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Pennsylvania is home to more than 12.6 million people making it the sixth most populous state in the U.S (kff.org, 2016). In the Northeast, it is the second most populous state after New York. Much of Pennsylvania is rural, but the majority of the population live in metropolitan areas. There are 67 counties in the state (kff.org, 2016). The majority of the state’s population (87%) lives in metropolitan areas, and four counties (Philadelphia, Allegheny, Montgomery and Bucks) accounting for one-third of the state’s population (kff.org, 2016). Additionally, 52 of the state’s 67 counties are within the Appalachian region, accounting for almost half of the population (45%) (kff.org, 2016).For the State of Pennsylvania, the Kaiser Family Foundation Website statistics deemed less than one in ten (8%) of all Pennsylvanians were left uninsured as of 2014 (kff.org 2016)

Health Insurance Coverage of the Total Population in Pennsylvania, 2014In the Commonwealth Fund rankings of state health system performance, Pennsylvania dropped from 14th to 20th between 2009 and 2015 (commonwealthfund.org, 2015). For Adults ages 19-64 the uninsured state rate is 12% (commonwealthfund.org, 2015). For Children ages 0-18 the uninsured states rate is 5%, both currently ranked 13th (commonwealthfund.org, 2015). b. Social and demographic population patterns in Pennsylvania, including race/ethnicity, citizenship status and age distribution, are less diverse than other states in the Northeast and the United States overall.

Individuals who remained uninsured in 2014 were primarily low-income, in working families, and White non-Hispanic. Most elderly Pennsylvanians are covered by Medicare, most uninsured are nonelderly (under age 65). The Majority of nonelderly uninsured Pennsylvanians in 2014 had at least one full-time worker in their household (72%) and had income below 400% of the FPL (88%). Two-thirds (66%) of nonelderly uninsured Pennsylvanians identified as White, 16% identified as Black, 14% identified as Hispanic (Kff.org, 2015). 

Australia’s healthcare system is called Medicare which was introduced in 1984. Australia was ranked 4th out of 11 in the Commonwealth Fund’s survey on overall health care in 2014, France being 1st and the U.S being last.  Australians can choose to have Medicare only, or a combination of Medicare and private health insurance. Healthcare expenditure represented approximately 9.1% of the Gross Domestic Product, close to the Organization for Economic Co-operation and Development median but much less than that of the U.S. 16.9% (commonwealthfund.org, 2015).  Medicare is a national universal public health insurance for citizens and permanent residents, as well as coverage for those with temporary visas from other countries with reciprocal arrangements such as New Zealand. Australia has a population of about 22.7 million people as compared to the U.S. with 313.9 million people (commonwealthfund.org, 2015). Australia has a federal system of government, with a national (Commonwealth) government and six States and two Territories, creating a complex division of responsibilities and roles across the levels of government.  The Medicare system has three parts: Hospital, Medical and Pharmaceutical. Under the 2011 National Health Reform Agreement, the responsibility of the Australian government is for the funding of public hospitals and funding and governance of primary care (commonwealthfund.org, 2015). Medicare is funded mostly from general tax revenue, including a value-added tax from patient fees, and from a 2% Medicare Tax Levy on taxable income with some exceptions for low income individuals (commonwealtfund.org, 2015). If you earn more than a certain amount, you will pay a Medicare levy surcharge if you do not have private health insurance. The benefits one receives from Medicare are based on a schedule fees set by the Australian Government and are billed as “bulk billing” by the physician to the consumer. Doctors may choose to charge more than the schedule fee, having the patient have more out of pocket costs. Medicare usually pays for 85% of the Medicare schedule fee for out of hospital services other than general practitioner services which are 100% paid for by Medicare. Those who make more or those who prefer to have control over their health buy private health insurance, having the ability to choose which doctor to see, timely scheduling of appointments and choose which hospital to go to if admission is necessary. If you choose to have private insurance, Medicare will pay 75% of the hospital Medical Benefits Schedule (MBS) for the associated medical cost. The remaining 25%, Gap payments, which are hospital accommodations, doctor’s fees, certain procedures, equipment and prosthesis may be covered by your private insurance or left to the individual.

Medicare does not cover dental, physiotherapy, occupational therapy, speech therapy, eye therapy (glasses, contact lens), chiropractic services, podiatry, psychology service, home nursing, ambulance services, examinations for life insurance or hearing aids and other appliances (Privatehealth.gov.au, 2015). Private health insurance continues to grow as the population continues to age. Australians age 65 and older comprise 1.85 million people, representing 52% of the Australian population with Medicare and private insurance.

Ethnic groups in Australia are comprised of Whites (European ancestry) 90%, Asian 7% and Aboriginal and other 3% (Indexmundi.com, 2015). Many Australians consider themselves to be of mixed ancestry. Socioeconomic factors have the largest impact on health, accounting for up to 40% of all influences compared with health behaviors (30%), clinical care (20%) and physical environment (10%) (aihw.gov.au, 2014).  Indigenous Australians experience poorer health outcomes than other non-Indigenous Australians. They have two to three times the burden of disease processes than the general Australian population (aihw.gov.au,2014). The gap in the health of Indigenous versus non-Indigenous Australians is best expressed in life expectancy; 73.7 years for females and 69.1 years for males, as compared to the 83.1 and 79.7 years for non-Indigenous females and males (aihw.gov.au, 2014). The Australian Government in 2014-2015 had spent an estimated $920 million on the provision of health programs specifically for Aboriginal and Torres Strait Islander people, in the next 4 years they plan to invest $3.1 billion closing the gap and achieving health equality between populations by funding chronic disease management; primary health case base funding; child and maternal health services; and Stronger Futures in the Northern Territory, rural and remote areas (Health.gov.au, 2016). Cultural education is an important strategy for reducing the adverse impact on the health of the Indigenous Australians. Cultural education about Indigenous health needs are now being addressed by advocacy groups as well as aid with government funding and evolving policy changes. With Australia’s universal healthcare system there is a window of opportunity to address the knowledge gap and focus on the cultural-specific health beliefs of the Aboriginal and Strait Torres Islander population that influences the over 200 Indigenous groups in Australia.

References:

Kff.org Data Source: Kaiser Family Foundation estimates based on the Census Bureau's March 2015 Current Population Survey (CPS: Annual Social and Economic Supplement). Accessed February 10, 2016. “Total Number of Residents,”http://kff.org/other/state-indicator/total-residents/.

kff.org. The Pennsylvania Health Care Landscape. April 25, 2016. Retrieved from http://kff.org/health-reform/fact-sheet/the-pennsylvania-health-care-landscape/

Commonwealthfund.org Aiming Higher: Scorecard on State Health System Performance, 2014. Retrieved fromhttp:www.commonwealthfund.org/scorecard/state/40/Pennsylvania/

Commonwealthfund.org Health care system and Health Policy in Australia. 2015 Retrieved fromhttp://www.commonwealthfund.org/grants-and-fellowships/fellowships/australian-american-health-policy-fellowship/health-care-system-and-health-policy-in-australia

privatehealth.gov.au What is covered by Medicare? 2015 Retrieved fromwww.privatehealth.gov.au/healthinsurance/whatiscovered/medicare.htm

Indexmundi.com Australia Ethnic Groups June 30, 2015. Retrieved from www.indexmundi.com/australia/ethnic_groups.htm

Aihw.gov.au Are we getting healthier. Australian Institute of Health and Wellfar 2014 Australia’s health 2014. Retrieved fromhttp://aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129547598

Health.gov.au/indigenous. The Department of health January 28 2016. Retrieved from https://www.heath.gov.au/indigenous

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