Australian Politics and Policy - Senior, 2019a

Health policy
Figure 2 Medicare services per capita by age group, 2011–12. Source: data from
Department of Health 2019, Medicare statistics 2011–12.
government-owned public hospitals, governments are involved in delivering health
care. It is notable that what passes for public debate on health care often confuses
governments’ roles in funding and providing health care.
There are two broad principles driving government involvement. First, people
seek some mechanism to share their outlays for health care through insurance,
public or private. And second, there are reasons why there would be socially and
economically unacceptable outcomes if health care were left to private markets.
Community-rated health insurance
In times long past, those who could not afford health care went without, or
depended on the meagre offerings of charities. Colonial governments financed
services to provide care ‘for the hospital care or indigent class of the community’,
but such services provided in public hospitals were basic. 9 Also medical practitioners
would see it as a noblesse oblige (the paternalistic idea that those with
means had an unwritten obligation to help the less fortunate) to provide care for
the poor.
There has been a slow transition in health care from a ‘charity’ model, whereby
the poor or those with high needs had to rely on religious or similar charitable
institutions, to one of community sharing, whereby through contributions to
insurance-type arrangements, or through taxes, communities share all or part of
their health care expenses. The first mutual benefit societies developed in New
South Wales in the 1830s, but they covered only a minority of the population. It
9 Sax 1984, 25.
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