Bulletin

Issue: March 2005

Visitors

There's Medicare - and then there's Medicare

Australia has Medicare which provides universal health care to all Australians. The USA has a Medicare too which funds health care for Americans aged 65 and over and younger people with disabilities, about 14 per cent of the population.

There are some features of Australia’s Medicare system that the USA might look to imitate and conversely, Medicare USA also contains features that could be relevant in Australia.

These are among the conclusions that Dr Joan Stieber, a senior policy analyst with the Office of Legislation, Centers for Medicare and Medicaid Services, US Department of Health and Human Services, has reached since arriving in Australia last year.

Dr Stieber was based in the School of Public Health at La Trobe University, spending eight months in Australia as a 2004-2005 Packer Policy Fellow. The Fellowship grant enabled her to make a comparative analysis of preventative health services in Australia and the USA.

Her study included two major areas of enquiry. The first covered prevention funding and delivery systems and how well they meet prevention policy goals and how they could be improved.

The second covered efforts to evaluate the clinical and cost effectiveness of preventative health care initiatives in each country.

Dr Stieber explained that while American Medicare covers primarily the elderly, there are other public health insurance programs for low income people, and most Americans have private health insurance. However, there are still an estimated 45 million people without health benefits.

One of the features of American Medicare is that it covers most aspects of health care, including hospitals, outpatient care and ambulance services, under a single federal program. Conversely, while Australian health care has greater equity of access, it tends to be fragmented, with State Governments responsible for such services as hospitals and ambulances while the Federal Government pays for doctors and nursing homes.

The Australian system, apart from being universal, has other innovative features such as a national breast cancer screening program and initiatives to encourage general practitioners to become more involved in preventative medicine.

Dr Stieber said that the Australian political system’s adherence to the Westminster System, whereby the party with a majority in the lower house forms the government, has enabled Australian governments to enact big changes in health care – and in other fields as well – quite rapidly. In contrast, the American system is often characterized by legislative gridlock in Congress.

She said Australia, unlike the US, also had a well established process for assessing the cost-effectiveness of new medical services and pharmaceuticals for the purpose of insurance coverage.

Dr Stieber is one of two Americans who recently completed Packer Policy Fellowships in Australia funded by Australian media magnate, Mr Kerry Packer. The other is Ms Kate Vanden Broek from Boise, Idaho who conducted research in the Private Health Insurance Branch of the Australian Government Department of Health and Ageing in Canberra.

For a number of years, Australians have travelled to the USA on Harkness Fellowships to study aspects of American health care.

‘Ms Vanden Broek and I are the first Americans on “reverse” Harkness Fellowships to have come to Australia to examine aspects of Australian health care.

‘In addition to our research projects, an important goal of the Fellowship is to establish on-going communication and resource sharing links between the two countries,’ Dr Stieber said.