The values and operation of Australia's health system, including funding, sustainability, access and equity, and how it promotes health and wellbeing

What this dot point is asking

This dot point asks you to evaluate the Australian health system against four values - funding, sustainability, access and equity - and explain how each helps promote health and wellbeing. You must define each value, give examples of how the system delivers or struggles to deliver it, and link it to health outcomes. Questions often ask you to assess how well Medicare, the PBS, the NDIS or private health insurance meets one of these values.

Funding

Funding refers to how the health system raises and allocates money to pay for services. Australia funds health through:

• The Medicare levy (a percentage of taxable income) and general taxation, which pay for Medicare and public hospitals.
• The Medicare levy surcharge, which encourages higher earners to take private cover.
• Private health insurance premiums paid by individuals, supported by the means-tested private health insurance rebate.
• Individual out-of-pocket payments, such as gap fees and PBS co-payments.

Funding promotes health and wellbeing by ensuring services such as doctor visits, hospital care and medicines are paid for so people receive treatment.

Sustainability

Sustainability refers to the system's capacity to keep meeting health needs into the future, including funding, workforce and infrastructure. Pressures include an ageing population, rising rates of chronic disease and the high cost of new technology and medicines. The system promotes sustainability through measures such as PBS subsidies negotiated to control medicine costs, the Medicare levy that grows with incomes, and a focus on prevention and health promotion to reduce future demand. A sustainable system protects health and wellbeing because the care available today will still be available tomorrow.

Access

Access refers to people being able to obtain the health services they need, when and where they need them, regardless of who they are. Medicare promotes access by providing free or subsidised treatment to all citizens and permanent residents, and bulk billing removes the upfront cost for many patients. The PBS improves access to affordable medicines. Telehealth has improved access for rural and remote Australians. Access is not equal everywhere - rural and remote areas have fewer doctors and longer waits - which is a key limitation.

Equity

Equity refers to providing care fairly according to need, so that those who need more receive more, reducing health inequalities. The system promotes equity through:

• Bulk billing and the Medicare safety net, which protect people on low incomes from large costs.
• Means-tested PBS co-payments and concession rates for pensioners and concession card holders.
• Targeted programs for groups with greater need, such as Aboriginal and Torres Strait Islander health programs.

Equity promotes health and wellbeing by lifting the health of disadvantaged groups, narrowing the gap between population groups.

In the exam, define the value, give a concrete feature of the Australian system that delivers or limits it, and link it to a health and wellbeing outcome.