Australia’s Universal Health Care System
Paige Getman, Jack Wagner, Hannah Witt
University of Minnesota Duluth
Australia
Table of Contents
Introduction ……………………………………………………………………………………… 3
Historical Background …………………………………………………………………………... 3
Culture and Social Views on Health Care ………………………………………………………. 4
Economic Conditions ……………………………………………………………………………. 7
Demographic and Health Information ……………………………………………………………8
Financing, Organization, and Management of Health System ………………………………….10
Health Care Issues, Reforms, and Features ……………………………………………………..18
Conclusion ………………………………………………………………………………………21
References………………………………………………………………………………………..22
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Australia
Introduction
Australia is a country known specifically for its famous Sydney Opera House, the Great
Barrier Reef, kangaroos, and koalas, but one thing that Australia is not commonly known for is
its astounding health care system. From its national public health insurance that covers all
citizens and permanent residents, to its high performance in regard to health services and health
outcomes, Australia runs a health care system much like other developed countries. However,
there are a few things that differentiate Australia and its health system from other countries with
similar universal health systems. This paper will discuss the factors that have allowed Australia
to form and maintain its strong health care system, which will include Australia’s historical
health care background, the cultural and social background and views, the country’s economic
conditions, its demographics, the ways it finances a universal health care system, and some of the
current and past issues Australia’s health system has faced.
Historical Background
The health care system in Australia has developed immensely over the past half-century.
Currently, Australians access health care through Australia’s Medicare system, but it was not
always like this. Before Medicare, Australia operated under a health care system called
Medibank, which was funded by general revenue and provided “free treatment for public patients
in public hospitals, and subsidies to private hospitals to enable them to reduce their fees”
(Parliament of Australia, 2004). Medibank was the first legitimate attempt at extending health
care coverage to more of the Australian population, because before Medibank was created and
adopted in 1975, publicly funded health care was almost nonexistent. To add to the tension of
making a new health care system work, elections were taking place that affected health policy
and the overall governance of the health system. Under the newly elected officials in the
Australian government, Medibank ended up being a relatively short-lived system as it dissolved
in 1981 and converted into a private insurance company (Parliament of Australia, 2004).
Medibank was similar to the Medicare system that was soon adopted in 1984 and that is still
functioning as Australia’s health care system today.
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Australia
In terms of Australia’s global ranking, its health care system is ranked very high in
comparison with other developed countries because of the overall growth in life expectancy, the
fall of infant mortality rates, and the fall of death rates (Healthcare Information Network, 2016).
Also, Australia’s national public health insurance system allows the Australian population to
have access to a variety of public medical facilities at no cost. However, the Australian Medicare
system has its flaws and weaknesses as well. One of the major burdens to Australia’s health care
system is the role of politics and the inability of political parties to come to an agreement on how
the health system should be run. Being that Australia operates under a federalist government,
where the federal, state, and local governments work together to make decisions, the role of
Australia’s government in deciding health care regulations and policy has still left many to pay
high out-of-pocket costs for health services that are not covered by Medicare. From a historical
standpoint, the role of politics in Australia’s health care system has been a burden since the
beginning of Medicare, and even during the Medibank era. Luckily for Australia, the flaws in its
health care system do not seem to outweigh the positive features and services it provides to the
public, making it presumably one of the best healthcare systems in the world.
Cultural and Social Views on Health Care
Cultural Views
Culture is defined as “ the values, customs, social structures, beliefs, and patterns of
human activity and the symbolic structures that provide meaning and significance to human
behavior (Ausmed, 2019).” It is influenced by political and economic conditions, which can vary
between age, gender, class, education, and personality. In Australia, it is key in the healthcare
system to adapt practices to address the wants and expectations of patients. Australia is one of
the most diverse nations, with only two thirds of the population born there. There are over 300
different identified languages spoken. With any cultural view on health care, professionals are
advised to avoid making assumptions towards patients. Although most Australians have access
to a high standard of care, people of a non-English speaking background are more likely to
experience medication error, misdiagnosis, incorrect treatment, poorer pain management, and
poorer outcomes in general. To fix this issue, Australian health services have been expected to
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adapt as far as possible in cultural competence. Cultural competence is defined as a, “congruent
set of behaviors, attitudes, and policies that come together in a system, agency, or among
professionals and enables them to work efficiently in cross-cultural settings (Bainbridge et al.,
2015).”
Recently, there have been studies that found to bring together the cultures of health care
organizations with indigenous communities, such as Australia, that can improve access to health
care. A process that would work would be to consult with Indigenous Australian health services
and communities, then tailor service delivery to the needs and preferences of specific
communities, and then embed cultural competence within the health care organizational culture,
governance, policies, and programs (Ausmed, 2019).
According to the Medical Board of Australia, “culturally safe and sensitive practice is
defined as good medical practice guided efforts to understand and meet the cultural needs and
contexts of different patients to obtain good health outcomes.” This practice requires knowledge,
respect, and sensitivity towards cultural needs of patients, acknowledging and understanding
social, economic, cultural, and behavioral factors of the community, and understanding that
culture and beliefs can influence interactions with patients (Ausmed, 2019).
Social Views
Social context can be mixed into cultural context. The social status of a patient can
determine the health care delivered. The status can also help a health care figure out what roles
of social determinants may play in their health. Social context in health care is described to be
specific circumstances or environment that serves a social framework for individual or
interpersonal behavior. It often influences actions and feelings of a community. Social context
matters in health care due to the impact it has on delivery of care and the way it changes the
nature of the system. Also, the way different groups are treated can affect delivery, policy, and
access to care. Social support and capital have a major impact on the health system as well.
Social context considers the following: population size, demography, connectedness, family
groupings, values and norms, gender roles, and power within society (Australian Government,
2020).
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Australia
Australia’s population has been growing dangerously, which can have a major impact on
the social context of the health system. Three ways population growth can or has been affecting
Australia’s health care are a need for more infrastructure, a need for more and better-trained
health care professionals, and a need for multilingual health care professionals who demonstrate
cultural literacy. Sufficient human resources are a necessity when there is an increase in
population. This increase required Australia to train more administrators, doctors, nurses, and
support staff. Also, with the nation being diverse, having professionals trained to be multilingual
is much needed when practicing cultural sensitivity. All these aspects will help the social context
improve in Australia’s health system (The Health Industry, 2019)
The social norms and values of Australia take a role in the setting related to health
technology assessment and processes and decision-making. These social values related to justice
and equity are considered when weighing the factors. HTA processes support solidarity through
appropriate technology for all Australians. This process still contains autonomy and equity.
Social needs and conditions can be improved in Australia by lowering risky behaviors and
depending on the community environment as a society to choose healthier options. Also,
socioeconomic status has influence on health and the resources which are given to communities
to afford medical care. Early childhood development can strongly influence social views within
health. In 2018, children entering school who were developmentally vulnerable on one or more
Australian Early Development domains decreased slightly to 22 percent. Children in the lower
socioeconomic group were more vulnerable than children in the higher socioeconomic group
(Australian Government, 2020).
In Australia, the Australian Commonwealth legislation brings social support to parents
and families, specifically in the areas of disability, family support, and community services. The
influence that social support with Indigenous Australian communities revolves around
relationships formed with extended family members, that helps identify a basis for individual and
social identity. With non-Indigenous Australians, there are high levels of negative racial
stereotypes and discrimination. Several studies have reported systemic racism towards
Indigenous Australians. Social support and capital affect negative health behaviors: physical
exercise and smoking (Waterworth et al., 2014).
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Australia
Social determinants of health can strongly influence the outcomes of a person’s health,
along with housing or education outcomes. Australia has addressed social determinants of health
care for many years and have achieved much different outcomes, in areas such as childhood
vaccinations, compulsory seatbelts, screening for bowel and breast cancer, tobacco legislation,
and gun control. Although Australia has been addressing these determinants, there have still been
failures to address other determinants, by extension chronic disease. A third of Australia’s
disease burden is caused by factors that are preventable. These include smoking, excessive
alcohol consumption, and insufficient exercise. Even with the correct medication, a patient can
become more ill due to broader social factors of diet, sleep, mental health, work, and exercise.
An example, Australia has been ranked the eighth highest proportion of adult population who are
overweight or obese. If the percentage of obesity continues to grow in Australia, it could
overwhelm the health system with many chronic health problems (Schlesinger & Phillips, 2017).
Economic Conditions
Australia’s Gross Domestic Product is $1.3 trillion as of 2020. The Unemployment rate is
at 5.4% of the population. (The World Factbook, 2020). Just like any country, there are people
living in poverty. In this country, about 3.24 million individuals are living below the poverty
line, which is about $457 per week per single adult (Davidson, 2020). As of 2017-18, health
spending as a percentage of GDP was 10% which increased from 8.3% back in 2000-01 (Hinton,
2021). Australia as a nation spent about $185 billion on health goods and services or about
$7,485 per capita as of 2017-18 (Australian Institute of Health and Welfare). 68% of health
spending in this country is mostly raised by the government through tax revenue (The World
Facebook, 2011). Personal spending in healthcare was about 0.4% of individual wealth in 2017
which was the lowest since 2000 (The World Factbook, 2017). In terms of where money is spent
on healthcare, the largest spending amount was for hospital services, which was $51 billion, then
medical services, at $18 billion, then followed by private hospitals for $15 billion (Australia’s
Health, 2018). As of 2019, the country recorded a total of 212 licensed MRI machines, 157 being
partially registered, and 160 without a license at all (Branley, 2019). The country’s spending on
long term care is a bit concerning as it is only 1.2% of GDP and some call this spending
“embarrassingly low” for what should be spent on this age group, especially compared to other
groups (Cheu, 2020). As of 2017, roughly about 45.6% of Australian have private health
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Australia
insurance. About 54.6% of the population are covered by general treatment. Further, 87.5% of
Australians with health insurance have lifetime health cover (Jolly, 2018).
Demographic and Health Information
Below is statistics on Australia’s age structure (2020 est.):
0-14 years: 18.72% (male 2,457,418/female 2,309,706)
15-24 years: 12.89% (male 1,710,253/female 1,572,794)
25-54 years: 41.15% (male 5,224,840/female 5,255,041)
55-64 years: 11.35% (male 1,395,844/female 1,495,806)
65 years and over: 15.88% (male 1,866,761/female 2,177,996)
Table 1. This chart shows the percentage of the Australian population that falls into each age
subgroup category ranging from ages 0-14 years old, 15-24 years old, 25-54 years old, 55-64
years old, to 65 years old and above. The information compiled for the data of this table is from
the World Factbook.
The Ethnic Groups that Australia consist of are as follows (2011 est.):
English 25.9%, Australian 25.4%, Irish 7.5%, Scottish 6.4%, Italian 3.3%, German 3.2%,
Chinese 3.1%, Indian 1.4%, Greek 1.4%, Dutch 1.2%, other 15.8% (includes Australian
Aboriginal .5%), unspecified 5.4% (The World Factbook).
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Australia
Table 2. The information in this table includes the languages that Australia consists of which
includes English at 72.7%, Mandarin at 2.5%, Arabic at 1.4%, Cantonese at 1.2%, Vietnamese at
1.2%, Italian at 1.2%, Greek at 1%, other at 14.8%, and unspecified at 6.5%. This information
has been collected from the World Factbook, updated in 2016.
Education and Literacy rates:
Adult literacy rate in Australia remains about 99% of the population. Education expenditures of
the country is about 5.1% of the GDP as of 2017, and this is about 55% of the world (The World
Factbook, 2021).
Population Health and Statistics (Simone-Davis, 2019)
Top Ten Leading causes of death
1.
Ischaemic heart diseases
2. Dementia, including Alzheimer's disease
3. Cerebrovascular diseases
4. Malignant neoplasm of trachea, bronchus and lung
5. Chronic lower respiratory diseases
6. Malignant neoplasm of colon, sigmoid, rectum and anus
7. Diabetes
8. Malignant neoplasms of lymphoid, haematopoietic and related tissue
9. Influenza and pneumonia
10. Diseases of the urinary system
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Australia
Mortality Rates
Infant Mortality in Australia is about 3.05 deaths per 1,000 live births. Maternal Mortality is
about 6 deaths per every 100,000 live births as of 2017 (The World Factbook).
Life Expectancy
Ranked #14 in the entire world, Australia’s overall life expectancy from birth to death is 82.89
years. For males this statistic is slightly lower at 80.73 years and females stand a bit higher than
the overall average at 85.17 years (The World Factbook).
Relevant Health Behaviors
Alcohol use in the past 12 months (2016 est.) was an overall of 79.4% with males at 88.3% and
Females at 70.6%. The prevalence of current tobacco use among persons aged 15 years and older
(2018 est.) was an overall of 16.2%, with males at 18.7% and females at 13.6%. The prevalence
of obesity among adults, BMI >= 30 (2016 est.) was an overall of 29%, with males at 29.6% and
females at 28.4% (World Health Organization).
Covid-19 Response
Australia’s Covid-19 response was quite proactive. The country has only logged a total of
28,939 cases with only 909 deaths. Four key factors of Australia’s success were lowering their
base rate of infections, serious testing regimens in place, the development of contact tracing, and
building hospital capacity in case things went bad (Milbank Memorial Fund).
Financing, Organization, and Management of Health System
Financing
Australia’s health system can be split into two sectors, those being the public and private
health sectors. Both sectors function similarly but are financed differently. Australia’s Medicare,
or national public health insurance system, provides rebates against the cost of medical fees and
is primarily funded by a tax on income called the Medicare levy. The Medicare levy has
fluctuated over time, but currently sits at two percent on taxable income (The Commonwealth
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Australia
Fund, 2020). However, this levy does not cover the entire cost of Medicare. The Australian
government covers the rest of the cost of Medicare, which they pay for out of general
government expenditure. On the other hand, private health services require private health
insurance, which is currently owned by about half of the Australian population (Australian
Bureau of Statistics, 2017). The Australian population has the option to purchase complementary
health insurance, which is commonly referred to as hospital coverage. This coverage allows
individuals to access private hospital rooms and to have quicker access to nonmedical
emergencies. The population also has access to supplemental health insurance, which is referred
to as extras, or ancillary care, and that provides “coverages for dental, physiotherapy,
chiropractic, podiatry, home nursing, and vision services” (The Commonwealth Fund, 2020). For
the other half of the population that has not yet purchased private insurance for hospital coverage
and ancillary care, there is a good chance they are paying out-of-pocket for the many health
services not covered by Medicare. It is also important to mention that citizens and permanent
residents of New Zealand also have access to these same coverages at the same costs.
Reimbursement Systems
Primary care in Australia is the frontline of its health care system. Australian residents
have access to primary care facilities when there are health-related issues that are not a serious
medical injury, which would otherwise require a hospital’s care. According to the
Commonwealth Fund website, only 14 percent of primary care facilities charge for medical
services. These fees average about $22 USD per visit (The Commonwealth Fund, 2020). With no
cost for public hospitals, and rarely a cost for primary care facilities, physicians and general
practitioners are typically paid a salary or commission from the Australian government.
Physicians with a private practice, however, can charge whatever they deem necessary for the
amount of care needed, which is commonly termed fee-for-service (FFS). Specialists can be
public or private but are typically private and charge a fee-for-service as they are able to charge
any rate that is necessary based on the amount of care a patient requires.
As for the public hospitals in Australia that account for 65 percent of beds, they are
funded through Medicare, which is supplied by the Medicare income tax and government
expenditure. This allows public hospitals to provide in-patient care at no cost. Australian citizens
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Australia
and permanent residents “will not have to pay for hospital clinical services, doctors’ and
specialists’ fees, medication, hospital accommodation and operating theatre fees” (Department of
Health and Human Services, 2019). It is also important to note that Australia’s public hospitals
are funded based on the volume of services and volume of patients, which is known as activitybased funding. Private hospitals, on the other hand, are funded the same way private physicians
and specialists are paid, which is through charging fee-for-service (The Commonwealth Fund,
2020).
There are also a couple scenarios that are treated differently under Medicare. Since
Medicare provides public health services at no cost, higher-income individuals or families may
be required to purchase private health insurance or fall victim to a higher income tax (The
Commonwealth Fund, 2020). The reason the Australian government regulates this is to make
sure the high-income population does not take advantage of free services, as well as they will
contribute to the greater good by funding private health insurers, private health facilities, and
private physicians and specialists. Also, under Medicare, private hospital patients are covered up
to 75 percent by Medicare, as long as it complies with the Medicare Benefits Schedule
(Department of Health and Human Services, 2019). The Medical Benefits Schedule acts as a
safety net to allow public and private patients access to an extensive list of government
subsidized health services at little to no cost (Medicare Benefits Schedule, 2020).
Government Regulation
Australia’s national, state, and local governments are the primary controllers of the
country’s universal health care system, and they each play important roles in regulating and
controlling health care policy. The Australian government as a whole funds a majority of health
care from the federal, state, and local territory government levels, and each level of government
has its own responsibility in the management of Australia’s health care system. At the federal
level, the Australian government is responsible for a few major things. This level of government,
known as the Commonwealth, is responsible for maintaining the Medicare benefits Schedule
(MBS), which provides access to government subsidizes health services, as well as the
Pharmaceutical Benefits Scheme (PBS), which is an extensive list of medicines that are paid for
by the government and are offered for little to no cost (Australian Government Department of
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Health, 2020). According to the Commonwealth Fund website, the maximum charge for
prescription medication is currently $28 USD per prescription (The Commonwealth Fund, 2020).
Also, the national Australian government is responsible for regulating the private insurance
industry, monitoring the quality, effectiveness, and efficiency of primary health care services,
regulating medicines, and collecting and publishing health statistics, to name a few. As far as the
state and local governments, their main duties and responsibilities are to manage public hospitals
with regards to funding and access to health services. State and local governments are also
responsible for access to preventive services, such as free cancer screenings, as well as
registering and accrediting health professionals (Australian Government Department of Health,
2020). As a whole, the Australian government provides funding to public hospitals and regulates
and maintains the current healthcare industry through policy.
Health Care Resources
Based on statistical trends, Australia’s health care system has been forced to
accommodate for the ageing population, the increasing rates of chronic disease, increased costs
of medical research and innovations, and the acquisition of better health data and data records
(Australian Government Department of Health, 2020). This has required more doctors to
specialize in their practices and required a higher number of physicians in general. According to
data acquired from the World Bank website, there are 3.678 practicing physicians per 1,000
people as of 2017 (World Bank, 2017). As shown in Table 1, there has been steady growth in the
number of physicians since the 1970s, which may be particularly due to an ageing population
and a growing population. The growth in the number of physicians in the 1970s was presumably
due to the introduction and implementation of the Medibank and Medicare health care systems.
In terms of the number of specialists per 1,000 people, registration data from the Australian
Health Practitioner Regulation Agency’s website suggests that with around roughly 70,000
specialists total and a current population of around 25.6 million, there are around 2.9 specialists
per 1,000 people (Australian Health Practitioner Regulation Agency, 2020). Also, from some
minor calculations, here are some statistics representing the growth in physicians per 1,000
people over three decades and based on values covering a range of about ten years.
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Australia
● During the period from 1991-2000, there was an average of 2.4 practicing
physicians per 1,000 people.
● During the period from 2001-2010, there was an average of 2.8 practicing
physicians per 1,000 people.
● During the period from 2011-2017, there was an average of 3.44 practicing
physicians per 1,000 people.
Number of Physicians per 1,000 Population - Australia
Table 1. This chart shows the number of practicing physicians per 1,000 people according to the
World Bank. It can be noticed that the number of physicians has steadily increased since the
1970s.
Another measure of Australia’s health care resources are the number of beds per 1,000
people. With 65 percent of beds being provided by public hospitals, there are currently 3.8 beds
per 1,000 people (World Bank, 2016). As shown in Table 2, there has been a rather sharp
decrease in the number of beds particularly in the 1980s and early 2000s. The general decrease in
beds can be blamed for the general decrease in demand for inpatient beds due to improved
technology and efficiency in health services, as well as an increase in community-based medical
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services. The average length of hospital stays has also decreased, adding to the decrease in
demand for beds (FitzGerald, Mahon & Wilson, 2010). With the decrease in beds, there has been
heightened concern regarding the effect of the ageing population on the demand for health
services, which will require a higher number of beds and elderly care facilities. This could
present a multitude of issues relating to access to care, especially for the growing population of
elderly age 65 and older.
Hospital Beds per 1,000 Population - Australia
Table 2. This chart shows the number of hospital beds per 1,000 people according to the World
Bank. It can be noticed that the number of hospital beds has dropped significantly since the
1980s, with a severe drop in the late 90s, early 2000s.
To reiterate what was stated earlier in the paper, Australia gives much of the population
access to the growing number of community-based health service facilities. These are different
from primary care facilities in the sense that they are more directed toward populations that “are
at risk of the poorest health and have the greatest economic and social needs” (Department of
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Australia
Health and Human Services, 2019). The innovative community health facilities are called
Community Health Services (CHSs) and are funded by the various Departments of Health, which
operate under state and local governments. One of the main goals of CHSs is to develop health
care programs and activities to improve the social and physical environments in local
communities. Giving a greater volume of the population access to quick and easy services that
CHSs offer gives more light to the progressing development of social health care services that, in
turn, help the country improve overall health outcomes. Also, the CHSs can be viewed as partly
responsible for the decrease in the demand for hospital beds and inpatient hospital visits. CHSs
are just another strategy the Australian government uses to maintain its ability to supply and
deliver care to a greater number of the Australian population.
Delivery and Access Issues
For Australia’s universal health coverage, a high volume of the population of all
socioeconomic classes have access to public hospitals and public health care facilities, but not
everyone has full access to these services. There are also a growing number of health challenges
that relate to the way health facilities deliver care. Specifically, there are challenges that arise
due to an ageing population, change in disease patterns, a shortage of general practitioners,
dentists, and nurses, especially in rural and remote regions of Australia, the quality and safety of
care, and the increasing costs of private health (Armstrong, Bruce K., et al., 2007). These factors
all play into the growing concern over delivery and access to health care in Australia.
In Australia, an ageing population is at the forefront for issues relating to delivery and
access to care. As individuals age, they are at a heightened risk of becoming disabled due to
chronic illness. The infrastructure of Australia’s health care system may also be a barrier to the
way health facilities deliver care to elderly folks. According to data from the Medical Journal of
Australia, “the average Australian can expect to live 73 years of healthy life. Actual life
expectancy is some 10 years longer” (Armstrong. Bruce K., et al., 2007). With these data values
holding steady, it contributes to a variety of other issues, but mainly to issues related to health
spending. The Australian governments at all levels have to allocate more funds to areas with a
greater population of elderly people over the age of 65 because of the higher level of care
required, as well as the greater demand for research and development of medical technology to
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care for this particular population. Apart from the ageing population and change in disease
patterns, it is important to mention the care that populations living in rural and remote regions of
Australia receive. There has been a growing issue with chronic diseases in indigenous
populations that may not have immediate access to health care facilities, or the already-low level
of physicians and specialists located in these outer-metropolitan areas (Armstrong. Bruce K., et
al., 2007). This issue can also be seen to have some relation to the growing number and growing
demand for community health services, like CHSs. Another issue with delivery and access to
care resides in Australia’s growing shortage of general practitioners, dentists, and nurses.
Although the number of physicians per 1,000 people has been proven to be growing over recent
decades, it has not been growing as consistent as the Australian population. The bulk of
shortages of health care workers is a particular issue in rural and remote locations in Australia
and as this is paired with a change in disease patterns, rural and remote populations may not have
access to health facilities to receive care for certain chronic illnesses. This issue holds the
government of Australia responsible and exposes their weak action toward extending health care
to a greater volume of outer-metropolitan areas. The next main issue with Australia’s health care
delivery in particular, is the concern over quality and safety of care. According to the Medical
Journal of Australia, there were over $1 billion in costs related to medical errors, which half were
seen as potentially preventable (Armstrong. Bruce K., et al., 2007). This also presents an issue
with how the Australian government manages health care facilities and health care policy. The
final issue with access to Australian health care services is the growing out-of-pocket costs
related to private insurance. The funding of private health services has become very costly to the
point that patients’ out-of-pocket costs have grown almost 50 percent. This is also a major issue
for individuals in the lower-income socioeconomic category because access to private specialists
may already have been restricted due to the high costs of private health insurance, but also
completely restricts these populations from having access to specialists in general. There are
public specialists that offer health services, but it may force lower-income populations and half
of the Australian population that does not own private health insurance to have to wait longer to
receive care (Armstrong. Bruce K., et al., 2007). All in all, the issues relating to delivery and
access to care are continuing to be a burden to Australia’s health care system, and hopefully the
system can conform with the major changes taking place within the Australian population.
Public Satisfaction of the Health Care System
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Australia
The overall public satisfaction of Australia’s health care system is quite difficult to
measure. According to an article on the Parliament of Australia’s website, author Rebecca de
Boer discusses the level of public satisfaction with supporting evidence from a survey conducted
in 2010 called the Menzies-Nous 2010 survey. This survey aimed to measure how Australians
perceive the health care system, and according to the observations and findings, the survey
suggests that on average, Australians are satisfied with the healthcare system. Australians are
confident that they can access health care that is safe and high-quality, but there are growing
concerns over the affordability of healthcare in the private sector (de Boer, 2010). There are also
an extensive list of other factors that play into the Australians’ overall satisfaction with its health
care system. Some of these factors include access to appropriate medical technology and
affordable drugs, the access to doctors and specialists in the public and private sectors and
waiting times to receive health and medical care. Also, the survey from 2010 pointed out and
predicted a growing issue in Australia’s health care system. According to the survey, access to
health care for the elderly population was considered to be either fairly or very difficult (de Boer,
2010). As this topic was discussed earlier in the paper, it proves that the ageing Australian
population has been a burden for at least a decade and continues to be a burden on Australia’s
health care system to this day.
Health Care Issues, Reforms, and Features
Health Care Issues
Australia’s health system has been facing many challenges due to the growing chronic
conditions, ageing population, workforce pressures, and inequities in health outcomes and access
to services. Studies reveal that many of these outcomes are determined by where a person lives,
specific conditions, and the services provided. These studies clearly show that people living in
rural areas in Australia have a lower life expectancy and more likely have a chronic condition
(Department of Health, 2013).
The most common chronic conditions occurring in Australia as of 2020 are arthritis,
asthma, back pain, cancer, cardiovascular disease, chronic obstructive pulmonary disease,
diabetes, and mental health conditions. Statistics show that at least one in every two Australians
have been impacted by these common conditions and around nine in every ten deaths are
associated with them. There are more people living with one or more chronic condition, mostly
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known because there are better and more advanced treatments available. Risk factors for
developing a chronic condition can either come from what a person can change or what a person
cannot change. For example, a person can change habits for smoking, drinking, being
overweight, and not being physically active. A person cannot change factors based on age,
gender, and genes. For Australians, common risk factors include smoking tobacco, not getting
enough physical activity, drinking too much alcohol, poor diet, high blood pressure, and poor
cholesterol levels. If citizens of Australia were to practice reducing these risk factors, they could
be healthier for longer (Australian Government, 2020).
With the increasing costs in the provision of health care services, due to the health and
well-being of an ageing population, Australia governments will have issues. As of 2013, 14
percent of the population were aged 65 and it has been projected the percent of the population
aged 65 will increase to 21 percent. Governments in Australia withheld changes in the health
care system with fear of voter backlash, but recently, they have been forced to address these
changes. The increasing budgetary burden creates efficient gains and subsidizes private health
care, with expectations of higher income earnings moving to private medical providers (Macri,
2016).
Although there have been improvements in health outcomes in Australia, the
improvements have not been equally throughout. There is a significant difference with health
care treatment that wealthier people receive versus poor people. With this being said, the
increasing urbanization across the nation has created health challenges. The governments are
struggling with planning of healthy and sustainable communities. These issues in urbanization
include access to fresh food, higher rates of obesity, asthma rates, and increasing mental wellbeing issues (Macri, 2016).
Health Reforms
Recently, Australian governments signed a 2020-25 Addendum to the National Health
Reform Agreement (NHRA) that aims to improve the health outcomes for citizens and to ensure
sustainability in the health system. The NHRA is an agreement between the Australian
Government and all state and territory governments. The concept of the agreement is to provide
better care in the community and is the key mechanism for transparency, governance, and
financing in the health system. With this agreement, the government contributes funds to the
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Australia
states and territories for public hospital services: emergency departments, hospitals, and
community health settings. For states and territories, there are specific responsibilities the NHRA
recognizes them to do. These responsibilities are to determine the mix of services and functions
delivered in their jurisdiction and a system-wide public hospital service planning and
performance (Australian Government, 2020).
The NHRA has four main goals that the government is determined to reach. These goals
include improving efficiency and ensuring financial sustainability, prioritizing prevention and
helping people manage their health, delivering safe and high-quality care, and driving bestpractice and performance using data and research. In order to reach these goals, the NHRA has
been providing increased funding for public hospitals and setting new pathways for long-term
reforms. Along with supporting delivery of new lifesaving high-cost therapies (Australian
Government, 2020).
Under the NHRA, there was also an agreement to process long-term system-wide health
reforms. These reforms are placed to examine how well the different components of the health
system interact. The reason for these reforms has been to understand and remove systemic
barriers and give flexibility to health services to try new solutions to address these barriers. In the
long-term system-wide reforms, there are six different reform outlines. These include
empowering people through health literacy, preventing and wellbeing, paying for value and
outcomes, joint planning, and funding at local levels, enhancing health data, and nationally
cohesive health technology assessments. These reforms are needed in Australia in order to
support better coordinated care within the community, focus on prevention, and keeping people
healthier longer. It will also reduce pressure on hospitals and improve people’s experiences using
services across health, aged care, disability, and mental health (Australian Government, 2020).
Unique Features
Australia has something important in their health care system that differs from the United States:
a national health insurance program. The country’s system is broken into two principles:
universal coverage and personal choice. Citizens usually believe everyone should get affordable
care. Every citizen is eligible for Medicare, national universal health program, and is allowed to
receive medical care at public hospitals and other health care providers.
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Australia
A unique feature about Australia’s universal public health insurance program is
enrollment for citizens is automatic. With free public hospital care and substantial coverage for
physician services, pharmaceuticals, and certain other services, about half the citizens buy
private supplementary insurance to pay for private hospital care, dental services, and other
services. If a higher-income household does not purchase private insurance, the federal
government of Australia charges a tax penalty for free public service. It is unique for Australia to
have federal government, state government, and local governments involved in the healthcare
system. The federal government provides funding and indirect support for inpatient and
outpatient care with Medicare and pharmaceutical benefits. Their role is limited in direct service
delivery. For the state government, they own and manage service delivery for public hospitals,
ambulances, public dental care, community health, and mental health care. Along with
contributing their own funding. The local governments play a much smaller role in the delivery
of community health and preventive health programs (Commonwealth Fund, 2020).
Conclusion
As discussed above, there are many reasons why Australia has a high-performance health
care system. Its national public health insurance that covers all citizens and permanent residents
is one thing that Australia’s health care system has in common with other developed countries. It
is an extremely efficient system in regard to health services and health outcomes. With this being
said, Australia and its health system have dissimilarities from other countries that use universal
health care. Factors that have allowed Australia to form and maintain its strong health system
includes its historical background, cultural and social background, economic conditions,
demographics, finances, and current and past issues and reforms.
21
Australia
References
Armstrong, B., Gillespie, J., Leeder, S., Rubin, G., & Russell, L. (2007, November 05).
Challenges in health and health care for Australia. Retrieved February 24, 2021, from
https://www.mja.com.au/journal/2007/187/9/challenges-health-and-health-care-australia
Ausmed. (2019, July 22). Cultural considerations in healthcare. Ausmed | Document CPD
Online For Free. https://www.ausmed.com/cpd/articles/cultural-considerations-inhealthcare
Australian Government Department of Health. (2020, October 02). The Australian health system.
Retrieved February 24, 2021, from https://www.health.gov.au/about-us/the-australianhealth-system
Australian Government. Health Expenditure. Australian Institute of Health and Welfare,
www.aihw.gov.au/reports/australias-health/health-expenditure
Australian Government. (2020, April 3). Australia's children. Australian Institute of Health and
Welfare. https://www.aihw.gov.au/reports/children-youth/australiaschildren/contents/social-support
Australian Government. (2020, March 3). Chronic conditions in Australia. Australian
Government Department of Health. https://www.health.gov.au/health-topics/chronicconditions/chronic-conditions-in-australia
Australian Government. (2020, October 15). National Health Reform Agreement.
https://www.health.gov.au/initiatives-and-programs/2020-25-national-health-reformagreement-nhra.
Australian healthcare system – pros and cons. (2016, October 23). Retrieved February 24, 2021,
22
Australia
from https://healthncare.info/australian-healthcare-system-pros-cons/
Bainbridge, R., McCalman, J., Clifford, A., & Tsey, K. (2015, July). Cultural
Competency. Australian Institute of Health and Welfare.
https://www.aihw.gov.au/getmedia/4f8276f5-e467-442e-a9ef-80b8c010c690/ctgcip13.pdf.aspx?inline=true
Branley, Alison. “Julia Was Told She Might Have a Brain Tumour - but the MRI Scan Was Her
Real Fear.” ABC News, ABC News, 27 Dec. 2019, www.abc.net.au/news/2019-1228/mri-scan-fears-for-cancer-sufferers-in-coffin-likesituation/11807242#:~:text=There%20are%20212%20fully%20licensed,have%20a%20li
cence%20at%20all.
Chapter - private health insurance. (2013, March 26). Retrieved February 24, 2021, from
https://www.abs.gov.au/ausstats/abs@.nsf/Lookup/E334D0A98272E4DCCA257B39000
F2DCF
Cheu, Sandy. “Australia Spending Less than International Counterparts.” Australian Ageing
Agenda, 23 Mar. 2020, www.australianageingagenda.com.au/royal-commission/australiaspending-less-than-international-counterparts/.
Commonwealth Fund. (2020, June 5). Australia.
https://www.commonwealthfund.org/international-health-policycenter/countries/australia
Davidson, Peter, et al. (2020, Feb 21). “Poverty in Australia 2020 - Part 1: Overview.” Peter
Davidson, Peter G.
Saunders, Bruce Bradbury, Melissa Wong, Australian Council of Social Service,
University of New South Wales,
23
Australia
apo.org.au/node/276246#:~:text=Key%20findings%3A,the%20poverty%20line%20in%2
0Australia.
De Boer, R. (2010, December 06). Perceptions of Australia's health care system. Retrieved
February 24, 2021, from
https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Li
brary/FlagPost/2010/December/Perceptions_of_Australias_health_care_system#:~:text=
The%20survey%20found%20that%2C%20on%20average%2C%20Australians%20are,ac
cess%20care%20%28including%20appropriate%20medical%20technology%20and%20
Department of Health. (2013, April). Systemic national challenges in health care. Department
of Health | Welcome to the Department of Health.
https://www1.health.gov.au/internet/publications/publishing.nsf/Content/NPHCStrategicFramework~systemic#:~:text=The%20National%20Primary%20Health%20Care,outcom
es%20and%20access%20to%20services
Hinton, Published by Thomas, and Mar 1. “Australia: Health Expenditure as Percentage of
GDP.” Statista, 1 Mar. 2021, www.statista.com/statistics/628582/australia-healthexpenditure-as-percentage-of-gdp/.
Hospital beds (per 1,000 people) - Australia. (2016). Retrieved February 24, 2021, from
https://data.worldbank.org/indicator/SH.MED.BEDS.ZS?locations=AU
Hospital costs and payments. (2019, January 03). Retrieved February 24, 2021, from
https://www.betterhealth.vic.gov.au/health/servicesandsupport/hospital-costs-andpayments
“How Much Does Australia Spend on Health Care?” Australia’s Health, 2018. Australian
Government,www.aihw.gov.au/getmedia/941d2d8b-68e0-4883-a0c0138d43dba1b0/aihw-aus-221-chapter-2-2.pdf.aspx.
24
Australia
“Indicators.” World Health Organization, World Health Organization,
www.who.int/data/gho/data/indicators.
Jolly, William. “Australian Health Insurance Statistics 2018.” Canstar, 19 Mar. 2018,
www.canstar.com.au/health-insurance/who-has-health-insurance/.
Macri, J. (2016, January 6). Australia's health system: Some issues and challenges | Insight
medical publishing. Health & Medical Economics Journals | open access journals.
https://health-medical-economics.imedpub.com/australias-health-system-someissuesand-challenges.php?aid=8344
Mbs online. (2020, September 20). Retrieved February 24, 2021, from
http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home
Medicare - Background Brief. (2014, March 24). Retrieved February 24, 2021, from
https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Li
brary/p ublications_Archive/archive/medicare
Physicians (per 1,000 people). (2017). Retrieved February 24, 2021, from
https://data.worldbank.org/indicator/SH.MED.PHYS.ZS
Simone-Davies, Joanne. “Causes of Death, 2019.” Parliament of Australia, 29 Oct. 2020,
www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/
FlagPost/2020/October/Causes_of_death.
Schlesinger, N., & Phillips, S. (2017). Social determinants of health in Australia. PwC.
https://www.pwc.com.au/health/health-matters/social-determinants-in-healthaustralia.html
Statistics. (2020, December). Retrieved February 24, 2021, from
25
Australia
https://www.medicalboard.gov.au/News/Statistics.aspx
The Health Industry. (2019, March 22). Population Growth. My Health Career.
https://www.myhealthcareer.com.au/health-industry/australian-population-growth-andhealth-care/
“The World Factbook.” Central Intelligence Agency, Central Intelligence Agency, 24 Feb.
2021, www.cia.gov/the-world-factbook/countries/australia/#people-and-society.
Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. (2020, June 05).
Australia: Commonwealth Fund. Retrieved February 24, 2021, from
https://www.commonwealthfund.org/international-health-policycenter/countries/australia
Waterworth, P., Rosenberg, M., Braham, R., Pescud, M., & Dimmock, J. (2014,
October). The effect of social support on the health of Indigenous Australians in a
metropolitan community. ScienceDirect.com | Science, health and medical journals, full
text articles and books.
https://www.sciencedirect.com/science/article/pii/S0277953614005619?casa_token=eYv
F5EwmykwAAAAA:cR2DA3PZICc0azKpXDz5F-p2h1YKe5EYJjHufCzImmfT3oN62lfBQcE0hwecVxsBglHjzEiCvw
Weyden, M., Gregory, A., McCarthy, S., Watterson, L., Mullins, R., Senanayake, S., . . .
Williams, A.
(2010, September 06). Volume 193 issue 5. Retrieved February 24, 2021, from
https://www.mja.com.au/journal/2010/193/5
“What the US Could Learn from Australia's COVID-19 Response.” Milbank Memorial Fund, 10
Feb. 2021, www.milbank.org/2020/04/what-the-us-could-learn-from-australias-covid-19response/.
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