Health Care: The Australian Option

Australia has had universal health insurance in place since shortly after the enactment by the Whitlam government of its Medibank legislation in 1974. Changes have been made to the system from time to time, but its core principle of universal access to medical treatment and public hospital care has remained the same. Basically, Medibank - or Medicare as it has been known since 1983 – provides an 85% refund of an agreed fee schedule for medical services, along with free public hospital treatment and accommodation. Doctors can either ‘bulk bill’ Medicare for 85% of the scheduled fee as payment in full for their services, or charge the fee directly to the patient who then claims the 85% rebate against it. Public hospitals also recover their costs directly from Medicare. Social Security pensioners usually are bulk billed, as also in most instances are low income earners.

In return, taxpayers other than those on low incomes pay a 1.5% income tax surcharge known as the Medicare Levy. Insurance against the cost of private hospital accommodation is available from a government insurer (Medibank Private) or a number of private sector insurers, some of which are mutuals or former mutuals. Measures introduced by the former government encouraged private hospital insurance through a 30% subsidy of the premium. Taxpayers with incomes of $AU75,000 and over who fail to take out private hospital insurance are penalised with a 1% loading on their Medicare levy. Currently, some 43% of Australians choose to be privately insured. There is a separate Pharmaceutical Benefits Scheme, whereby most prescribed medicines are priced down in negotiations between the government and the manufacturers, and subsidised at the point of delivery to patients.

The upside is that nobody – and in particular no child – is denied necessary medical treatment or hospital care, and the aggregate cost of health services has been contained well below that of comparable countries. Conversely, public hospital waiting times for some procedures are unacceptably long – albeit also currently being systematically reduced – and, as regard private medical services, there is a gap in many instances between the scheduled fee on which the 85% rebate is payable, and the amount actually charged by practitioners either to maintain their profitability or because they believe they can get away with it. However, Australians overwhelmingly and with good reason support Medibank/Medicare, see its continuation as being in both their own and the public interest and have indicated repeatedly at elections that they would reject any attempt to weaken or dismantle it.