Health policy in Australia

In a book written 40 years ago, the Australian health system was described as “a strife of interests masquerading as a contest of principles”. Some critics would argue that little has changed. Looked at through a political lens, healthcare is a competitive game played out across national bodies with special interests such as the Federal, state and territory, and local governments with differing wants, needs and goals; a large private sector vying with public providers for a greater share of the pie; and identifiable sectors such as aged care, acute care, public health and primary care each with dissimilar roles, functions and purposes. Critics would also argue that the system falls short in providing universal coverage, with excessive co-payments and uneven distribution or resources, such that marginalized and vulnerable groups (indigenous populations, poorer people, the aged) receive less, and poorer quality, care. Perhaps paradoxically, despite the complex challenges of delivering care effectively to all, for most Australians most of the time, the system delivers best practice care at a world standard. It is a technologically sophisticated, evidence-based, highly rated system, benchmarking internationally such that on most measures it is in the top five performing health systems, and often in the top three depending on the measure chosen. This chapter describes the system and discusses this paradox.