Living in the parallel universe in Australia: public Medicare and private hospitals

• Published in: Canadian Medical Association journal (CMAJ) 2005-09, Vol.173 (7), p.745-747
• Main Author: Duckett, Stephen J
• Format: Article
• Language: English
• Subjects: Australia; Canada; Elective surgery; Finance; Health care; Health care industry; Health insurance; Health Services Accessibility; Hospitals; Hospitals, Private - economics; Humans; Interinstitutional Relations; Management; Medicare; Medicare - economics; National Health Programs; Patient Admission - statistics & numerical data; Private medical care; Private Sector; Public Sector; Quality of Health Care; Services; Waiting period
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.051011

The decision in the recent Chaoulli court case may presage the development of a nontrivial private sector in the Canadian health care system. Australia models many aspects of its Medicare system on Canada's plan: Australia has a national, universal scheme that is administered, in terms of hospital access and fees, at the State level within a national framework. But in Australia, a prominent private system exists alongside, the public system. In 2003/04 about 40% of all hospital admissions were to private hospitals. Because private hospitals have tended to specialize in elective surgery, Australians still rely on the public sector for their emergency services. Public hospitals have therefore not undergone "ghettoization" into services oriented mainly toward poor people and those who are otherwise disadvantaged. This factor has been important to maintaining high-quality services in public hospitals in Australia. Before 1999, patient separations from private and public hospitals grew at roughly the same rate: about 100 000 per annum. This balance changed in the period 1999/2000 through 2001/02, however, when the health insurance policy changes showed their most concentrated effect. The combined growth across the 2 sectors was about 10% higher than in previous years, but in public hospitals the rate declined to an annual increase of about 40 000, compared with an increase to about 180 000 additional separations at private hospitals. Most of the increase was in same-day or short-stay procedures; numbers in longer-diagnosis-related groups grew relatively little over this period. (Australian National Diagnosis Related Groups classify medical admissions into groups with similar clinical condirions or related diagnoses and therefore similar resource usage. This facilitates comparisons of the activity and performance of hospitals.)