Australian Economic Review最新文献

The past 40 years of Medicare have seen effective policy for reducing income-related inequities in healthcare use. In this article, we describe how past and current Medicare policies have shaped, and continue to shape, healthcare access for other priority populations—Aboriginal and Torres Strait Islander peoples and LGBTIQ+ populations. Drawing on empirical evidence, we also document the importance of structural-, place- and demographic-specific nuance when designing and implementing such policies. We conclude by offering recommendations on how Medicare can strive for better and more equitable access for these priority populations over the next 40 years and beyond.

With population ageing and increased longevity, Australia faces pressing policy issues on caring for older people. As Medicare turns 40, it is timely to assess how the system has been performing, and what changes are needed to modernise Medicare. This article examines the quality and efficiency of care using hospital administrative data. We find that the current system provides good quality and efficient care for older patients, except for those living in residential aged care homes. These patients receive lower quality care yet stay longer in hospitals. We suggest alternative approaches designed around bundled payments and a single budget holder to provide incentives for integrated team-based care.

The health landscape has changed enormously since the introduction of Medicare 40 years ago. Not only have population health needs changed, the provision of health care has also evolved. A wider range of health practitioners with enhanced skills and competencies are ready and able to provide high-quality primary health care. However, expecting the funding model introduced 40 years ago to be fit for purpose to support this expanded workforce may be unrealistic. Whilst optimising person-centred team care might be the vision, currently missing is the systems thinking approach required to realise the synergistic benefits of health care teams.

To understand what Medicare aimed to achieve, we need to revisit the medico-politics of the time, and the fear of the spectre of socialised medicine. That determined what could be changed (universal insurance and contributions according to means) and what could not (private medical service provision and fee-for-service). We consider what Medicare has achieved in terms of community acceptance, fairer contributions, affordability at its establishment; and how those aims can be assessed today. While Medicare is undoubtedly a success, there are inflexibilities in its structure that are challenging in ensuring it is fit for the next four decades.

Australia's Medicare is at a mid-life reflection point. This is not a moment for existential dread or rash actions. Instead, it is a time for age-related improvement. Middle-aged Medicare would benefit from policy that reflects the benefits of subtractive change to reduce its complexity. In addition, policies prioritising the use of data science to enact technologically innovative approaches would improve overall flexibility. Finally, policy can play an important role in strengthening connections between health profession cadres, incentivising them to work together at the top of scope. With education, practice, and policy collaborating, we can enable Medicare's wellbeing for years to come.

As health care costs rise in Australia, the affordability of primary care and private health insurance (PHI) are critical concerns. Key questions include whether primary care should be free for all, and what role should PHI play alongside Medicare. The Government spends $6.7 billion on PHI rebates, yet these incentives have limited impact. The Government should reduce public support on PHI and improve primary and preventive care. Primary care should be free for all low-income people and children regardless of where they live, and cheaper for other population. This can be achieved with the current budget and better policy design.

The traditional break–fix model of healthcare, characterised by reactive interventions after the onset of diseases, is undergoing a significant transformation globally, including in Australia. This is occurring at the same time that revolutionary technologies such as artificial intelligence and precision prevention of disease are emerging. This article explores the imperative to transition from our current break–fix model of health care towards a predict–prevent model, emphasising proactive healthcare strategies underpinned by technology.

Medicare is now 40 years old, but the blueprint was developed in the 1960s by John Deeble and Richard Scotton working at the Melbourne Institute. Starting with a desire to understand the Australian health system of the early1960s, Deeble and Scotton collected much information and data on the provision of health services and their financing. This led them to be highly critical of the health system and, in response to a challenge from the Labor leader, Gough Whitlam, the development of a new system which we now know as Medicare.

The debate over universal dental insurance in Australia has persisted since the mid-1970s, as dental care was excluded from Medibank (the predecessor of Medicare) for political and economic reasons. Importantly, dental care expenses are often more predictable than other types of medical care, making insurance design more challenging. We provide an overview of proposals for public dental insurance in Australia, arguing that income-contingent loans to fund higher dental costs may provide a mechanism for expanding insurance while limiting government expenditure. Finally, we argue that a randomised controlled experiment could offer insights into the effectiveness and sustainability of various insurance models for dental care.

Four topics related to the operation of regulatory systems are considered. These concern the matters of dealing with globally sub-optimal decisions made by regulators, the problem of specifying boundaries between groups of regulated entities in the application of regulation, dealing with a situation in which there are multiple regulators, and the alignment of regulation across jurisdictional borders. It is argued that current responses to these dilemmas tend to add to levels of inefficiency in the economy, with consequences for growth. Options for resolving them are considered, including new approaches to the design of regulation.