Why does universal coverage in Australia still leave some groups with worse access to health care?
Assess equity of access to health care in Australia, including barriers faced by priority populations and the strategies designed to overcome them
A focused HSC Health and Movement Science answer on equity and access to health care in Australia. Distinguishes equity from equality, maps the main barriers (geographic, financial, cultural, language, time, digital), and reviews strategies including bulk-billing incentives, the Aboriginal Health Worker model, RFDS, telehealth and refugee health services.
Reviewed by: AI editorial process; not yet individually human-reviewed
Have a quick question? Jump to the Q&A page
Jump to a section
What this sub-topic is asking
NESA wants you to define equity (as opposed to equality), identify the barriers that stop priority populations from getting the care they need despite Medicare's universal design, and assess the strategies designed to bridge those gaps. Strong responses use named Australian examples and reach a calibrated judgement about how far universal coverage actually delivers equitable access.
The answer
Access is the ability to obtain appropriate health care when and where it is needed. Equity is the principle that care should be matched to need (not divided equally) so that groups with greater need receive greater investment.
Equity versus equality
Equality distributes the same resource to everyone (e.g. one GP visit subsidy per person, identical bulk-billing rebate everywhere).
Equity distributes resources in proportion to need (e.g. higher rebates for concessional patients, dedicated funding for ACCHSs, additional incentives for rural practice, refugee-specific health programs).
A purely equal system can reproduce existing inequities because populations starting from worse health, lower income or worse access continue to fall behind under identical inputs. The Australian system is universal in design but uses equity adjustments to try to redress this.
The main barriers to access
- Geographic
- Remote and very remote Australia has fewer GPs per capita, fewer specialists, longer travel times, fewer hospitals and limited allied health. The Modified Monash Model classifies locations by remoteness, and workforce data show steep falls in service density from major cities to remote areas.
- Financial
- Out-of-pocket costs, gap fees, transport costs, lost income from time off work, and the cost of services outside Medicare (most dental, most allied health). Even small co-payments deter use by lower-income groups; the AIHW reports cost-related deferral of care, dental visits and prescriptions.
- Cultural and language
- Limited cultural safety in mainstream services; staff that do not reflect the communities they serve; English-only health information; clinical encounters that miss culturally specific concerns. This is particularly significant for Aboriginal and Torres Strait Islander Australians, recent migrants and refugees.
- Time and structural
- Working-hours-only services, long appointment waits, complex booking systems, and services concentrated away from where people live or work. Affects shift workers, carers, parents and the time-poor.
- Health literacy and digital access
- Understanding the system, knowing when and where to seek care, navigating online booking, telehealth and the My Health Record. Digital exclusion (no smartphone, no data, low digital literacy) creates a second-tier barrier.
- Discrimination and stigma
- Real and perceived discrimination in services (racial, gender, sexuality, disability, mental illness, weight) delays presentation and reduces continuity.
Strategies to address barriers
- Medicare bulk-billing incentives
- Commonwealth payments to GPs who bulk-bill concession card holders, children and pensioners, including the tripling of the bulk-billing incentive announced in 2023, specifically targeting financially sensitive groups.
- Aboriginal and Torres Strait Islander Health Worker model
- A regulated workforce category, trained and embedded in ACCHSs and some mainstream services, providing culturally safe primary care, health promotion and clinical assistance. Combined with Aboriginal Health Practitioners (a separately regulated profession), this workforce is central to the NACCHO model.
- Royal Flying Doctor Service (RFDS)
- Delivers emergency aeromedical retrieval, GP and primary care clinics, dental, mental health and telehealth across remote and very remote Australia. Long-standing example of a service designed around geographic equity.
- Telehealth
- Medicare-funded telehealth, expanded significantly during the COVID-19 pandemic and partly retained, lowers the geographic and time barriers for many consultations. Limits: requires connectivity and digital literacy; not appropriate for physical examinations and acute presentations.
- Refugee and migrant health programs
- State-funded refugee health services in NSW, Victoria and other jurisdictions provide initial health assessments, immunisation catch-up, mental health support and translated information; Translating and Interpreting Service (TIS National) supports clinical consultations.
- LGBTQI+ health services
- Dedicated services (e.g. ACON in NSW, Thorne Harbour Health in Victoria) provide community-led, culturally appropriate primary care, mental health and sexual health services for LGBTQI+ Australians, addressing documented stigma in mainstream care.
- Gendered access initiatives
- Women's health centres and dedicated men's health initiatives address differing presentation patterns (men present later, women carry more unpaid caring load, gendered conditions need dedicated services).
Assessment of progress
Universal coverage closes some gaps and leaves others. Bulk-billed GP visits remove one financial barrier but not transport, time off work or specialist gap fees. Telehealth narrows geographic distance but assumes digital access. Workforce maldistribution (urban concentration of doctors) remains a long-standing structural issue despite incentive schemes. The honest judgement is that Australia's system is more equitable than many comparable systems but still produces graded outcomes by income, remoteness and Aboriginal and Torres Strait Islander status.
Examples in context
Example 1. The Royal Flying Doctor Service (RFDS). Founded by Reverend John Flynn in 1928, the RFDS provides aeromedical emergency retrieval, GP and primary care clinics, dental, mental health and telehealth across remote and very remote Australia. It is funded through a combination of Commonwealth and state grants, fundraising and Medicare. Its value for HMS answers is that it is a named, long-standing, geographically targeted equity intervention that you can point to without hedging, and it illustrates that geographic equity requires dedicated service design rather than just better signposting to the mainstream system.
Example 2. The Aboriginal and Torres Strait Islander Health Worker workforce. This is a regulated workforce category trained to provide culturally safe primary care, health promotion, clinical assistance and community liaison. Aboriginal Health Workers and Aboriginal Health Practitioners are embedded in ACCHSs and increasingly in mainstream services. The workforce model addresses several barriers at once (cultural, language, trust, continuity) and is a key reason the NACCHO model achieves better engagement than mainstream services in many sites. For exam purposes this is the canonical workforce-based equity strategy.
Try this
Q1. Distinguish between equity and equality in health care, using one example. [3 marks]
- Cue. Equality = same resource to everyone (identical Medicare rebate); equity = resource matched to need (extra bulk-billing incentive for concession card holders, dedicated ACCHS funding). Equity is needed when starting positions differ.
Q2. Identify three barriers to access for Australians living in remote areas, and for each, describe a strategy used to address it. [6 marks]
- Cue. Geographic distance plus the RFDS aeromedical service. Workforce shortage plus rural training incentives and the Modified Monash Model classification. Time and continuity plus Medicare-funded telehealth. Bonus: cultural barriers plus the Aboriginal and Torres Strait Islander Health Worker workforce in remote ACCHSs.
Q3. Assess the extent to which Medicare delivers equitable access to health care for all Australians. [8 marks]
- Cue. Medicare is universal in design and bulk-billing covers many GP visits, which removes one financial barrier. It does not cover most dental or allied health, leaves significant specialist gaps, and is delivered by a workforce concentrated in cities. Equity adjustments (bulk-billing incentives, telehealth items, ACCHS funding) narrow but do not close gaps for priority populations. Reach a calibrated judgement: more equitable than many comparable systems, not yet fully equitable.
Related dot points
- Examine the structure, funding and roles of Australia's health care system, including Medicare, the PBS, public and private hospitals, primary care, allied health, and Aboriginal Community Controlled Health Services
A focused HSC Health and Movement Science answer on the structure and funding of Australia's health care system. Covers Medicare, the PBS, public and private hospitals, primary care, allied health, and Aboriginal Community Controlled Health Services with their funding flows and respective roles.
- Analyse health inequalities between population groups in Australia and explain why specific groups are designated priority populations
A focused HSC Health and Movement Science answer on health inequalities and priority populations. Distinguishes inequalities from inequities, identifies who is designated a priority population in Australia, explains how priority status is decided, and contrasts targeted versus universal approaches with named programs.
- Analyse the determinants of health (individual, sociocultural, socioeconomic, environmental) and how they interact to create health inequities in the Australian population
A focused HSC Health and Movement Science answer on the determinants of health. Defines individual, sociocultural, socioeconomic and environmental determinants; explains how they cluster and interact; applies the framework to a named Australian priority population.