Australian Politics and Policy - Senior, 2019a

Health policy
Conclusions
Despite inconsistencies, boundary problems and messy funding, Australians
achieve good health outcomes. In an evaluation of the health care arrangements in
11 high-income countries, the Commonwealth Fund gave Australia fourth place –
behind the UK, Switzerland and Sweden. Australia scores well on quality of care,
but comparatively poorly on access. The access problems in Australia relate mainly
to costs and difficulties paying medical bills, particularly relating to co-payments in
private insurance. 25
Many decades of incrementalism have delivered Australia a set of arrangements
which work, but which, by most measures, could work better if the parts could be
brought together as an integrated system, particularly in terms of Commonwealth–
state divisions and in developing more coherent and equitable funding arrangements.
The adjustment of our arrangements from a focus on acute care to one based
on chronic care is ongoing. Also there is still a slow transition from what once was
a labour-intensive set of individual professional practices to a more technologyintensive
service industry model, which will still have to meet community
expectations of high-quality individual care and compassion. Some emerging
technologies, based on genetic manipulation, could have profound effects on our
health care arrangements, as well as opening up new ethical questions.
Theremaybescopeforthosewithmeanstocontributemorefromtheirown
pockets to their own health care. This is a normative question, which needs to be
puttothecommunity.Australiansmayoptformoresharing,ortheymayoptto
pay more from their own pockets.
Whatever the outcome of such deliberations, there will almost certainly be a
need to provide more collective funding for those with high needs or limited means.
If governments are determined to pursue a ‘small government’ policy, they will
probably try to achieve this collective funding through private health insurance,
in spite of its costs and difficulties in achieving community rating, cost control
and administrative efficiency. Otherwise the most equitable and efficient means of
funding growing health care expenditure is through higher taxes.
References
Australian Institute of Health and Welfare (AIHW) (2018a). Australia’s health 2018. Canberra:
AIHW.
—— (2018b) Health expenditure Australia 2016–17. Canberra: AIHW.
—— (2017a). Health-adjusted life expectancy in Australia: expected years lived in full health 2011.
Canberra: AIHW.
—— (2017b). Trends in cardiovascular deaths. Bulletin 141. Canberra: AIHW.
25 Davis et al. 2014.
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