Like what you've read?

On Line Opinion is the only Australian site where you get all sides of the story. We don't
charge, but we need your support. Here�s how you can help.

  • Advertise

    We have a monthly audience of 70,000 and advertising packages from $200 a month.

  • Volunteer

    We always need commissioning editors and sub-editors.

  • Contribute

    Got something to say? Submit an essay.


 The National Forum   Donate   Your Account   On Line Opinion   Forum   Blogs   Polling   About   
On Line Opinion logo ON LINE OPINION - Australia's e-journal of social and political debate

Subscribe!
Subscribe





On Line Opinion is a not-for-profit publication and relies on the generosity of its sponsors, editors and contributors. If you would like to help, contact us.
___________

Syndicate
RSS/XML


RSS 2.0

Federation, fee-for-service medicine and other problems in Australian health care

By Gavin Mooney - posted Monday, 17 May 2004


The key problems of the Australian health service at a structural level relate to two key issues: first, the existence and size of the private sector; and second, the commonwealth-states split.

At the more macro level, the under-funding of the public system and the consequent lack of attention to equity stems from a chronically low tax base, and an all-too-little-progressive tax system.

At the more micro level, problems arise because of the continuing dominance of fee-for-service medicine in general practice; a focus on bulk-billing rates rather than on equity more generally; the under-funding and lack of cultural security in health services for Aboriginal people; the lack of technical efficiency and budget integrity in our major hospitals; and inefficiencies of allocation that see mental health and aged-care services relegated to Cinderella status. Finally, it is problematical that the AMA has too often almost a monopoly voice in advocacy in health care and that the Australian citizenry's voice is so muted.

Advertisement

Two numbers dominate health policy discussion in Australia: the percentage cover of private health insurance and the bulk-billing rate. They are not only unhelpful but stifle serious policy and political debate about the private sector and equity.

Compared to most OECD countries, Australia has a large private sector. This distorts social priorities in health care and results in inequities not only between rich and poor but also geographically. The latter is because private health-care, with its high financial returns to its staff, is almost wholly a metropolitan phenomenon. That makes it yet harder to attract staff to the bush.

Arriving in Australia just before the 1993 federal election, I was stunned at the very open attacks by the Australian Medical Association (AMA) on Medicare. I was used to the power exercised by the BMA in the UK and the Danish Medical Association. But the AMA's near apoplectic, explicitly ideological outbursts in opposing a public health-care system were breathtaking. Today it has learned a modicum of subtlety. It is clear, however, that it remains uncomfortable with public health care.

The split between the states and the Commonwealth is among the dafter parts of our system. Recently, some federal Liberal backbenchers suggested that the public hospitals should become the responsibility of the Commonwealth. Predictably, in my own state of WA, both sides of politics opposed the idea - after all, it would have seriously eroded their power base. The argument voiced was that the states are closer to an understanding of the preferences of the people. However, the question of who runs health services can, and should, be separated from how citizens' preferences are built into decision making. Centralising the management of health services nationally can be combined with being driven by state, regional or local community preferences.

The commonwealth-states split creates problems that are much wider than simply duplication and cost-shifting, bad as these are. The extent to which one can currently pursue allocative efficiency and equity is greatly compromised by the split. One bucket of money, one system would allow a far better opportunity to pursue some common objectives. Given this split, the sheer size of the private system and its pollution of the public system and we have a recipe for what may well be one of the worst designed and least equitable health-care systems in the developed world.

There is a need for some serious thinking about overall health-care policy objectives rather than continued fatuous discussion around a couple of numbers. What do we as Australian citizens want from the social institution that is health care? As a community, what good do we seek from our health-care system? That is the debate we need to have.

Advertisement

While we await a time when all health services are run by the commonwealth or all by the states, a joint commonwealth-states fund should be set up amounting to perhaps 10 per cent of the existing total spend and which could be used to purchase any health services. Cost-sharing would replace cost-shifting.

Aboriginal health is appalling. The fact that we have known this for years is worse. Not caring to do anything much about it is the real tragedy not just for Aboriginal people but for all Australians. It is a cancer on the decency of this society.

Institutional racism remains rife in health care. While Aboriginal health policy requires an across-government strategy, nonetheless it remains the greatest failure of the Australian health-care system. It appears that the people of Australia want to discriminate positively in favour of Aboriginal health. They are seemingly prepared to give a higher weight to improving Aboriginal health than to a similar improvement for non-Aboriginal people. The evidence is tentative, however, because neither governments nor researchers have taken the trouble to investigate this phenomenon in any detail. Perhaps governments don't want to know. Much progress could be made simply by listening to Aboriginal people with respect to how they want their health problems tackled and under what system of governance. A real start can be made by building culturally secure health services to overcome the cultural barriers that Aboriginal people face in trying to use health services.

  1. Pages:
  2. Page 1
  3. 2
  4. All

Article edited by Fiona Armstrong.
If you'd like to be a volunteer editor too, click here.



Discuss in our Forums

See what other readers are saying about this article!

Click here to read & post comments.

Share this:
reddit this reddit thisbookmark with del.icio.us Del.icio.usdigg thisseed newsvineSeed NewsvineStumbleUpon StumbleUponsubmit to propellerkwoff it

About the Author

Gavin Mooney is a health economist and Honorary Professor at the Universities of Sydney and Cape Town. He is also the Co-convenor of the WA Social Justice Network . See www.gavinmooney.com.

Other articles by this Author

All articles by Gavin Mooney
Related Links
Curtin University Social and Public Health Economics Research Group
Feature: The Genome of a new health system
Photo of Gavin Mooney
Article Tools
Comment Comments
Print Printable version
Subscribe Subscribe
Email Email a friend
Advertisement

About Us Search Discuss Feedback Legals Privacy