This paper is the first in a series that examines the way health services are funded and delivered in other nations. The nations profiled all aim to achieve the noble goal of Canada?s health care system: access to high quality care regardless of ability to pay. How they organize to achieve that goal differs markedly from the Canadian approach. So do their performances and results.

The first nation studied in this series is Australia. The Australian health care system provides some of the best outcomes when compared with other developed nations that have universal approaches to health care insurance. A careful examination of the Australian health care system will provide insights and information that will be useful in the Canadian debate over the future of Medicare.

Health system performance?Canada compared to Australia

Looking at factors such as the ability of the health care system to provide healthy longevity, low levels of mortality from disease, and effective treatment for both chronic and terminal illnesses, it seems the Australian health care system broadly performs at a level similar, if not superior, to that in Canada. Specifically, the Canadian health care system outperforms the Australia?s in four of 13 measures examined: two of three measures of primary care performance, and two of five measures of patient safety. Conversely, the Australian health care system outperforms the Canada?s in eight measures: infant mortality, mortality amenable to health care, two of three measures of in-hospital mortality, one of three measures of primary care performance, and three of five measures of patient safety.

Lessons for Canada

The combination of superior access to health care and potentially superior health outcomes for substantially lower cost suggests there is much Canadians can learn from the Australian health care system. Importantly, emulating the Australian health care system would not require a marked departure from the current tax-funded, provincially managed, federally supported health care system in Canada. An Australian approach to health care in Canada would primarily require important changes to financial flows within provincial tax-funded systems, a greater reliance on competition and private ownership, and public support for private insurance cover.

The Australian health care system departs from the Canadian model in the following important ways:

• cost sharing for outpatient medical services;
• some private provision of hospital and surgical services;
• activity-based funding for hospital care;
• broad private, parallel health care sector with taxpayer support and dual practice.

Of these core policy differences, three can be implemented by Canada?s provinces without violating the letter of the Canada Health Act (CHA): private hospital services and surgical facilities; activity-based funding; and public support for private insurance coverage with dual practice.