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Tuesday, May 16, 2017
What Canada can learn from Australia on health care
There are elements to adapt and ones to
avoid, from pharmacare, to home care, to hospital efficiency and funding, to a
mix of private and public health delivery
Stephen Duckett Expert Adviser EvidenceNetwork.ca
Click image for Hi-Res
Australia/Troy Media/ - A recent conference in Toronto addressed whether
Australia has anything to teach Canada about how Canadian medicare might evolve.
It's a useful question to explore.
and Canada share many characteristics, but Canadians may not know that one of
them is that Australia's universal health insurance scheme, Medicare, was
modelled on Canada's - albeit adapted to account for constitutional differences
between the countries.
a number of areas where Australia's experience might prove helpful. The first is
the public funding of pharmaceuticals.
has had a national Pharmaceutical Benefits Scheme since the late 1940s. It
provides comprehensive coverage against the cost of pharmaceuticals for the
whole population. The scheme, though, requires patients to make a modest
co-payment for each prescription. For people on income support (retirees, the
unemployed) the co-payment is $6.30; for the rest of the population, it's
$38.80. There is a safety net, which drops the price to zero or $6.30 after 50
to 60 prescriptions a year.
of the scheme is obvious: medicines - even the most expensive of the new
formulations - become affordable to most people.
listed on the scheme only if they've been shown to be cost-effective. This helps
to ensure the costs are commensurate with the benefits. The scheme pays more
than some countries for listed drugs - for example, New Zealand and the United
Kingdom pay less. But the prices paid in Australia are about one-third of those
paid by Canadian provinces.
downside of the Australian design is the mandatory co-payments. About one in 12
Australians who used medication say they have deferred filling or did not fill a
prescription because of cost. Among the 20 per cent of Australians with the
lowest incomes, that rises to one in 10.
area where Canada can learn from Australia is in-home care. Australia has a
national home care program that aims to keep people in their own homes as long
as possible, and out of more expensive residential aged-care
program has grown over the past 50 years, with a major enhancement in the 1980s.
It provides funding support for a wide range of services, from low-intensity
programs such as meals on wheels through to intensive in-home nursing care. The
program is being transformed, so funding will no longer be provided to
organizations but rather to individuals who need what is described as "consumer
area where lessons may be learned is in efficiency. The Australian hospital
sector is more efficient than Canada's, and further efficiency is being driven
by national adoption of activity-based or case-mix funding.
arrangement, hospitals are paid for the work they do - up to a cap. The price
per patient reflects average national costs, with marginal adjustments for such
factors as whether a patient comes from a remote area. Case-mix has replaced a
variety of schemes such as area funding, which was problematic in metropolitan
areas where a significant number of patients came from outside the local area,
and global budgets, which were associated with substantial variations in
efficiency between hospitals, with no evidence that higher-cost hospitals were
providing higher-quality services.
should not get the impression, however, that all is rosy in Australia.
Australians pay relatively high out-of-pocket costs for pharmaceuticals and
medical services. This hits the poor hardest.
also has a mixed public and private system, with physicians permitted to work in
both sectors. Private health insurance for private hospital care is subsidized -
at about 25 per cent of the cost of premiums - and there are tax penalties on
middle-to-high-income earners who don't have private insurance.
to the original political justification for the subsidies, there's no evidence
that subsidizing private care has had any benefit on the public hospital system.
In fact, waiting times for public hospital care and proportion of care in the
private system are directly rather than inversely related. In other words, more
private care is associated with more public waiting.
can learn from Australia's health care policies - both in what to adapt and what
Duckett is an expert adviser with EvidenceNetwork.ca and director of the health program at
Grattan Institute, an independent public policy think-tank based in Melbourne,
Australia. He's a former head of the Australian government Department of Health
and was the inaugural president and chief executive officer of Alberta Health