There is currently no overarching health authority in Oceana. Whilst there are some regulatory and inspection functions carried out by the Ministry of Health, most administrative functions are left to the discretion of individual hospitals and practices throughout Oceana. Coordination and cooperation between different hospitals and practices is limited, which impacts on the cost of healthcare, due to duplication of services.
The hospital sector can be categorised into four main types:
- Charity hospitals: hospitals that offer reduced prices and/or free treatment to Oceanan citizens on low incomes.
- Private hospitals: hospitals that are run as commercial concerns in a competitive healthcare market.
- Local government hospitals: hospitals run by local government authorities, with variable charges or free treatment at the point of use.
- University teaching hospitals: hospitals owned and run by universities with the aim to provide clinical education to doctors and nurses as well as to provide healthcare.
Hospitals vary considerably in their quality, size, and in their ability to deal with various conditions. An inability to deal with a multiplicity of conditions is not always because the hospital is inadequate; there are some specialist hospitals that focus upon treatment of particular conditions or branches of medicine. The majority of specialist hospitals are psychiatric hospitals such as Briggait Hospital in Glaschu.
Charity and private hospitals tend to be smaller and less financially stable, although this is not always the case, and there are a few incredibly prestigious independent voluntary hospitals. For instance, the Emporium Free Infirmary is a large charity hospital rated highly in all metrics by the Ministry of Health.
There is also considerable regional variation between the types of hospitals available across Oceana; Glaschu City Council has a considerable local government hospital sector, partially due to the circumstances of the Revolution and the policy choices of the OSP-led council, while North-East Marpesia has more charity and private hospitals.
The primary care sector relies largely on the individual general practitioner. This area is currently mostly regulated by the College of General Practitioners, an independent professional body, as well as the more generalist Oceana Medical Association. However, although the CGP tries to provide financial aid, advice and support to GPs and practices, the body simply does not have enough capital to provide the resources that many GPs need. Some GPs, especially in urban areas, pool their resources in order to provide equipment, but overall the primary care sector is badly underfunded and poorly equipped, and most GPs rely on user charges and fees.
As the GP is often the first point of contact for the patient into the medical system, this acts as something of a deterrence to receiving primary care. This can often lead to the need for expensive emergency treatment further down the line, which impacts considerably upon the financial health of the hospital sector.
Public and Preventative CareEdit
Finally, there is the public and preventative care sector, which is primarily a local government concern. This is incredibly variable, with services provided, such as screening, health education, inoculation, etc, generally being better in urban councils such as Glaschu City Council, Clutha City Council and Korken & District Council; this is to an extent due to these cities often having gone under local government reform in the 19th century and beyond, whilst other cities and rural areas have to deal with local government organisation that has changed little since medieval times.
Funding Healthcare ExpenditureEdit
Beyond government subsidy of the hospital service and some of the primary care sector, health expenditure is primarily financed through health insurance. Health insurance in Oceana is regulated by the government, and is usually non-profit and part-financed through employers. There is also a small but expanding trade union health insurance sector since the Revolution as well as an expanding for-profit private sector healthcare insurance market.
These methods of funding healthcare expenditure, however, have the drawback that individuals often need to be employed in order to receive healthcare coverage, and coverage of dependents such as children or partners is not guaranteed. This means there are currently considerable gaps in healthcare coverage.
[source: OCPS/HSS/2, 2012, Overview of Healthcare in Oceana, http://www.scribd.com/doc/113428066/OCPS-HSS-2-Overview-of-Healthcare-In-Oceana]