UNIVERSAL HEALTH CARE IN
THE 21ST CENTURY
Dr Anne-marie Boxall
Director, Deeble Institute for Health
Policy Research
Austr...
THE DAWN OF THE 21ST CENTURY
WINSTON
CHURCHILL
“THE FARTHER BACKWARD YOU CAN
LOOK, THE FARTHER FORWARD YOU
ARE LIKELY TO SEE”
Medibank developed in 1968
Designed to address problems of the day
 Access to GPs, medical specialists, and public hosp...
THEN AND NOW
 Simplicity
 “The simpler we make a health scheme the more chance it has of
delivering the services to those who need th...
 Does universal access to health care matter?
 Is Medicare still universal?
 What can we do about it?
CRITICAL QUESTIONS
DOES UNIVERSAL
HEALTH CARE MATTER?
 The WHO says so
 All WHO member states (includes Australia) made a commitment to
achieving universal health cover (Worl...
IS MEDICARE
UNIVERSAL IN THE 21ST
CENTURY?
Free access to public hospitals remains
Waiting lists for elective surgery can be long
 PHI have preferential access
A...
Bulk-billing rates for medical services
High for GPs (83%)
Low for medical specialists (28%)
Access to doctors very li...
Jurisdiction Bulk-billing rate (all services, %)
ACT 65.8
WA 71.1
Tas 74.1
Vic 76.6
Qld 77.5
SA 78.1
NT 85.0
TOTAL 77.4
Da...
GP bulk-billing rates (2010-11 data)
46% Canberra, Fraser (ACT), 57% Curtin
(Perth, WA), 59% Higgins (Melbourne, VIC)
9...
Federal budget 2014-15
$7 co-payment on all previously bulk-billing GP,
pathology and diagnostic imaging services
MBS r...
MEDICARE ≠ HEALTH SYSTEM
 Medicare is not the entirety of health system
 Insurance scheme that covers medical and hospit...
WHO FUNDS HEALTH CARE?
Australian
government
43%
State/territory
governments
27%
Health insurance
funds
8%
Individuals
17%...
Federal government
 E.g. PBS, ACCHOs, mental health services, dental
health
State governments
E.g. Community Health Ce...
AUSTRALIAN GOVERNMENT FUNDING
MBS/PBS, 35.6
Payments to
states, 15.1
Rebates for PHI,
4.7
DVA,
3.6
Medical
expenses
rebate...
Universality of Medicare being eroded but
need to look beyond Medicare to solve the
problem
Two longstanding problems un...
Medicare established alongside PHI scheme
Voluntary PHI scheme in place since 1950s
Medibank layered on top in 1975 – m...
Private insurance covers some of the same
services as Medicare (duplicative insurance)
 Hospital treatment
 Some allied...
THE ROLE
OF PHI IN
VARIOUS
OECD
COUNTRIES
SOURCE: OECD
HEALTH AT A
GLANCE, 2013
Large duplication between Medicare and private
insurance has never been addressed
Duplication means people with PHI some...
WHAT CAN WE DO TO
MAINTAIN UNIVERSAL
ACCESS?
Universal access being eroded because
haven’t tackled longstanding problems
Not easy public policy problems to solve
Te...
Clarifying role of PHI
 Limiting role to covering optional extras (no govt subsidies)
 Opt-out system where Medicare an...
 We don’t have a clean slate to work with
 Medibank and Medicare built on existing system (FFS, insurance
model and stro...
Our health system increasingly not meeting its
objective of providing universal access to health
care
Need for reform, b...
Contact details
Dr Anne-marie Boxall
Director, Deeble Institute for Health Policy Research
Australian Healthcare and Hospi...
Anne-Marie Boxall - Deeble Institute for Health & Policy Research, Aus Healthcare & Hospitals Assoc, Uni of Syd - Universa...
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Anne-Marie Boxall - Deeble Institute for Health & Policy Research, Aus Healthcare & Hospitals Assoc, Uni of Syd - Universal healthcare in 21st century Australia

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Anne-Marie Boxall delivered the presentation at the 2014 Future of Medicare Conference.

The Future of Medicare Conference was a timely event as the Abbott government debates a full over haul of the Australian healthcare system. This conference presented a chance for government representatives, regulators, health care providers in the public and private sector, educators and private investors to come together and debate the proposed changes to Medicare as well as discuss the best practice methods of implementing new measures and frameworks.

For more information about the event, please visit: http://bit.ly/FutureofMedicare2014

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Anne-Marie Boxall - Deeble Institute for Health & Policy Research, Aus Healthcare & Hospitals Assoc, Uni of Syd - Universal healthcare in 21st century Australia

  1. 1. UNIVERSAL HEALTH CARE IN THE 21ST CENTURY Dr Anne-marie Boxall Director, Deeble Institute for Health Policy Research Australian Healthcare and Hospitals Association
  2. 2. THE DAWN OF THE 21ST CENTURY
  3. 3. WINSTON CHURCHILL “THE FARTHER BACKWARD YOU CAN LOOK, THE FARTHER FORWARD YOU ARE LIKELY TO SEE”
  4. 4. Medibank developed in 1968 Designed to address problems of the day  Access to GPs, medical specialists, and public hospitals  Acute illness and injury OBJECTIVES OF MEDICARE
  5. 5. THEN AND NOW
  6. 6.  Simplicity  “The simpler we make a health scheme the more chance it has of delivering the services to those who need them most”  Affordability  “Everyone will contribute towards the nation’s health costs according to his or her ability to pay”  Universality  “Medicare will provide the same entitlement to basic medical benefits, and treatment in a public hospital to every Australian resident regardless of income”  Efficiency  “Having the maximum number of health dollars spent on delivering health services rather than administering them”  Neal Blewett, Second reading speech, Parliament 1983 KEY FEATURES OF MEDICARE
  7. 7.  Does universal access to health care matter?  Is Medicare still universal?  What can we do about it? CRITICAL QUESTIONS
  8. 8. DOES UNIVERSAL HEALTH CARE MATTER?
  9. 9.  The WHO says so  All WHO member states (includes Australia) made a commitment to achieving universal health cover (World Health Assembly, 2005)  The UN explains why (UN General Assembly 2012)  It is the right of every human being to the enjoyment of the highest attainable standard of physical and mental health WHY DOES UNIVERSAL CARE MATTER?
  10. 10. IS MEDICARE UNIVERSAL IN THE 21ST CENTURY?
  11. 11. Free access to public hospitals remains Waiting lists for elective surgery can be long  PHI have preferential access Almost 2/3 of all elective surgery in private hospitals  75% in some speciality areas Access to private hospitals limited  No PHI, or living in rural and remote areas LIMITS OF UNIVERSALITY - HOSPITALS
  12. 12. Bulk-billing rates for medical services High for GPs (83%) Low for medical specialists (28%) Access to doctors very limited in some areas LIMITS OF UNIVERSALITY – MEDICAL CARE
  13. 13. Jurisdiction Bulk-billing rate (all services, %) ACT 65.8 WA 71.1 Tas 74.1 Vic 76.6 Qld 77.5 SA 78.1 NT 85.0 TOTAL 77.4 Data: Medicare Australia, March 2014 quarter VARIATION IN BULK-BILLING ACROSS STATES
  14. 14. GP bulk-billing rates (2010-11 data) 46% Canberra, Fraser (ACT), 57% Curtin (Perth, WA), 59% Higgins (Melbourne, VIC) 99% Chifley, 98% Fowler, Blaxland (Western Sydney, NSW) LOCAL VARIATION
  15. 15. Federal budget 2014-15 $7 co-payment on all previously bulk-billing GP, pathology and diagnostic imaging services MBS rebate reduced by $5  Only applies for first 10 visits for concession card holders, children <16  Low Gap Incentive Payment paid if these people are only charged $7 co-payment Possible end of bulk-billing threat to universality PROPOSED CHANGES TO BULK-BILLING
  16. 16. MEDICARE ≠ HEALTH SYSTEM  Medicare is not the entirety of health system  Insurance scheme that covers medical and hospital services (small range of allied health services)  Many other health programs and initiatives funded through various means  Preserving universal health care cannot rely entirely on Medicare (without radical reform)
  17. 17. WHO FUNDS HEALTH CARE? Australian government 43% State/territory governments 27% Health insurance funds 8% Individuals 17% Others 5%
  18. 18. Federal government  E.g. PBS, ACCHOs, mental health services, dental health State governments E.g. Community Health Centres, drug and alcohol programs, child health clinics Private health insurers Hospital care, some out of hospital and ancillary services, ambulance services OTHER PROGRAMS AND INITIATIVES
  19. 19. AUSTRALIAN GOVERNMENT FUNDING MBS/PBS, 35.6 Payments to states, 15.1 Rebates for PHI, 4.7 DVA, 3.6 Medical expenses rebate, 0.5 ($billion), 2011 MBS/PBS Payments to states Rebates for PHI DVA Medical expenses rebate
  20. 20. Universality of Medicare being eroded but need to look beyond Medicare to solve the problem Two longstanding problems undermining universality  Fragmented financing arrangements thwarts quality care for chronic disease  Mixed public-private health insurance with unclear roles ADDRESSING PROBLEM OF UNIVERSAL CARE
  21. 21. Medicare established alongside PHI scheme Voluntary PHI scheme in place since 1950s Medibank layered on top in 1975 – mixed public/private insurance model Various experiments with balancing mixed system Today - Medicare is universal, but 47% also have private insurance Structure of our mixed system a problem that needs addressing UNIVERSAL INSURANCE + PRIVATE INSURANCE
  22. 22. Private insurance covers some of the same services as Medicare (duplicative insurance)  Hospital treatment  Some allied health services Private insurance covers some additional services and benefits (supplementary insurance)  Dental services, optical products  Additional allied health cover  Medical specialist fees in private hospital Private insurance cannot cover some Medicare services  GPs ROLES FOR PHI IN AUSTRALIA
  23. 23. THE ROLE OF PHI IN VARIOUS OECD COUNTRIES SOURCE: OECD HEALTH AT A GLANCE, 2013
  24. 24. Large duplication between Medicare and private insurance has never been addressed Duplication means people with PHI sometimes have:  Faster access to health care  Access to a wider range of services  ….sometimes they also have higher out of pocket costs While some people have privileged access, universality is being eroded PROBLEMS WITH DUPLICATION
  25. 25. WHAT CAN WE DO TO MAINTAIN UNIVERSAL ACCESS?
  26. 26. Universal access being eroded because haven’t tackled longstanding problems Not easy public policy problems to solve Tendency to look at small-scale financing solutions (co-payments and safety nets) Should we consider larger-scale structural reforms?  They are always contentious  Little detailed policy analysis/modelling underway CAN WE FIX IT?
  27. 27. Clarifying role of PHI  Limiting role to covering optional extras (no govt subsidies)  Opt-out system where Medicare and PHI compete (must cover primary health care) Alternative health system models  Allow people to cash-out government benefits and control own funds (Medical Saving Accounts)  Allow third-party to control funds and manage care (Health Maintenance Organisations) SOME OPTIONS
  28. 28.  We don’t have a clean slate to work with  Medibank and Medicare built on existing system (FFS, insurance model and strong private sector)  Future reforms will be strongly informed by current arrangements  Reform is not easy  Labor’s long campaign for Medibank  Helps to have well developed policy proposal  Failure is often a stepping stone to success  Medibank dismantled but paved way for Medicare  New policy proposals often pragmatic solutions to problems  Medicare contested ALP policy  Bipartisan support (publicly), ideological positions harder to determine PROSPECTS OF REFORM: LESSONS FROM HISTORY
  29. 29. Our health system increasingly not meeting its objective of providing universal access to health care Need for reform, but problem not just Medicare Thinking about reforms in infancy and analysis limited ‘In a society as wealthy as ours there should not be people putting off treatment because they cannot afford the bills. Basic health care should be the right of every Australian’ Neal Blewett, 1984 CONCLUSION
  30. 30. Contact details Dr Anne-marie Boxall Director, Deeble Institute for Health Policy Research Australian Healthcare and Hospitals Association E: aboxall@ahha.asn.au QUESTIONS?

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