The Australian health care system performs well by international standards in terms of health services and outcomes. However, it also struggles to provide equitable access to care for all Australians and often fails to prevent and manage chronic disease effectively.
Medicare is regarded as the backbone of Australia’s health care and accessibility. The original intentions of Medicare – a funding system for universal health care that is simple, fair and affordable – are largely agreed and valued. The scheme however, was superimposed on an existing set of health care services provided by the states, not-for-profit and private providers and private insurance policies held by about half the population. Over the last 45 years, there have been many amendments, workarounds, superimposed fixes and band aids applied to our health system from multiple sources with competing agendas.
The result is less an Australian health system than a complex set of services, with multiple providers and multiple payers generating complexity for both patients and providers alike.
The complexity of the system has further increased due to a rapid rise in the incidence of chronic diseases in the population, and rising demand for services. The Australian population is ageing and lifestyles have changed over time, making chronic disease our most dominant contemporary health issue. The demographics of the community are changing and Australia’s geographical size and diversity remain challenging. Expenditure on health care is projected to rise faster than both national income and personal incomes.
Dramatic and continuing advances in medical knowledge and technologies combined with developments in many other areas, including information and communication technologies, have both enabled significant improvements and efficiencies in health care and at the same time led to increased expectations and use of services.
The health needs of the population in Australia in 2019 are very different from those in 1975 when Medibank, the first version of Medicare, was established. The pace of adaptation has been insufficient to offset rising community concerns about gaps in service, long waiting times, lack of access to the latest drugs or technologies, and rising health insurance premiums and co-payments. The calls for action have grown louder, budget pressures at both state and federal levels of government have increased; and there is competing (and related) pressure from the aged care and disability sectors. Part one of this report provides an overview of the growing complexity of funding and access to health care services.
Successive governments have sought advice on how to deal with the pressures on, and of, the health system. Multiple reviews and reports related to the health care system have been instigated by federal and state governments over the past 40 years.
Part two of this report examines a range of Australian government reviews into the health system. The reviews examined are the most prominent that focussed on the function and capability of Australia’s health services, to provide universally available, affordable and appropriate health care services for all, with specific consideration of those that address chronic and complex conditions and diseases.
This report shows that national reviews consistently agreed on the same underlying challenges and that new models of health care delivery and financing were required to address these challenges. The reviews differed in the emphasis given to clinical and financial matters; they varied in their proposals for specific changes to the mix of finances. However, and most tellingly, the reviews considered in this report all highlighted the current complexity of arrangements as a major impediment to improving both the patient experience and health outcomes, and the efficiency of the system.