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December 25, 1996, Vol 276, No. 24 >
ARTICLE | December 25, 1996

The Australian Health Care System: Title and subTitle BreakAre the Incentives Down Under Right Side Up? FREE

John W. Peabody, MD, DTM&H, PhD; Stephen R. Bickel, MD, MBA, MPH; James S. Lawson, MBBS, MD, MHA
[+] Author Affiliations

Edited by Annette Flanagin, RN, MA, Associate Senior Editor.

Reprints: John W. Peabody, MD, PhD, RAND, 1700 Main St, Santa Monica, CA 90407-2138.


JAMA. 1996;276(24):1944-1950. doi:10.1001/jama.1996.03540240022014
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References

AFTER EXAMINING the Australian health care system, readers should recall George Bernard Shaw's comment about 2 countries separated by a common language. The statement is more than just poetic when the subject is health. Any comparison of the United States with Australia is facilitated by a familiar nomenclature, a shared heritage, and a similar practice of medicine. The mortality and morbidity rates in the 2 countries are comparable. In addition, the existence of parallel public and private financing of services in both countries leaves an overall impression that little distinguishes Australia from the United States.

Despite comparable outcomes and similar revenue sources, there are marked differences in the organization, funding, and delivery of health care in the 2 countries. Australia's system is financed by public and private sources that are designed to operate in parallel, while costs are regulated by a combination of global hospital budgets, strict fee schedules, and

REFERENCES

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Australian Institute of Health and Welfare. Australia's Health 1994: The Fourth Biennial Health Report of the Australian Institute of Health and Welfare . Canberra, Australia: Australian Government Publishing System; 1994;:116-182.
2 +
Stewart ME, Levit KR, Sensenig AL.  National health expenditures, 1993 . Health Care Financ Rev . (Fall) 1994;;16:247-294.
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Australian Institute of Health and Welfare. National Health Labour Force Bulletin No. 3: Medical Labour Force 1992-1993 . Canberra, Australia: Australian Institute of Health and Welfare; July 1995;.
4 +
American Medical Association. Survey and Data Resources: Physician Characteristics and Distribution in the United States, 1995-96 . Chicago, Ill: American Medical Association; 1996;.
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Lawson J, Forde K.  Medicare related payments to Australian medical practitioners . Aust Health Rev . 1993;;16:353-370.
6 +
World Bank. World Development Report 1995: Workers in an Integrating World . New York, NY: Oxford University Press; 1995;.
7 +
Richardson J.  Medical technology and its diffusion in Australia . Int J Technol Assess Health Care . 1988;;4:407-431.
8 +
Schieber G, Poullier JP, Greenwald LM.  US health expenditure performance: an international comparison and data update . Health Care Financ Rev . (Summer) 1992;; 13:1-87.
9 +
Committee for the Economic Development of Australia. A Plan for Health Policy Reform: Report of the Strategic Issues Forum . Canberra, Australia: Committee for the Economic Development of Australia; December 1993;:22-119.
10 +
World Health Organization. World Health Statistics: Annual 1993 . Geneva, Switzerland: World Health Organization; 1994;.
11 +
Hailey DM, Roseman C.  Health care technology in Australia and New Zealand: contrasts and cooperation . Health Policy . 1990;;14:177-189.
12 +
World Health Organization. WHO Symposium. Presented at Health System Reforms: Australia, Hong-Kong, New-Zealand, Singapore; November 1994; Manila, Philippines.
13 +
Peabody JW, Lee SW, Bickel S.  Health for all in the Republic of Korea: one country's experience with implementing universal health care . Health Policy . (December) 1994;;30:29-42.
14 +
Peabody JW, Yu J, Wang Y, Bickel SR.  Health system reform in the Republic of China: formulating policy in a market-based health system . JAMA . 1995;;273:777-781.
15 +
Labonte R.  Medicare in Australia: should Canadian doctors envy physicians down under? alternatives . Can Med Assoc J . (April) 1987;;136:888-892.
16 +
Organization for Economic Cooperation and Development (OECD). The Reform of Health Care Systems: A Review of Seventeen OECD Countries . Paris, France: Organization for Economic Cooperation and Development; 1994;:55-80.
17 +
Collopy BT.  Audit activities in Australia . BMJ . 1991;;303:1523-1525.
18 +
Private Health Insurance Administration Council and Australian Institute of Health and Welfare Health Expenditure Data Base. Australia's Health 1996: The Fifth Biennial Health Report of the Australian Institute of Health and Welfare . Canberra, Australia: Australian Government Publishing Service; June 1996;.
19 +
Lawson JS.  Decentralizing health services in Australia . World Health Forum . 1991;;12:96-98.
20 +
ICI Australia Operations. Mediguide: A Guide to Understanding Medicare . Melbourne, Australia: ICI Australia Operations; 1994;:5-6.
21 +
Arnold PC.  Medicare down under: bureaucracy triumphant . JAMA . 1988;;259:2903.
22 +
Australian Health Insurance Commission. Annual Report 1994-1995: Health Insurance Commission . Canberra, Australia: Australian Health Insurance Commission; 1995;.
23 +
Altman S, Jackson T.  Health care in Australia: lessons from down under . Health Aff (Millwood) . (Fall) 1991;;10:129-146.
24 +
Australian Health Insurance Commission. Annual Report 1995-1996: Health Insurance Commission . Canberra, Australia: Australian Health Insurance Commission; 1996;.
25 +
Lawson JS.  Lessons from the Australian system . Physician Exec Int Health Care . 1993;;19( (6) ):17-20.
26 +
Organization for Economic Cooperation and Development. Organization for Economic Cooperation and Development (OECD) Health Data: Comparative Analysis of Health Systems . Paris, France: Organization for Economic Cooperation and Development; 1993;:55-80.
27 +
Schieber G, Poullier JP, Greenwald LM.  Health care systems in twenty-four countries . Health Aff (Millwood) . (Fall) 1991;;10:22-38.
28 +
Johnsson J.  Aussie CEO's: managing private hospitals in a public system . Hospitals . (June) 1991;:42-46.
29 +
Lawson J.  A comparison of costs: Australian public non teaching, public teaching and private hospitals . Aust Health Rev . 1995;;18:116-122.
30 +
Cooper-Stanbury M, Solon R, Cook M, et al. Hospital Utilisation and Costs Study 1991-1992, Vol 1: A Survey of Public Hospitals and Related Data . Canberra, Australia: Australian Government Publishing Service; 1993;:1-193. Australian Institute of Health and Welfare, Health Services Series monograph No. 5.
31 +
Donaldson C, Gerard K.  Minding our P's and Q's? financial incentives for efficient behavior . Health Policy . 1991;;17:1751-1776.
32 +
Gillett S, Mays L. Waiting Lists: Towards National Statistics . Canberra, Australia: Australian Institute of Health and Welfare; 1994;:170-176.
33 +
National Health Strategy. Hospital Services in Australia: Access and Financing, National Health Services Issues Paper No. 2 . Canberra, Australia: National Health Services; 1991;.
34 +
Collopy BT, Balding C. The Australian Development of National Quality Indicators in Health Care . Washington, DC: Joint Commission on Accreditation of Healthcare Organizations; 1993;:510-516.
35 +
Hailey DM.  The influence of technology assessments by advisory bodies on health policy and practice . Health Policy . 1993;;25:243-254.
36 +
Richardson J. The Effects of Consumer Co-Payments in Medical Care: National Health Strategy Background Paper No 5 . Canberra, Australia: Commonwealth Department of Health, Australian Government Publishing Service; 1991;.
37 +
Mackey P. Pharmaceutical Benefits Scheme and the Pharmaceutical Industry—1990 Update . Canberra, Australia: Parliamentary Research Service, background paper for the Parliament of Australia; 1990;.
38 +
Schwartz WB.  The inevitable failure of current cost-containment strategies: why they can provide only temporary relief . JAMA . 1987;;257:220-224.
39 +
Selby Smith C, Hailey D, Drummond M.  The role of economic appraisal in health technology assessment: the Australian case . Soc Sci Med . 1994;;38:1653-1662.
40 +
Adams T.  Australia's health in the 1990's . J Public Health Policy . (Spring) 1992;; 13:97-101.
41 +
Kassirer JP.  Our ailing public hospitals . N Engl J Med . 1995;;333:1348-1349.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Australian Institute of Health and Welfare. Australia's Health 1994: The Fourth Biennial Health Report of the Australian Institute of Health and Welfare . Canberra, Australia: Australian Government Publishing System; 1994;:116-182.
2 +
Stewart ME, Levit KR, Sensenig AL.  National health expenditures, 1993 . Health Care Financ Rev . (Fall) 1994;;16:247-294.
3 +
Australian Institute of Health and Welfare. National Health Labour Force Bulletin No. 3: Medical Labour Force 1992-1993 . Canberra, Australia: Australian Institute of Health and Welfare; July 1995;.
4 +
American Medical Association. Survey and Data Resources: Physician Characteristics and Distribution in the United States, 1995-96 . Chicago, Ill: American Medical Association; 1996;.
5 +
Lawson J, Forde K.  Medicare related payments to Australian medical practitioners . Aust Health Rev . 1993;;16:353-370.
6 +
World Bank. World Development Report 1995: Workers in an Integrating World . New York, NY: Oxford University Press; 1995;.
7 +
Richardson J.  Medical technology and its diffusion in Australia . Int J Technol Assess Health Care . 1988;;4:407-431.
8 +
Schieber G, Poullier JP, Greenwald LM.  US health expenditure performance: an international comparison and data update . Health Care Financ Rev . (Summer) 1992;; 13:1-87.
9 +
Committee for the Economic Development of Australia. A Plan for Health Policy Reform: Report of the Strategic Issues Forum . Canberra, Australia: Committee for the Economic Development of Australia; December 1993;:22-119.
10 +
World Health Organization. World Health Statistics: Annual 1993 . Geneva, Switzerland: World Health Organization; 1994;.
11 +
Hailey DM, Roseman C.  Health care technology in Australia and New Zealand: contrasts and cooperation . Health Policy . 1990;;14:177-189.
12 +
World Health Organization. WHO Symposium. Presented at Health System Reforms: Australia, Hong-Kong, New-Zealand, Singapore; November 1994; Manila, Philippines.
13 +
Peabody JW, Lee SW, Bickel S.  Health for all in the Republic of Korea: one country's experience with implementing universal health care . Health Policy . (December) 1994;;30:29-42.
14 +
Peabody JW, Yu J, Wang Y, Bickel SR.  Health system reform in the Republic of China: formulating policy in a market-based health system . JAMA . 1995;;273:777-781.
15 +
Labonte R.  Medicare in Australia: should Canadian doctors envy physicians down under? alternatives . Can Med Assoc J . (April) 1987;;136:888-892.
16 +
Organization for Economic Cooperation and Development (OECD). The Reform of Health Care Systems: A Review of Seventeen OECD Countries . Paris, France: Organization for Economic Cooperation and Development; 1994;:55-80.
17 +
Collopy BT.  Audit activities in Australia . BMJ . 1991;;303:1523-1525.
18 +
Private Health Insurance Administration Council and Australian Institute of Health and Welfare Health Expenditure Data Base. Australia's Health 1996: The Fifth Biennial Health Report of the Australian Institute of Health and Welfare . Canberra, Australia: Australian Government Publishing Service; June 1996;.
19 +
Lawson JS.  Decentralizing health services in Australia . World Health Forum . 1991;;12:96-98.
20 +
ICI Australia Operations. Mediguide: A Guide to Understanding Medicare . Melbourne, Australia: ICI Australia Operations; 1994;:5-6.
21 +
Arnold PC.  Medicare down under: bureaucracy triumphant . JAMA . 1988;;259:2903.
22 +
Australian Health Insurance Commission. Annual Report 1994-1995: Health Insurance Commission . Canberra, Australia: Australian Health Insurance Commission; 1995;.
23 +
Altman S, Jackson T.  Health care in Australia: lessons from down under . Health Aff (Millwood) . (Fall) 1991;;10:129-146.
24 +
Australian Health Insurance Commission. Annual Report 1995-1996: Health Insurance Commission . Canberra, Australia: Australian Health Insurance Commission; 1996;.
25 +
Lawson JS.  Lessons from the Australian system . Physician Exec Int Health Care . 1993;;19( (6) ):17-20.
26 +
Organization for Economic Cooperation and Development. Organization for Economic Cooperation and Development (OECD) Health Data: Comparative Analysis of Health Systems . Paris, France: Organization for Economic Cooperation and Development; 1993;:55-80.
27 +
Schieber G, Poullier JP, Greenwald LM.  Health care systems in twenty-four countries . Health Aff (Millwood) . (Fall) 1991;;10:22-38.
28 +
Johnsson J.  Aussie CEO's: managing private hospitals in a public system . Hospitals . (June) 1991;:42-46.
29 +
Lawson J.  A comparison of costs: Australian public non teaching, public teaching and private hospitals . Aust Health Rev . 1995;;18:116-122.
30 +
Cooper-Stanbury M, Solon R, Cook M, et al. Hospital Utilisation and Costs Study 1991-1992, Vol 1: A Survey of Public Hospitals and Related Data . Canberra, Australia: Australian Government Publishing Service; 1993;:1-193. Australian Institute of Health and Welfare, Health Services Series monograph No. 5.
31 +
Donaldson C, Gerard K.  Minding our P's and Q's? financial incentives for efficient behavior . Health Policy . 1991;;17:1751-1776.
32 +
Gillett S, Mays L. Waiting Lists: Towards National Statistics . Canberra, Australia: Australian Institute of Health and Welfare; 1994;:170-176.
33 +
National Health Strategy. Hospital Services in Australia: Access and Financing, National Health Services Issues Paper No. 2 . Canberra, Australia: National Health Services; 1991;.
34 +
Collopy BT, Balding C. The Australian Development of National Quality Indicators in Health Care . Washington, DC: Joint Commission on Accreditation of Healthcare Organizations; 1993;:510-516.
35 +
Hailey DM.  The influence of technology assessments by advisory bodies on health policy and practice . Health Policy . 1993;;25:243-254.
36 +
Richardson J. The Effects of Consumer Co-Payments in Medical Care: National Health Strategy Background Paper No 5 . Canberra, Australia: Commonwealth Department of Health, Australian Government Publishing Service; 1991;.
37 +
Mackey P. Pharmaceutical Benefits Scheme and the Pharmaceutical Industry—1990 Update . Canberra, Australia: Parliamentary Research Service, background paper for the Parliament of Australia; 1990;.
38 +
Schwartz WB.  The inevitable failure of current cost-containment strategies: why they can provide only temporary relief . JAMA . 1987;;257:220-224.
39 +
Selby Smith C, Hailey D, Drummond M.  The role of economic appraisal in health technology assessment: the Australian case . Soc Sci Med . 1994;;38:1653-1662.
40 +
Adams T.  Australia's health in the 1990's . J Public Health Policy . (Spring) 1992;; 13:97-101.
41 +
Kassirer JP.  Our ailing public hospitals . N Engl J Med . 1995;;333:1348-1349.

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