I posted a comment in response to a question on the blog but WordPress ate it so I will try to Post some thoughts about the Australian system. In the 1970s, Australia may have had the best system in the world but politics, as usual, screwed it up. When I was first starting out in the 1970s, we were out for dinner with a couple of Australian surgeons. They explained the system as it existed at the time. The hospitals were almost all owned by the states which funded them. There was a private health care system, called “Medicare” in which individuals who wanted private care paid a monthly premium though the Post Office. All hospital care was in the state owned public hospitals. The hospital based specialists cared for everyone regardless of insurance status in the same setting.
In the early days of the National Health Service in England, a similar situation existed with private patients in NHS hospitals. Then, in the early 1970s, under the Labour government, the unions of NHS employees refused to care for private patients. The result was that Harley Street specialists and their patients left for Belgium. A few years later, there was a small scandal in which the Labour Health Minister had her hysterectomy performed in Belgium by a private specialist. Such hypocrisy is an old story.
In Australia, the Labor Party campaigned in the 1984 election telling voters that, if they were elected, health care would be free. They would abolish the Medicare premium. As it happened, they had made no provision to pay doctors. It’s not clear if this was the result of ignorance on their part or if it was a calculated risk in an election they did not expect to win.
I visited Australia a few years later and saw the remains of the mess. Big states, like New South Wales, had no private hospitals and hospital based specialists, like surgeons, had no source of income. Patients dropped their Medicare premium and the doctors were screwed. With time, there has been a reorganization and official descriptions gloss over the story. If you read this description, for example, there is no description of the chaos that I found in 1988. There were daily newspaper stories, at the time, of patients going without treatment.
I was visiting friends, two GPs in Toowoomba, in Queensland. From them, I learned considerable background. Queensland, the most conservative Australian state, had both private and public hospitals. The public hospitals were not on the same level of sophistication and equipment as the private ones. The doctors in Queensland told their patients that, if they wanted private care, they had better pay their Medicare premiums. My friends owned their own office building and surgery center (called day-surgery). The public hospital also had a day surgery across the street from the private one. A year after my visit, the public hospital approached the two GPs and asked them if they would take over management of the publicly own day surgery as well as their own.
I think most of the major mistakes of the Labor government have been corrected with time. I don’t think the system is as good as it was 30 years ago.
Thanks very much for this! Quite interesting.