Essays on Australia

Health policy is amongst the most controversial topics in the Australian political sphere. It has been a significant issue at every federal election since the 1940s, when the Commonwealth first entered the scene, with the Chifley Labor Government introducing a national hospital service that was later removed by the Menzies Liberal-Country Party Government.

Health is Australia’s largest industry, with an expenditure in 2008-09 of $112.8 billion, or 9 per cent of GDP, five times larger than defence spending. Australia is ranked as having one of the best health systems in the world. Yet this is hardly comforting to the tens of thousands of people who are failed by it. Areas in crisis are Indigenous, rural and mental health, and health financing.

The so-called “ideological cleavage”, between the Liberal-National Coalition’s liberalist-individualist stance and Labor’s social-liberal stance, has resulted in a long-term oscillation between private and public insurance that is singular among OECD nations. It is a major detriment to the long-term security of the system.

When the Coalition was elected under John Howard in 1996, Medicare was rolled back, with a greater emphasis on the private sector, using both punitive measures, such as taxing those without private health insurance, and rewards, such as rebates.

Kevin Rudd initiated funding reform after the National Health and Hospitals Reform Commission, which reported in June 2009, and recommended that the Commonwealth increase its share of public hospital funding in return for taking some GST revenue from each state. To this day, with some states still reluctant to agree, the result has amounted to little, with the GST redistribution largely gone, the states demanding their rights to continue management of their respective systems, and a watered down oversight body. Also gone are the Government’s promises of a maximum four-hour wait in emergency departments and operations in private hospitals when public hospital waiting lists are full.

While the States and Territories have genuine concerns, it is unfortunate to see the difficulties of the Federal system obstructing well-meaning, albeit complex, reform that would deliver better patient outcomes.

Other funding issues facing the health system include the impact of user charges and the rising cost of health.

Higher user charges, which have tended to occur under Coalition governments, lead to people on lower incomes using fewer services than they require, and therefore often receiving inadequate primary and preventative health care. While this saves the taxpayer some money in the short term, in the long term the costs are far greater. A possible remedy would be to means test the safety net system in order to help fund better primary and preventative healthcare for those who most need it.

At the same time, the rising cost of health care must also be addressed. While an ageing population may be an issue, research suggests it does not significantly correlate with an increase in health care costs. Even so, costs rise every year. International studies have found that single payer systems, where the state pools finances from a variety of sources, such as public funding and employer funding, and then pays for universal healthcare, are more effective, more efficient, and less complex to administer. Yet in recent years Australia has moved away from this system toward a multipayer system, with a mix of public and private funding. This would now be difficult to change.

Mental illness is the third largest cause of disability burden in Australia, accounting for an estimated 27 per cent of years lost to disability. Depression accounts for more work days lost than any other physical or mental illness. An estimated one in five Australians experience one or more mental disorders at one time in their lives.

It is only now that the Government has initiated significant reform of mental health care. In the 2011-12 Federal Budget, Labor promised $2.2billion of extra funding for mental health care over five years. $12 million has also been put towards establishing a National Mental Health Commission. This funding boost received widespread support from experts, including the Australian Council of Social Services and the Mental Health Council of Australia.

The systems of reform initiated by the Rudd and Gillard Governments have the potential to revolutionise health care. Funding should not determine our health future, but debates in Australia still tend to focus on funding, an issue resolved in most other OECD countries decades ago. It is up to future governments to build on this reform, particularly in mental health, Indigenous health, and health care in rural areas. The Gillard Government has begun this with its mental health reform, but there is still a long way to go for health care in this country.

The John Button School Prize awards $2,500 for the best essay on a subject concerning Australia’s future by a Victorian student who is in Years 10 to 12 and is younger than 19. It also awards $2,000 to the student’s school and both student and school receive a commemorative plaque. A complete version the above essay extract can be found and a competion application form is at

www.johnbuttonprize.org.au