Healthcare in Australia: A Fundamental Right or a Privilege of the Wealthy

This article was originally published on the Consumers Health Forum of Australia's website at https://chf.org.au/blog/beyond-symptoms-healthcare-australia-fundamental-right-or-privilege-wealthy

I've always believed healthcare is a fundamental social determinant; that access to healthcare is essential for a fair society, and that Australians expect this from their governments. With less than a week away from the next Federal Budget, it's clear I need to reassess my healthcare assumptions as privatisation of the system continues to grow.

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Re-evaluating our healthcare assumptions: confronting costs and access

Increasingly, even those who are happy with the quality of the care that they receive, talk about the cost of healthcare. The key planks of our system are often understood as universal free healthcare (think Medicare) low-cost private healthcare (think no gap procedures) and affordable medicines (think the PBS). These assumptions are increasingly at odds with the actual out of pocket costs that Australians pay.

Every day GPs refer folks to see medical specialists and allied health professionals. However, due to the cost of these services, many people don’t go. ?More than once I have not booked an allied health appointment because I simply could not afford it. Too often people delay making an appointment with a medical specialist or surgical procedures, even when they have private insurance, because they're uncertain about what the out-of-pocket costs will be. People forgo medicines in favour of food in the fridge unaware that they have reached the PBS Safety Net, and their medicines are now free of charge.

Sometimes, there exists an affordable healthcare option, yet people remain unaware of its existence. Conversely, at other times, the only available option requires financial resources — and as the adage goes, money doesn't grow on trees.

Bridging the gap: aligning policy with public perception

Australia holds the promise of a world-class healthcare system in its hand. Increasingly, the reality falls short of the hype. This dissonance between promises and delivery can profoundly impact community trust and proactive engagement in essential healthcare.

Here’s the raw truth: a society that values fairness can't ignore healthcare. Free healthcare isn’t just a nice-to-have; it’s a must-have to ensure economic and social inclusion. Some might argue that we can't afford the healthcare we need or want. They will argue that the cost outweighs the benefits, especially considering other pressing financial needs within society. Perhaps this is true. The thing is, how do I, or anyone else, know what Australians think about important questions like this?

Unpacking the opaque social contract that gives governments the right to shape our healthcare system is critical. Deliberative processes can provide an opportunity for governments to more deeply understand what Australians want.

Once the contract has been spelt out, we can work together to decide how to prioritise where our taxes are spent. Maybe we do want to pay for an equitable healthcare system. I would argue that it is the most powerful way to build social cohesion and equity in Australia. Maybe we don’t.

Privatisation’s impact: balancing access and equity

Undoubtedly, private models of healthcare emphasise efficiency and profit, potentially overshadowing access and equity concerns. While recognising the benefits that privatisation can offer, such as innovation and choice, we should consider this matter thoughtfully.

Privatisation isn't inherently negative. It can facilitate patient choice, lead to certain efficiencies, mean investment in modern technology, promote healthy innovation and champion much needed disruption. Commercial approaches might improve care and the system, so we shouldn't hesitate to explore what can deliver better healthcare.?

Healthcare as a business looks to economies of scale, high throughput, low-cost models, and access to care determined by the size of your wallet. Privatisation in healthcare can lead to practices such as overdiagnosis and overtreatment. The broader landscape of healthcare in Australia is also being reshaped by more than just market forces. It is crucial to consider how other significant factors, particularly demographic changes and technological advances, are concurrently transforming our healthcare needs and systems.

Striking a balance: private gain vs. public good?

Australia has a complex and co-dependent hybrid healthcare system, with most people using both systems for their healthcare needs. We need clear boundaries and standards to ensure that privatisation complements public provision without compromising equity and accessibility.

Private health care should not be allowed to cannibalise the public system. Striking this balance is crucial to prevent the development of a two-tiered healthcare system, where access to quality care becomes contingent on financial means. Everyone, regardless of socio-economic status, rurality, ability and more, should has equitable access to essential healthcare services.

Navigating evolving challenges in healthcare provision

The landscape of healthcare is undergoing significant transformations, not only due to the privatisation discussed earlier but also due to demographic shifts and technological developments. Over the past 40 years, the planned impact of Medicare has been challenged by an ageing population, the rise of chronic diseases and the rapid pace of digital innovation. The rise in chronic diseases has necessitated a shift towards more sustained and integrated care solutions, which often come at a high cost. Similarly, advancements in technology such as genomic medicine and telehealth are reshaping patient expectations and the capabilities of healthcare providers.

Each of these evolving challenges interacts with the dynamics of privatisation. Where privatisation may drive innovation, such as in the delivery of telehealth services, it must be carefully managed to ensure that it does not exacerbate existing disparities or overlook the needs of less economically advantaged populations.

Finding the right balance, with clear national policies on the roles of private operators in healthcare, could reduce any negative effects on access and quality. Such a national framework, which would weave together legislative, regulatory, commercial, and ethical principles into a consensual and transparent framework, is essential for ensuring that the benefits of privatisation are maximised while minimising any potential drawbacks. This framework should prioritise patient welfare, affordability, and equity, while also fostering a culture of accountability and responsibility among all stakeholders.

Only through careful planning and regulation can we ensure that our healthcare system contributes positively to our health, rather than exacerbating existing disparities and challenges.

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Amplifying consumer voices: harnessing the untapped resource

Social network rating is a thing nowadays. Whether we’ve eaten in a restaurant, hopped in a ride share or bought a gift online, we are regularly being asked ‘how did we do?’ by industries and organisations.

While there are ways to measure things like a person’s experience of care (PREMs), and the outcomes of their period of care (PROMs), these have not been fully implemented throughout our healthcare systems. Where we do ask people about their healthcare experiences, they seldom know whether their feedback is heard and has influence that will benefit future users of a healthcare service.

Knowing that the users of the system get to shape the system builds trust and confidence – whether that is a dietician who actively listens to your needs through to a clinic that showcases how it changes its practice through active engagement with patients and carers. Given the dwindling trust in authority, particularly in governments, government-funded healthcare must work openly and proactively to maintain and build public trust.

Remember the elevated levels of community distrust during the height of the COVID pandemic? Trust is essential for great therapeutic relationships, for concordance with care plans and for creating a feeling of safety. There is much more we can do across the healthcare system to enhance trust.

It's no surprise that I believe health consumer organisations play a vital role with all of this. They can provide education for people about their health care rights, support people to develop their advocacy skills (whether that be so they can provide clear feedback to those involved in their care or sit on a national policy implementation taskforce) and build an active and well informed independent community voice to provide balance in national healthcare conversations. ?I’ll be continuing to tell anyone who will listen that they need to listen – not to me - but to patients, carers, and the community.?

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Looking forward: the future of Australian healthcare

Let’s take a moment to reflect on what's at stake. Our healthcare system is not just a funding or policy matter; it's a reflection of our values as a society. I am hoping to see evidence in the upcoming Federal Budget of commitments to prioritise accessibility, fairness and accountability in healthcare.

Essential healthcare is not a luxury; it is a fundamental right that ensures every Australian has the opportunity to lead a healthy, productive life. This commitment to health equity is foundational to our collective wellbeing and directly contributes to the broader goal of economic inclusion.

As Treasurer Chalmers aptly noted, 'Social democrats always argued that sharing growth was right in itself – that economic inclusion is the measure of a decent society.' By prioritising healthcare, we are investing in a more inclusive and equitable future for all Australians.