Country Profile: Australia

Population 20,000,000 (primarily urban)

Form of Government Parliamentary democracy

Economic System Capitalist

Health Care Model National Health Insurance (Medicare)

GDP $890B

% GDP spent on health care 9.7

Per capita income $38,420 (2006, adj US $)

Health care expense per capita $3,528

Health care expense per capita normalized to income of 50K $4,591

Life expectancy (m/f) 79/84 (as of 2006)

Healthy life expectancy (m/f) 71/74

Overview

• Goals: Equity, efficiency, and quality
• Tax funded
• Ready access
• Generally cost-effective, good outcomes
• High level of public support
• Concerns about long-term sustainability due to rising costs
• Disagreements about funding and accountability between national and state governments
• Waiting lists for elective surgery
• Disparities in urban and rural care
• Continuing poor health of indigenous population

Structure

The Australian health care system is a mix of public funding and public and private care. The national government's role is limited to funding and formulating health policy on a population basis. States provide additional funding, provide public hospitals, and have great authority in administration of health policy. Localities are primarily concerned with providing environmental health services. The private sector supplies the majority of general practitioners and specialists, a number of private hospitals, diagnostic services, and supplemental insurance.

Because of the division-of-power structure of Australia's democracy, the national government and the state governments must achieve consensus in matters of health policy. (Australia has six states.) Clinical practice is largely self-regulated, although licensing and accreditation is required of most providers.

Financing
The public-private financing breakdown is two-thirds/one-third, with the national government paying nearly half of health costs, collected through general taxation and a mandatory Medicare levy of 1.5% of personal income. The majority of consumer expense is for uncovered pharmaceuticals.

Delivery

Treatment is largely free and unlimited, although public hospital services are prioritized. Two-thirds of Australia's doctors are general practitioners in private practice; in addition to providing primary and preventive care, these doctors perform minor surgery and serve as referral gatekeepers to the rest of the health care system.

70% of the hospitals that provide secondary and tertiary care are public. Combined with cost pressures, improvements in surgical technique and patient management has reduced the average length of stay in recent years. The chief complaint about Australian secondary care is about lengthy waits for elective surgery, a function of the prioritization of services.

Australia's national and state governments have combined to deliver a robust public health program that has had notable success in reducing coronary disease, the AIDS/HIV infection rate, cigarette smoking, and the mortality rate from traffic accidents. Australians enjoy a high level of immunization vaccination that has reduced the level of infectious disease, although not entirely.

Challenges
As with virtually all developed nations, Australia's health care system faces financial pressure brought about by budget constraints and medical inflation. Health care services in Australia are not well integrated, and debate is ongoing regarding the proper balance of public and private insurance. The health inequalities experienced by indigenous Australians are so protracted and severe that the World Health Organization calls them "intractable."

Overall
Australia has three basic goals for its health-care system: Equity, efficiency, and quality. Progressive taxation protects equity, although there are concerns that a two-tier system could develop. The mixed national-state governance compromises efficiency and also renders reform difficult. In recent years, quality has emphasized measurement of health outcomes, which have improved as reflected in Australia's long life expectancy.

WHO ranking 32 (US 37)

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