Article examines the current provision of health care and out‐of‐pocket fees within Australia through a micro‐economic lens, identifying the access and equity implications of the dual public–private system, and considers potential systems‐level options for a way forward.
In Australia, 15% of all expenditure on health care comes directly from individuals in the form of out‐of‐pocket fees (out of pocket payments). There is concern that vulnerable groups — socio‐economically disadvantaged people and older Australians in particular, who also have higher health care needs — are spending larger proportions of their incomes on out‐of‐pocket fees for health care or being forced to forego care.
Health care services in Australia are delivered through a mixture of public and private providers, with governments subsidising the costs of care but out‐of‐pocket fees remaining a significant component. Under the universal health care system, individuals can access care in public hospitals free of charge while costs at private hospitals are subsidized under Medicare. However, Australia also has numerous policy incentives and penalties to encourage Australians to take out private health insurance and access private hospitals, and thus private specialist health care.
The authors conclude that there are numerous options for reducing out‐of‐pocket fees and promoting affordability. Moving forward with active, bold reform should be a priority to ensure promotion of equity and truly universal health care in Australia.
