Just a little grist to the mill of this debate...
HOW AUSTRALIA'S HEALTH SERVICE COMPARES INTERNATIONALLY
Four indicators are often used to compare health services in different countries. These are: universal coverage; level of satisfaction among the population with the health system; health status and overall cost to the economy. On each of these Australia rates well.
Health status
Australians enjoy a high overall level of population health status on almost every criterion. Most measures of death and illness show Australia ranks in the middle range of developed countries.
Age-standardised death rates take into account the different age distributions across countries. Comparing the number of deaths per 100,000 people provides a comparison of a nation's overall health status.
In 1992, Australia had the fifth lowest rate among 19 comparable developed countries, bettered only by Japan, Hong Kong, Sweden and Canada (AIHW,1998). Australia's death rate was 16% lower than the rates for the USA and New Zealand, which ranked 15th and 16th respectively.
Life expectancy in Australia in 1996 was 78.2 years, one year greater than the OECD median and 2.1 years more than the USA - while infant mortality was equal to the OECD median of 5.8 per 1000 live births (Anderson 1998).
In 1995, a comparison of eight developed countries recently ranked Australia second only to Japan in achieving the lowest potential years of life lost for all causes except suicide for people under the age of 70 in 1995 (Anderson 1998).
Spending on health care
Australia's total spending on health care, as a proportion of GDP and in the proportion coming from the public sector, ranks in the middle of the developed countries for which data are available.
Note that the USA, with only 46.7% of its health care expenditure in the public sector spends 67% more than Australia as a proportion of GDP and 2.3 times as much per capita. Yet despite this additional spending, the USA reports a worse population health status and has 40 million people without any form of health insurance. Most of its higher spending simply goes in higher costs.
International health expenditure indicators, 1997
Country Amount per head Proportion of GDP % Public contribution %
Australia 1,750 8.4 68.7
USA 4,090 14.0 46.7
UK 1,347 6.7 84.5
Canada 2,095 9.3 68.7
Germany 2,339 10.4 77.4
New Zealand 1,352 7.6 77.4
Ref: International health: how Australia compares, AIHW 1998, p127
Since these figures were released, falls in the Australian dollar against the US dollar make our spending comparisons even more favourable.
Every OECD nation's health spending has risen since 1970. However, where the public sector dominates the market, such as Australia and the UK , cost rises have been slower and more controlled. In Australia the cost of health care has been relatively stable for the last 10 years.
Australia's proportion of GDP on health went from 5.2% to 8.4% between 1970 and 1995; while the USA rose from 7.4% to 14.5% over the same period (AIHW 1996). The USA rate has only plateaued in the 1990s, mainly as a result of bureaucratic "managed care" restrictions on the supply of medical services, something Australia has so far avoided.
Contrary to claims of health cost blow outs, recent trends show that the rate of increase in health care spending was slower in nearly all countries in the 1990s than it had been in the 1960s, 1970s and 1980s (Anderson, 1998).
Fairness, Access and Choice
National expenditure on health care is only one measure of comparison. Other important areas include; how fairly the costs are shared; how accessible the health care services are and how much consumer choice is available.
Countries with universal health insurance cover, such as Australia, ensure that all people have access to medical and hospital care when they need it.
Countries which rely more on private funding of health care, such as the USA, emphasise the right of individuals to choose how their health care needs are met. But in reality, choice is determined by personal wealth. Around 40 million Americans or 16% of the population remain uninsured. For them, the choice may be limited to using dwindling public services, bankruptcy or going without needed care.
The UK's National Health Service provides universal health care cover, but offers only limited choice. In international terms, this system is efficient in terms of health outcomes, and fair, because nearly all health care is paid for by progressive taxation.
Getting the balance right
An effective health care system not only recognises health as a public concern, but ensures everyone has a stake in their own and each other's health. Everyone pays their fair share, according to their capacity. It accommodates the values and rights of the individual and allows for choice and active involvement in decision making about health care.
Most importantly, an effective health care system maximises access for all, so that health and health care is seen as a basic right and not a commodity for sale only to those who can afford it.
Australia has managed to walk the thin line between more extreme models by attempting to balance fairness, access and choice as well as maximise health outcomes.
Our health care system is essentially a hybrid of public and private provision. However, one key feature of its public arm is universal health insurance coverage. Universal health coverage is a feature of all OECD countries except for the USA, and means that everyone, rich and poor, is insured against major individual health care costs. Universal health coverage also ensures that all taxpayers contribute to the cost of maintaining the system, according to their capacity to do so.
If the rich were exempt from contributing to the public system via means testing or "opt out" provisions, the diminished tax base would render the public system unworkable. However, the current system ensures all Australians have access to quality care on the basis of need, a choice of GP and the right to choose and pay for private care if they wish.
There is always room for improvement in health care. Australia's system is not perfect, but by international comparisons it gets the balance right. As Dr Michael Wooldrige, Federal Minister for Health, often states: the choice is clear; what country other than Australia would you like to be sick in?
References
De Looper M and Bhatia K, International Health: How Australia Compares, Australian Institute of Health and Welfare, Canberra 1998
Anderson GF, Multinational Comparisons of Health Care, Centre for Hospital Finance and Management Johns Hopkins University USA, Commonwealth Fund,1998
August 2001
See also the Medical Journal of Australia for a physician's viewpoint
http://www.mja.com.au/public/issues/173_01_030700/leeder/leeder.html
