An exploration of the Australian Healthcare system
Written by Shukti Sarma
In 2013, Bloomberg announced in a worldwide poll that Australia has the best healthcare system overall. Talking about the poll, Alison Verhoeven, Chief Executive, Australian Healthcare and Hospitals Association (AHHA), said, “Australia’s healthcare investment as a percentage of GDP sits at approximately 8.9% per capita. With life expectancy of 81.8 years, Australia is on a par with other high performing countries in this ranking, showing that our investment in a universal healthcare system is a winning model.”
No mean feat, that. But as we know, nothing is perfect. The report later also identified some major problems that Australia is facing regarding healthcare- an ageing population, increasing levels of chronic disease and escalating health care costs. However, one factor which is rarely discussed is the politics of healthcare.
Government representatives are saying that the healthcare system is going to get a complete overhaul. But what does that mean for the patients?
Penny wise and Australian dollar foolish?
In Australia, the federal government pays a large percentage of the cost of services in public hospitals. And this depends on whether the government chooses to subsidise the costs. The government subsidises treatment and insurance costs via the Medicare scheme. Now, with the economy still reeling from recession, healthcare costs have escalated, and with rising levels of chronic diseases in the country, the government is looking at cutting costs.
And cost cutting in healthcare or other such public services never go down well.
Take the latest controversy about medical payments, for example. There is a proposal waiting for thr government according to which, the government will make a co-payment of $6 for each of the first 12 bulk billed visits to a GP each year. This is a highly problematic viewpoint, suggested by suggested by Terry Barnes, a former health adviser to Tony Abbott, in a submission to the high-powered National Commission of Audit. A report for the Australian Centre for Health Research think-tank says that if implemented, the scheme will save the Government $750 million over four years and act as a deterrent for those seeing doctors unnecessarily.
There is of course, the question of long term impact of diseases and follow up treatments- which are not ‘unnecessary’. Also, it comes across as a short term solution, and many health experts say that this could lead to a bigger fallout and land up the government with a huge bill over long term.
The benefits of a universal healthcare system, sponsored by the state, are well known. But a fully state-sponsored system is entirely dependent on the government; and like every other thing, a government is subject to human faults and weaknesses.
In her 2006 book about the (lack of) healthcare in USA, “Solving the Health Care Problem. How Other Nations Succeeded and Why the United States Has Not”, author Pamela Behan documented the evolution of Australia’s healthcare system. Since the Second World War, the country has seen a cycle of building and dismantling the health insurance system. The author concludes that Australia’s healthcare system is made possible by the political polarization of the society, and the presence (and success) of the Australian Labour Party.
No wonder, healthcare promises play a big role in Australian politics and have a major influence on votes. The Liberal Party has been widely criticized for its willingness to cut healthcare subsidies, and many studies show that there is a significant difference in health status between the aborigines and the non-aborigines. The Labour Party, on the other hand, is promising insurance for the disabled, dental healthcare coverage and mental health.
Needless to say, when two sharply contrasting ideologies fight and one inevitably emerges on top, the system is bound to undergo a change. And whichever way it may play out, a system lacking in consistency does not stand to benefit the patients.
Prescription for wellness
While costs will always remain a contentious issue, what the policymakers should take into account is Australia’s demographic shift. With an ageing population, there will be need for universal healthcare, but it also should be cost effective.
There is also the matter of private investors in healthcare. Public and private bodies endeavours must go hand in hand, and private funding/participation is a must if the government wants to cut some costs. However, this will require effective regulation and some minimum standards to be met for service providers.
Reforms are definitely needed, and the government should take a long term view of the situation. And the solution cannot be arrived at without taking the patients into account.
How healthcare can safeguard itself against cyberthreats
One of the most fundamental lessons from the COVID crisis is that health should always be a priority. In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.
The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics.
From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world.
The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years.
This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate.
Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.
To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care.
Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change.
It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device.
These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.
Despite this, there are fundamentals that any organisation should implement:
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.
In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.
Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents.
Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.
This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents.
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.
Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.
As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.
Fighting future threats
With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.
To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced.
This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.