Challenges for Medicare and universal health care in Australia since 2000

Abstract

In 2021, the overall performance of the Australian health care system was ranked third of eleven high income countries by the Commonwealth Fund (New York), but only eighth for providing affordable, timely access to care. 1 As in other countries, the Australian health care system has been challenged by coronavirus disease 2019 (COVID-19), leading to the establishment of a major taskforce for improving access to primary health care. 2 The publicly funded universal health care scheme introduced in 1984, Medicare, is underpinned by principles of simple, fair, and affordable health care. 3 But Medicare is a complex system comprising multiple financial schemes at the federal and state levels and subsidies to the private sector (Box 1).In this review, we identify the financing and policy challenges for Medicare and universal health care in Australia, as well as opportunities for whole-of-system strengthening. In particular: What have been the major challenges and problems for the Australian universal health care system since 2000? What policy reforms have been proposed to improve the system? MethodsWe searched the MEDLINE Complete, Health Policy Reference Centre, and Global Health databases (all via EBSCO) for publications to 14 August 2021 on Medicare, the Pharmaceutical Benefits Scheme, and the universal health care system in Australia. For further studies and grey literature we searched the Analysis & Policy Observatory (APO; https://apo.org.au), the Australian Indigenous HealthInfoNet (https://healt hinfo net.ecu.edu.au), the Australian Public Affairs Information Service (APAIS; https://search.infor mit.org/ourco llect ions/ index es/APAIS), Google, Google Scholar, and the Organisation for Economic Co-operation and Development (OECD) websites (https://data.oecd.org/healt hres/health-spend ing.htm). The major search term concepts were "Medicare", "Pharmaceutical Benefits Scheme", "health financing", "out-of-pocket costs", "universal healthcare", and "public-private sector partnership" (Supporting Information, part 1). Study selection, data extractionFor this review, we included articles on the Australian health care system published since 2000 that reported quantitative or qualitative research or data analyses; we also included opinion articles, debates, commentaries, editorials, perspectives, and news reports published from 1 January 2015. We excluded articles in languages other than English, program-, interventionor provider-specific articles, publications regarding groups not fully covered by Medicare (eg, asylum seekers, prisoners), and search results for which full text was not available (eg, conference abstracts).Author MA screened the titles and abstracts of retrieved items for relevance; authors MA, PC, and MH independently reviewed the full text of articles for eligibility. The included articles were grouped by emergent themes for our analysis. ResultsOur database search identified 940 potentially relevant publications; after screening and full text review, 28 study reports were deemed eligible for our rev...

Challenges for Medicare and universal health care in Australia since 2000

“…In their article discussing challenges for Medicare in Australia since 2000, Angeles and colleagues explicitly excluded coverage of groups that lack Medicare access, including people in prisons. 1 They did, however, note the lack of success in addressing the vast health inequities faced by Indigenous Australians. 1 Australia is currently failing to meet its Closing the Gap targets to reduce the number of Indigenous adults and children in custody.…”

“…1 They did, however, note the lack of success in addressing the vast health inequities faced by Indigenous Australians. 1 Australia is currently failing to meet its Closing the Gap targets to reduce the number of Indigenous adults and children in custody. 2 Indigenous people continue to be massively over-represented in Australian custodial settings, where they are further disadvantaged by exclusion from Medicare.…”

The feasibility of integrating an alcohol screening clinical decision support tool into primary care clinical software: A review and Australian key stakeholder study

“…Primary care services in Australia provided by general practitioners (GPs-i.e., family physicians), practice nurses, and Aboriginal Health Workers are subsidised by public/government funding through the Medicare Bene ts Scheme (Australia's publicly universal health care insurance scheme-referred to below as 'Medicare'). Despite the subsidy, patients' out-of-pocket costs are rising in part due to a 'freeze' on Medicare rebates that commenced in 2013 [22]. Primary care professionals often have established longstanding therapeutic relationships with their patient by the time they begin planning for pregnancy or becoming pregnant.…”

What is the future of universal health coverage in Australia?

“…In their review of 76 articles published since 2000, Angeles and colleagues 7 provide a high level analysis of the fragmentation that characterises the way Australia delivers health care, and the resulting systemic problems such as increasing out‐of‐pocket costs, poorer health outcomes for Indigenous Australians, high drug prices, and policy confusion over the role of private health care in relation to the public system. The authors conclude that “reforms of the universal health care system over the past twenty years have been piecemeal and uncoordinated”, and that “[e]ffective, systemic, and comprehensive reforms of the Australian health system” are long overdue.…”