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Jeffrey Simpson

It wouldn't kill us to look at Australian health care Add to ...

Australia is by far the country most like Canada and, as such, the best country against which to benchmark ourselves.

Circumstances and details are different, of course. Solutions are never identical, but they are often surprisingly close. Solutions start from the same premises, only to diverge in their application. As in health care.

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Both countries start from the premise that there should be a comprehensive, public health-care system, available to all for basic medical needs. In this, both were and are quite unlike the United States.

The health profile of both countries is remarkably similar: life expectancy, morbidity rates, infant mortality, obesity (not all Aussies spend their lives surfing and swimming), incidence of common diseases, age of population and share of total health spending from public sources (about 70 per cent).

Now comes the wide diversion, or what to Canadians would be the Big No-No. Australia not only allows private insurance, it encourages a private system for doctors and hospital care, alongside the comprehensive public one.

In Canada, to this point anyway, any politician who suggested the Australian approach (or the quite similar New Zealand one) would be accused of anti-patriotic sentiments, immediately gunned down and buried in a political coffin marked "heresy."

Australia spends about 1.5 per cent less of its national income on health care than Canada. As in Canada, costs are rising about 6 per cent annually. Australian politicians are fretting about the increases. But the Australian population, it would appear from polls and interviews, is generally content with their system.

They complain about this or that part of it, especially waiting times in the public system (sound familiar?), but no party or major interest group wants to change the essence of the public-private system.

Australians seem to accept two propositions about private care that most Canadians do not: First, that a private system takes some spending pressure off the public system. Second, that a private system can deliver care faster, which helps patients. (An Australian friend went from a cancer diagnosis, through five tests, to surgery in two weeks using her private insurance.)

What Canadians would see as the inequities of such a system - "two-tier medicine" - Australians seem to accept as a reasonable compromise between efficiency and equity. (That tradeoff manifests itself also in Australian education, where there are many more private schools than in Canada, all receiving a state subsidy.)

Emergency room pileups in Canada, a chronic problem bordering on a disaster, are far smaller in Australia. In New South Wales and Victoria, the two largest states, 70 per cent of those who appear are seen within 20 minutes, according to the national statistical agency. That's unheard of in Canada.

Waiting times for elective surgeries can be shorter in the public system than in Canada, and far shorter in the private one, but patients still wait on average 160 days for a knee replacement, 105 for a hip job and 90 for cataract removal. Australia has a higher ratio of general practitioners, specialists and nurses relative to population than in Canada, ratios that help cut waits.

Forty-five per cent of Australians have private health-insurance for basis services (doctors, hospitals), and the national government encourages its purchase through the tax system. Everyone pays for Medicare, the basic public system, through a 1.5-per-cent levy on income. If higher-income individuals do not purchase private insurance, they pay another 1 per cent surcharge. Someone who uses the private system will likely find insurance covers most of the cost above that of the public system, but might have to pay the remaining difference.

Drug payments reflect the same public-private philosophy. Low-income people and those with chronic sicknesses pay $5.40 per prescription; the rest pay $33 per prescription under the public drug plan. Once certain overall expenditure limits are reached, low-income people pay nothing, and the per-prescription price drops to $5.40 for the rest.

Two studies of the Canadian system in the last decade, both in Quebec, have recommended variations on the Australian model. Those reports sank with nary a trace in Quebec, and obviously didn't make a ripple elsewhere in Canada, where political death awaits anyone who proposes how Australians organize and finance health care.

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