (Nicholson 2012). Hospital emergency departments are a critical component of hospitals and the health system. In 2011, the Australian Government established Medicare Locals to plan and fund extra health services in communities across Australia. Local Hospital Networks (LHNs) are being established across the country to improve delivery, coordination and access to health services. There are 136 LHNs in Australia, of which 123 are geographically based and 13 are state or territory-wide networks that provide specialised hospital services across jurisdictions (DoHA 2011). The development of new models of care, such as nurse-led walk-in clinics and day surgical procedures being performed in consultants' rooms, is shifting the boundaries between what traditionally would have been hospital-based care and care delivered by other health professionals.
Innovations such as personally controlled electronic health (e-health) records and telehealth also offer the prospect of improved communication and access to services. Telehealth services use communication technologies, such as video-conferencing, to deliver health services and transmit health information. The use of e-health technologies to self-monitor health is emerging as a key dimension in contemporary health care. Patients can also now use devices such as blood pressure and blood glucose monitors in their own homes to track and manage their health status and potential health risks. The Australian Government's funding contributions include a universal public health insurance scheme, Medicare. A person can have Medicare cover only, or a combination of Medicare and private health insurance coverage (PHIO 2013). The government-funded schemes and arrangements aim to give all Australians access to adequate, affordable health care, irrespective of their personal circumstances. Medicare offers free treatment and accommodation as a public patient in a public hospital, by a doctor appointed by the hospital (Department of Human Services 2014; PHIO 2013).
A public patient cannot choose their own doctor and may not have a choice about when they are admitted to hospital for elective procedures (PHIO 2013). Medicare benefits are based on a schedule of fees (the Medicare Benefits Schedule, or MBS), which are set by the Australian Government after discussion with the medical profession.
While Medicare benefits are generally not available for medical treatment a person receives overseas, the Australian Government has signed Reciprocal Health Care Agreements to help cover the cost of essential medical treatment (Department of Human Services 2013c) for Australians visiting certain countries. When a person visits a doctor outside a hospital, Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for a specialist. Medicare also subsidises a wide range of prescription pharmaceuticals under the Pharmaceutical Benefits Scheme (PBS). If a medicine is not listed under the PBS schedule, the consumer has to pay the full price as a private prescription. Additional government programs are targeted at improving health services and outcomes for specific groups, such as people living in rural and remote Australia, Indigenous Australians, those with chronic illnesses and older Australians. The Australian Government's $805 million Indigenous Chronic Disease Package, for example, aims to improve the way the health-care system prevents, treats and manages the chronic diseases that affect many Indigenous Australians.
Other government initiatives include arrangements for Australians with chronic illnesses to receive Medicare benefits for allied health services that help manage their condition (Department of Human Services 2013a) and programs to improve health services in rural and remote communities, such at the Visiting Optometrists Scheme (Rural and Regional Health Australia 2013).
There are also special health-care arrangements for members of the Australian Defence Force and their families, and for war veterans and their dependants (AIHW 2012).
Private health insurance is not compulsory, and people who opt to buy private health insurance can mix and match the levels and type of cover to suit their individual circumstances. Private patients have more control in choosing their treating doctor in hospital and may be able to reduce their waiting time for elective surgery by having treatment in a private hospital (Private Healthcare Australia 2013).
A person can choose to be treated as a public patient in a public hospital, even if they have private health insurance. Overall coordination of the public health system is the responsibility of all Australian health ministers, that is, the Commonwealth and state and territory ministers. The health ministers are collectively referred to as the Standing Council on Health, which has a supplementary coordination role. The Standing Council comes under the auspices of the Council of Australian Governments (COAG), which is the peak intergovernmental forum in Australia (AHMAC 2013). The Standing Council's major focus is on achieving 'a better health service and a more sustainable health system for Australia', and on closing the gap between Indigenous and non-Indigenous Australians (AHMAC 2013). The Standing Council is supported by the Australian Health Ministers' Advisory Council, which is a committee of the heads of health authorities from the Australian Government and the states and territories (AHMAC 2013).
State and territory governments license or register private hospitals, and each state and territory has legislation relevant to the operation of public hospitals.
The Australian Government's regulatory roles include overseeing the safety and quality of pharmaceutical and therapeutic goods and appliances, managing international quarantine arrangements, ensuring an adequate and safe supply of blood products, and regulating the private health insurance industry (AIHW 2010). A National Registration and Accreditation Scheme (NRAS) for health practitioners started on 1 July 2010. Due to limitations in primary health care information in Australia, there is currently insufficient information to fully describe who needs primary health care services, what care they receive (including where they receive it, for what reason and from whom), and the outcome. The implications of these limitations, and opportunities to improve information, are covered in detail in the Chapter 8 article 'Primary health care in Australia'.
This lack of data is in contrast to the comprehensive information available on Australian hospitals, including that published in the AIHW's annual Australian hospital statistics group of products. Currently it is not easy to profile 'patient journeys' as they progress through and receive services from different parts of the health system.
Data linkage techniques, carried out under stringent conditions to protect privacy, allow data to be analysed at the person level rather than the service level. Individual aspects of the health system are discussed in more detail throughout this report.
More information on health reform, health practitioner registration and Australian Government health policies is available from the Department of Health website. More information on intergovernmental arrangements and agreements is available at the COAG agreements webpage. There are 4 broad areas of health spending: hospitals, primary health care, other recurrent expenditure, and capital expenditure. Includes general practitioner and vocational registrar services, practice nurses, enhanced primary care services and other unreferred attendances. Includes recurrent expenditure not paid for directly by hospitals but that was not delivered in the primary health care sector, such as all medical services except general practitioner and vocational registrar services, practice nurses, enhanced primary care services and other unreferred attendances.
The distribution of funding by the Australian Government, state and territory governments and the non-government sector varies depending on the area of health expenditure (Figure 2.5). Primary health care services received $50.6 billion in funding, slightly less than hospital services. The state and territory governments provided close to two-thirds (65.1%) of the funding for capital expenditure. This equated to $7,995 per Indigenous person, which was around 1.5 times the $5,437 spent per non-Indigenous Australian in the same year. In 2010-11, publicly provided services such as public hospital and community health services were the highest expenditure areas for the Indigenous population. For health services that have a greater proportion of the costs funded through out-of-pocket payments, such as pharmaceuticals and dental services, Indigenous expenditure is generally lower relative to the non-Indigenous population.
A significant proportion of Aboriginal and Torres Strait Islander people live in Remote and Very remote areas and this has an effect on the cost of delivering goods and services.
Despite total expenditure growing faster than the broader economy, the main funders of health have not necessarily been spending a higher proportion of their incomes or revenues on health. The GFC slowed government revenues without having an immediate impact on health expenditure. Many studies have been conducted into the drivers of health expenditure over the past decade. On the surface this suggests that as a population ages, the number of people in the age groups where the most expenditure occurs will increase and, therefore, demand for health expenditure will increase (see Chapter 6 'Ageing and the health system'). The relationship between ageing and demand for health services is complex, however, and the extent to which current and projected growth in health expenditure can be attributed to population ageing is the subject of much debate. Much of the growth in health expenditure can be attributed to non-demographic factors such as the development of new technologies, pharmaceuticals and diagnostic and treatment techniques-these enable a wider range of health conditions to be managed more effectively.
The effect of population ageing on demand (and costs) for health services may also be mitigated by the fact that although lifetime health costs are concentrated in the last few years of life, as healthy life expectancy increases, end of life health costs are postponed (Calver et al.

The state of the broader economy plays an important role in determining health expenditure. Another important and related factor in determining health expenditure is the efficiency of the health system, which is heavily influenced by government policies.
The AIHW's definition of health expenditure closely follows the definitions and concepts provided by the OECD's System of Health Accounts framework (OECD 2000). Total health expenditure excludes some sources of expenditure, including Australian Defence Force expenditure, some local government expenditure and some non-government organisation expenditure.
There is a lack of comprehensive welfare expenditure information in Australia, which limits the degree to which comparisons and links can be made to this and other sectors.
There is a lack of health outcome measures that can be linked with health expenditure to assess the effectiveness of Australia's health care system.
A particularly important gap in the available data is estimates of how much money is spent on particular diseases, with the most recent estimates being from 2008-09. Disease expenditure information, while useful in its own right, does not necessarily give an indication of the loss of health due to that disease, the priority for intervention, or the need for additional expenditure. Health expenditure Australia 2011-12 (AIHW 2013a) contains detailed information and analyses of health expenditure and funding in Australia.
Expenditure on health for Aboriginal and Torres Strait Islander people 2010-11 (AIHW 2013b) provides estimates on health expenditure for Aboriginal and Torres Strait Islander people.
Expenditure on health for Aboriginal and Torres Strait Islander people: an analysis by remoteness and disease (AIHW 2013c) complements the preceding report and provides disaggregated expenditure estimates at the regional level as well as for specific disease and injury groups.
This publication provides the most recent estimates of disease expenditure in Australia (2008-09).
Health practitioners include medical practitioners, nurses and midwives, and allied health professionals such as medical practitioners, psychologists and optometrists. Nurses and midwives are the largest group in the health workforce, with 290,144 nurses and midwives employed in 2012 (Table 2.1).
Full-time equivalent number is based on a 38-hour week except for medical practitioners where it is based on a 40-hour week.
The number of nurses and midwives and dental practitioners has increased significantly in the last few years. More broadly, between the 2006 and 2011 Australian Bureau of Statistics Censuses, the number of people employed in the health care and social assistance industry increased from 956,150 to 1,167,633 (22.1%). Based on the Australian and New Zealand Standard Industrial Classification (ANZSIC) 2006, Revision 1 released in 2008.
Australia has a similar number of practising medical practitioners per capita as the OECD average and a higher per capita number of practising nurses (Figure 2.11). The concentration of health professionals in Major cities is greater than that for the broader population (Figure 2.12). The exception is Aboriginal and Torres Strait Islander health practitioners, where the full-time equivalent rate of employed practitioners is greatest in Remote and Very remote areas. Note: Data include not only those providing direct care to patients, but also those working in the health sector as managers, educators, researchers. The data presented here do not account for the demand for health care or consider changes in the productivity of the workforce. In addition to the training and education of the groups mentioned above, it is very important that all those with specific responsibilities in chemical emergency response should receive joint theoretical and practical training in the use and implementation of jointly agreed national and international emergency response plans.
Training should include communications exercises, small-scale (hospital and emergency service) response exercises, and full-scale simulations involving industry, health professionals, emergency services, and others with responsibilities in this area such as civil defence services and military authorities. The medical aspects of on-site as well as off-site emergency response plans should be tested under simulated conditions.
Following each exercise, a full evaluation and critique should be made and the findings circulated to all the parties concerned. Training in the implementation of plans should be scheduled regularly in order to allow well trained response teams to maintain their effectiveness at all times. Public authorities at all levels could provide training and course materials, including audiovisual materials, to trainers in order to facilitate their work. Industry should take a leading role in implementing joint training and exercises, and could provide resources for these activities. First responders to a chemical accident need to know right away the chemical(s) involved, the associated hazards, and first aid measures.
In some countries, Material Safety Data Sheets (MSDSs) containing basic information are legally required to accompany each product supplied to an end-user. MSDSs have existed for many years in a wide variety of formats, with a broad range of data quality and quantity.
The TREMCARD is written using internationally agreed, standard sentences with approved translations. When accidents occur on-site at production facilities, adequate information and technical expertise are generally readily available. A focal point of most information systems for hazardous substances is the globally recognised United Nations Substance Identification Number, together with the United Nations Hazard Classification. Star JonesLeave it to TV Personality Star Jones to craft the ideal accessory for a cooking challenge—an apron!
Employees have been directed to augment these kits with the personal supplies which will be necessary to sustain a prolonged emergency work period. Southland recognizes the importance of being properly prepared in the unfortunate event of a natural disaster.
The City of Los Alamitos continues to make emergency preparedness a priority and implores community members to take an active role in their own preparedness. Community members are encouraged to join these efforts by creating their own emergency supply kit. It can perhaps be best described as a 'web': a web of services, providers, recipients and organisational structures. Governance, coordination and regulation of Australia's health services is a big job, and is the joint responsibility of all levels of government, with the planning and delivery of services being shared between government and non-government sectors.
Personal incomes, broader economic trends and new technologies also affect spending on health. A 'healthy' health system, therefore, is fundamental to our national - and personal - wellbeing and prosperity.
The GP may refer them to a specialist or a public hospital, order diagnostic testing, write them a prescription or pursue other treatment options. Health providers include medical practitioners, nurses, allied and other health professionals, hospitals, clinics and government and non-government agencies.
Private sector health service providers include private hospitals, medical practices and pharmacies. Figure 2.1 provides an 'at a glance' picture of the main services, funding responsibilities and providers. The middle ring indicates the relative expenditure on each service in the sector (shown by the size of each segment) and who is responsible for delivering the service (shown by the colour code).
In the case of the hospital sector, this includes all services provided by public and private hospitals.
These interactions can range from conducting simple over-the- counter transactions at a pharmacy to seeking treatment for complex and sometimes chronic illnesses. A person does not routinely need a referral for this level of care, which includes services provided by general medical and dental practitioners, nurses, Indigenous health workers, pharmacists and other allied health professionals such as physiotherapists, dietitians and chiropractors.
It is part of a larger system involving other services and sectors, and so can be considered as the gateway to the wider health system.
It includes services provided by hospitals and specialist medical practices (see Chapter 8 'Primary health care in Australia'). They provide care for patients who have an urgent need for medical or surgical care, and in some cases also provide care for patients returning for further care, or patients waiting to be admitted. Medicare Locals were created as local organisations, to coordinate and deliver services to meet particular local needs (Australian Government 2013). LHNs are small groups of local hospitals, or an individual hospital, linking services within a region or through specialist networks across a state or territory.
An e-health record allows patients and their doctors, hospitals and other health-care providers to view and share the patient's health information, if the person has given prior consent.
Telehealth technology can improve access to services for people living in regional, rural and remote areas. A United States study (Fox & Duggan 2013) found that 69% of United States adults monitored a health indicator such as weight, diet or exercise, and that 20% used technology such as mobile phone applications or websites to do so. Medicare was introduced in 1984 to provide free or subsidised treatment by health professionals such as doctors, specialists and optometrists (Department of Human Services 2013b).
The major elements of Medicare include free treatment for public patients in public hospitals, the payment of benefits or rebates for professional health services listed on the Medicare Benefits Schedule, and subsidisation of the costs of a wide range of prescription medicines under the Pharmaceutical Benefits Scheme (Department of Human Services 2013b).
The schemes are supplemented by social welfare arrangements, such as smaller out-of-pocket costs and more generous safety nets for those who receive certain income-support payments (AIHW 2012). Practitioners are not required to adhere to the schedule (except for optometry) and can charge more than the scheduled fee. If the doctor bills Medicare directly (bulk-billing), the patient will not have to pay anything (PHIO 2013). Under the PBS, Australians pay only part of the cost of most prescription medicines bought at pharmacies. Non-PBS medicines are not subsidised by the Australian Government (Department of Health 2013b).
The goal is to reduce key risk factors for chronic disease in the Indigenous community (such as smoking), improve chronic disease management and follow-up, and increase the capacity of the primary care workforce to deliver effective care to Indigenous Australians with chronic diseases (Department of Health 2013a). Part of the cost of being admitted as a private patient is also covered by the Australian Government through the MBS and PBS.
Private insurance also offers cover for some or all of the costs of a range of other items or services not covered by Medicare, such as ambulance services, dental services, prescription glasses, and physiotherapy (Department of Health 2013e). Managing the individual Commonwealth, and state and territory health systems is the responsibility of the relevant health minister and health department in each jurisdiction. Membership of the council also includes the Commonwealth Minister for Veterans' Affairs and the New Zealand Health Minister (AHMAC 2013).
State and territory governments are also largely responsible for health-relevant industry regulations such as for the sale and supply of alcohol and tobacco products (AIHW 2010).
Such information could be very useful in providing insights into the overall effectiveness and efficiency of our health system. To date, there have been some useful data linkage projects that examine specific issues (for example, the movement between hospitals and residential aged care facilities described in Chapter 6).
Review and evaluation of Australian information about primary health care: a focus on general practice. A national health and hospitals network for Australia's future-delivering better health and better hospitals. Health expenditure data includes health expenditure by governments as well as individuals and other non-government sources such as private health insurers. Using the Organisation for Economic Co-operation and Development's (OECD) methods, in 2011-12, Australia's health expenditure to GDP ratio was slightly above average compared with other OECD countries (Figure 2.3).
Primary health care includes a range of front-line health services delivered in the community, such as GP services, dental services, other health practitioner services (for example, physiotherapists, optometrists), and all community and public health initiatives. The category 'other recurrent' includes areas of recurrent spending that were not paid for by hospitals but that were not delivered through the primary health care sector, such as medical services other than those provided by general practitioners, medical research, health aids and appliances, patient transport services and health administration. For example, the average per person expenditure on public hospital services for Indigenous Australians ($3,631) was more than double that for non-Indigenous Australians ($1,683). For example, the average per person expenditure on dental services was $149 for Indigenous Australians, compared with $355 for non-Indigenous Australians. Decisions about where and when money is spent on health often involve interactions between multiple bodies, including funders, providers and consumers.
Governments have remained the dominant source of funding for health in Australia, with the Australian Government continuing to provide the majority of health funding. Prior to the global financial crisis (GFC), which had its beginnings in 2007-08, the ratio of all government health expenditure to taxation revenue was relatively stable at around 20% (Figure 2.9).
And in any case, over the past 25 years health expenditure in Australia has risen at a faster rate than either population growth or ageing.

As shown earlier in this article, analysis of AIHW health expenditure data and international experience since the GFC suggests that while health expenditure has grown faster than the broader economy, it has tended to keep pace with growth in the revenue of governments, the key funders of health in Australia (Figure 2.9). In 2010, the OECD argued that life expectancy across OECD countries could be increased by 2 years if all countries had health systems as efficient as the most efficient systems across the OECD countries. For example, over-the-counter pharmaceuticals spending in Australia currently has no systemised data collection. Not all health expenditure can be readily allocated to disease or injury groups-in 2008-09, the figure was around 30% of recurrent health expenditure. Expenditure on health for Aboriginal and Torres Strait Islander people 2010-11: an analysis by remoteness and disease. In-patient hospital use in the last years of life: a Western Australian population-based study. The number of full-time equivalent nurses and midwives employed for every 100,000 people is almost 3 times that of the next largest profession, medical practitioners. For example, the number of full-time equivalent medical practitioners employed rose by 16% from 2008 to 2012 and the number of nurses and midwives rose by 7% (see Chapter 9 'Indicators of Australia's health'). International comparisons are affected by different regional distributions, scopes of practice and by different hours worked in the various countries. In the future, longitudinal data from the National Registration and Accreditation Scheme, introduced in 2010, may enable a better understanding of the movement of different types of health professionals between work areas and geographical areas.
This will enable them to practise their skills, and to become familiar with taking part in a broad co-operative effort to respond to a chemical accident. Unannounced tests of the total plan or relevant parts of the plan should be carried out, even under adverse conditions.
Much basic information on chemical hazards can generally be found on safety data sheets and transport emergency cards.
Chemical releases within installations may be readily recognised and identified from the chemicals used and processes employed at the installation, unless they are products of chemical reactions or of thermal decomposition. MSDSs are intended primarily for the employers of people handling the product, so that they in turn may disseminate the information to their employees. The IPCS and the European Community produce such cards (ICSCs, or International Chemical Safety Cards). When used together with additional information, such as that setting out first aid measures, MSDSs are a valuable source of general information for follow-up procedures beyond the initial action level. Within the European Community, regulations require that written emergency instructions be carried in the vehicle cab. At storage facilities or reprocessing plants, however, information may be restricted to product labels, supported by additional information such as data sheets. Through the distribution of these kits, employees were compelled to renew their commitment to Disaster Service in the community.
The credit union has dedicated significant resources developing our internal disaster preparedness plan, so we welcomed the opportunity to help the city enhance their emergency response plan by funding these Go Kits for city employees,” said Matthew Herrick, Vice President of Sales and Marketing.
Even though city staff will respond following a major disaster, it is likely that city resources will be quickly depleted. For more ideas about assembling a kit of for other disaster planning suggestions, visit cityoflosalamitos.org. The amount was around 1.7 times as high as in 2001-02, with health expenditure growing faster than population growth. But patient and clinical care are just 2 components of a much broader and complex network that involves multiple providers working in numerous settings, supported by a variety of legislative, regulatory and funding arrangements. Further, a good health system 'delivers quality services to all people, when and where they need them'. These providers deliver a plethora of services across many levels, from public health and preventive services in the community, to primary health care, emergency health services, hospital-based treatment, and rehabilitation and palliative care.
The Australian Government and state and territory governments fund and deliver a range of other health services, including population health programs, community health services, health and medical research, Aboriginal and Torres Strait Islander health services, mental health services, and health infrastructure (see Chapter 8). Health funding and the composition of the workforce are covered in detail in a separate article and snapshot in this chapter, but an overview is provided here to outline the main elements of Australia's health system. The outer ring indicates the relative size of the funding (shown by the size of each segment) and the funding source for the difference services (shown by the colour code). Primary health care includes a range of front-line health services delivered in the community, such as by a GP, physiotherapy and optometry services, dental services and all community and public health initiatives. Public sector provision is the responsibility of state and territory governments for public hospitals, and a mixture of Australian Government and state, territory and local governments for community and public health services. And while some of us have more interactions with health practitioners than others, even people who rarely visit a doctor or who have never been admitted to hospital are exposed to elements of the health system almost daily, including through health promotion messages or community health campaigns in the media. Through assessment and referral, individuals are directed from one primary care service to another, and from primary services into secondary and other health services, and back again (AIHW 2008). On 13 May 2014 the Australian Government announced that the 61 Medicare Locals would be replaced with a smaller number of Primary Health Networks, to be operational from 1 July 2015.
Responsibility for hospital management is devolved to LHNs, to 'increase local autonomy and flexibility so that services are more responsive to local needs' (Australian Government 2010).
This information can include a summary of medications, hospital discharge records, allergies and immunisations (Department of Health 2013f). Patients who previously had to travel to the nearest major city to see a specialist can instead use video-conferencing, which might be offered at their local GP or another local health-care venue (DoHA 2012). Digital platforms such as these can incorporate functions such as sensing and geospatial tracking to provide tailored feedback and enhance the ability for accurate assessment (Norman et al. In these instances the patient is required to pay the extra amount, often called a 'gap' payment (ABS 2013; Queensland Government 2013). However, pharmaceuticals provided in public hospitals are generally provided to public patients for free, with the cost covered by state and territory governments.
Voluntary and community organisations and agencies also make important contributions, including raising money for research, running educational and health promotion programs, and coordinating voluntary care. At present, relevant data are derived from different sources-notably primary care data from the Australian Government and data on hospitalisations from the states and territories-and is not identified at the patient level in a uniform way. However, there is untapped capacity to use data linkage to look at complex population-level health issues by examining what happens to people as they move through the health system, as suggested above. The providers of health goods and services include hospitals, primary health care providers such as general practitioners (GPs), and other health professionals. Australia's position within the OECD has not changed significantly over recent years as the ratio for other countries has also increased. Hospital expenditure includes all spending incurred by hospitals and excludes expenditure on hospital-based services where the hospital did not directly incur the costs.
The share of funding provided by the Australian Government has declined, however, and so has the share provided by non-government sources, which includes individual out-of-pocket expenditure. Most of this funding was also sourced from individuals through private health insurance premiums. That suggests that, in broad terms, government revenues were increasing at the same rate as health expenditure. The ratio has decreased slightly since 2009-10 as growth in government tax revenues has increased again. This is largely due to the fact that health care expenditure is generally higher in the older age groups. This in turn suggests that health expenditure tends to correlate with increased revenue more strongly than increased demand for health services.
This included capital expenditure, expenditure on non-admitted patients, over-the-counter pharmaceuticals, patient transport services, aids and appliances, administration, most community and public health services, and other health practitioner services.
Further information on health expenditure can also be found in the online data tables and cubes. In 2012, there were 1,124 full-time equivalent nurses and midwives employed for every 100,000 people. In part this reflects an increase in the availability of training places for people studying in the relevant fields. It is of great importance that those with responsibilities in the event of a chemical accident are personally acquainted, and that they are used to working effectively with one another. Lessons learned from the evaluation of exercises, and from the investigation of actual accidents or near-misses, should also be included. Often the information most immediately available on hazards is found on labels and placards, the focal point of which is the United Nations Substance Identification Number and United Nations Hazard Classification. Concerning chemical releases from transport accidents, the necessary information should be made available by the responsible personnel (either owners or operators of the transport vehicle), or it should be obvious from shipping documents, safety data sheets, or placards and symbols on containers. MSDSs are not necessarily intended for emergency responders, but they can be used by scientific staff to advise the emergency responders.
Before they can be utilised fully by response teams, however, they may require expert interpretation. The European Chemical Industry Council (CEFIC) has produced a series of instructions called TREMCARDS. The transport of chemicals presents situations with perhaps the greatest accident potential and greatest difficulties in accident response. Community members can prepare for this by planning to be self-sufficient for at least a few days following the event. Rather, the two are intertwined, and our nation's spending on health services reflects this. Their needs and expectations are shaped by many factors, including the nature and extent of their health status, as well as factors such as age, gender, where they live and their cultural background.
Primary Health Networks are expected to align more closely with state and territory health network arrangements, and reduce duplication of effort. For example, pharmaceuticals paid for by hospitals are included but pharmaceuticals purchased by patients directly from hospital-based pharmacies are excluded.
While the ratio of expenditure to GDP was increasing, the ratio to government revenues was relatively stable. In 2008-09, expenditure in Australia on adults aged 85 and over was almost 20 times as high per person as expenditure on children aged 5 to 14 (Figure 2.10).
Some have cautioned, however, that over time an ageing population (perhaps with higher levels of chronic disease) with high expectations of access to new health technologies and quality services, will increase and compound the independent effect of population ageing on health system costs (Goss 2008; Productivity Commission 2005, 2013).
While Australia was identified as having one of the more efficient health systems, the OECD still suggested that life expectancies in Australia could be improved through improved health system efficiency (OECD 2010).
There were 374 medical practitioners and, in other examples, 85 psychologists and 15 podiatrists. For example, the number of domestic commencements in medicine increased between 2007 and 2012 by 18.6% (DoHA 2012, 2013). In addition, to provide rapid initial information on chemical hazards and appropriate response actions, some countries have adopted a hazard grouping system. Nevertheless, for various reasons first responders may have great difficulty identifying the substances released and, in fact, may not even recognise the hazards unless there is a sensory cue such as a strong, pungent odour or eye and skin irritation. There are currently approximately 800 of these cards covering chemical substances, grouped substances having similar properties, and mixed loads of packaged goods.
Lack of information concerning the chemical(s) involved, and problems in rapidly locating experts familiar with them, can exacerbate these difficulties. One Source where someone can learn valuable skills to help yourself and your community following a disaster is CERT (Community Emergency Response Team). Similarly, some medical services are provided by specialists in hospitals but these services are not paid for by the hospital as they may be covered by the Medicare Benefits Scheme or some other arrangement.
For every 1,000 people employed in Australia (ABS 2014), there were 35 medical practitioners and nurses and midwives employed in 2008.
It is important to note that these examples are not exhaustive, and each group of services consists of many types of activities. Madame Paulette is located at 1255 Second Avenue in New York City.

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    Person per day, and don't.
  2. KATANCHIK38 writes:
    Earthquake Safety Rules Unlike hurricanes every particular person more fat it consists. Cool, the lids.