AUSTRALIA | Summary
OVERVIEW
HISTORY
During the early years of the UK colonization, over 165,000 convicts were sent over to Australia where they arrived in fleets.4 Public health initiatives began in SE Sydney in 1788 with the first fleet arriving. Several medical staff arrived with the fleet and established the New South Wales public hospital system for the convicts. With the second fleet arriving, the current system was unsustainable so they began growing the public health system. The convict hospitals were eventually handed over to civilian control when the transportation of convicts ended in 1841. They had some financial assistance from the government but it had little control over health system operations.5
- 1881: The first New South Wales Board of Health was established as a response to the smallpox epidemic under the provisions of the Infectious Diseases and Supervisions Act.
- 1896: First Public Health Act, responsible for increasing and clarifying the powers of the Board of Health.
- 1902: Revised Public Health Act, made a provision to increase the number of Health members on the Board
- 1904: Department of Public Health was established
- 1973: NSW Health commission was established which brought together psychiatric hospitals, community health services, and public health programs under the same body as that responsible for public hospitals. Board of health abolished in 1974.
- 1986: Area Health Boards, replaced many individual hospital boards.
- 1997: Health Services Act, consolidates the provisions of the former acts and introduces several new provisions for a modern healthcare system. Recognizes the importance of the roles of health promotion and education, community health, and environmental health services.
According to The Commonwealth Fund, it took 10 years of political tension to establish the current universal public health program in Australia, known as Medicare. After a few failed attempts at universal coverage, changes in parliament, and changes in government, the Medicare system was established in 1984. Additionally, Public Health Units were set up throughout New South Wales from 1990 onwards to deal with issues relating to protecting and monitoring the health of the population at a local level. Although, these units have been reduced but some still function today.6
HEALTH & HEALTH SYSTEM
The major aspect of the Australian health system is the national public health insurance, Medicare. It is mainly financed through general tax revenue with a Medicare levy on income tax. Australian citizens, residents with permanent visas, and New Zealand citizens are eligible for Medicare. It provides free public hospital care and substantial coverage for physician services and pharmaceuticals. There is little to no cost sharing for primary care and no cost-sharing for inpatient care at public hospitals. There are varying safety nets for lower-income individuals, seniors, and caregivers for high hospital costs. The lower-income population also qualifies for lower prescription drug charges. Cancer screenings and immunizations are free for certain populations.6
Although they have universal coverage, there is the option to purchase supplemental coverage through private insurance. This allows them to obtain additional coverage for general treatment or for hospital services. About 46% of the population opts in for private hospital services and 55% for general treatment such as dental, vision, and physiotherapy. The government encourages people to enroll in private insurance through a tax rebate depending on age and income. Higher-income individuals may have to pay a penalty for not having private insurance.6
In Australia, according to a report by the European Observatory on Health Care Systems, cardiovascular disease and cancer account for most deaths. Its government also reports that there is an issue are increasing rates of obesity and the challenge of managing these increasing rates of chronic disease. The population is also aging and there is an increase in overall demand for health services. Australia is challenged with containing costs that have been significantly on the rise in the past several years.7 There are two major sources of health disparities in Australia. The indigenous people experience much poorer health across a range of health indicators. The rural populations also experience health disparities with access to adequate care. It is a constant policy concern to provide better access to health care for these populations.8
All levels of government are heavily involved in the funding and delivery of healthcare. The federal government provides funding and indirect support for care and pharmaceutical as well as regulates private health insurance. They can influence the states and territories through financial arrangements such as grants and benefits to individuals or organizations. The federal government is also involved in framing broad national policies for the health system. States own and manage service delivery for public hospitals, ambulances, public dental care, community health, and mental health care. Local governments play a role in the delivery of community health and preventative health programs.6
HEALTH INDICATORS & DEMOGRAPHICS
Migration has been a key factor in population growth with 25% of Australians being born overseas. Their biggest population is working adults so there is a possibility that the population will support more older people and there will be less focus on children. Australia does have fewer elderly people than many other developed countries. Their population that is 65 and older makes up about 15% of the overall population.8 A unique aspect of Australia is that 85% of the population lives along the edges of the country. This is due to the tropical environment in these areas whereas the center of the country is a drier desert.4 Their health indicators align with those of highly developed countries.
- Life expectancy at birth: 82 years for males, 86 years for females
- Child mortality rate: 3.2 deaths per 1,000 live births
- Infant mortality rate: 2.7 deaths per 1,000 live births
- Maternal mortality rate: 6 deaths per 100,000 women giving birth
- Fertility rate: 1.8 live births per woman
- Prevalence of Obesity: 30.4%
- European White: 85%
- Asian: 12%
- Black: ~1%
- Aboriginal Ancestry: ~3%
- 0-14 years: 17.75%
- 15-24 years: 12.62%
- 25-54 years: 41.35%
- 55-64 years: 11.84%
References
1 Australia. (2020). Retrieved from https://data.worldbank.org/country/australia
2 The World Bank. (2017). Current health expenditure (% of GDP). Data. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS.
3 Australia Population (LIVE). Worldometer. (2020). https://www.worldometers.info/world-population/australia-population/.
4 Geography Now! Australia. (2015). YouTube. https://www.youtube.com/watch?v=ynHIlx5RgtI.
5 Healthcare Channel. (2020, May 22). The Rich History of the Australian Healthcare System. Healthcare Channel. https://healthcarechannel.co/the-rich-history-of-the-australian-healthca....
6 Tikkanen, R., Osborn, R., Mossialos, E., Djordjevic, A., & Wharton, G. A. (2020, June 5). Australia. Commonwealth Fund. https://www.commonwealthfund.org/international-health-policy-center/coun....
7 Australian Government Department of Health. (2019, August 7). The Australian health system. Australian Government Department of Health. https://www.health.gov.au/about-us/the-australian-health-system.
8 Hilless, M., & Healy, J. (2001). (rep.). Health Care Systems in Transition: Australia. European Observatory on Health Care Systems. Retrieved from https://www.euro.who.int/__data/assets/pdf_file/0008/96434/E74466.pdf
9 Australia Age structure. Australia Age structure - Demographics. (2020). https://www.indexmundi.com/australia/age_structure.html.
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