health care Occasional Papers: Health Financing Series Volume 1

Size: px
Start display at page:

Download "health care Occasional Papers: Health Financing Series Volume 1"

Transcription

1 International Health Financing approaches in Australia: to funding The Objectives health care and Players Occasional Papers: Health Financing Series Volume 1 Prepared by Bill Ross, Jamie Snasdell-Taylor, Yael Cass and Susan Azmi; Commonwealth Department of Health and Aged Care

2 Commonwealth of Australia 1999 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without permission from AusInfo. Requests and enquiries concerning reproduction rights should be directed to the Manager, Legislative Services, AusInfo, GPO Box 1920, Canberra ACT Health Financing Series Volume one ISBN Publication approval number: 2647 Papers published as part of the Occasional Paper Series are not meant to be prescriptive and do not represent any official Department of Health and Aged Care position. They are intended to further stimulate discussion on a range of critical issues, and cover essential points of the debate. The views expressed in these papers are not the views of the Commonwealth Government. This paper is also available on the Department's web site: For further information about this paper contact: Occasional Papers Department of Health and Aged Care Portfolio Strategies Division MDP 85 GPO Box 9848 Canberra ACT 2601 Text layout and design by Sue Hunter

3 Foreword Much of the public focus on Australia s health care system is around issues of how to best provide high quality, accessible care at a reasonable cost. That is a discussion well worth having. Yet frequently that discussion is polarised around arguments about whether the health system as a whole, or at least important components of it, are in crisis or unsustainable. Concerns about public hospital waiting lists and the affordability of private health insurance are two examples of this manifestation. Against that, there are also many good news stories about health: exciting new medical and pharmaceutical breakthroughs, or gains in public health through successful immunisation campaigns being examples. The fascination about health issues and the debate about priorities and approaches are understandable and necessary. At one level, birth, sickness and eventual death are aspects of life that confront all of us. We want the best for our families and more generally for society as a whole. At another level, almost one in every twelve dollars spent in Australia is directed at health care. The point is that we all have a keen interest in good health and in finding ways of better achieving it. In Australia, we have a health system that serves us well, and compares well, on many key indicators, to overseas systems. While there is room for improvement, the complexity of the system makes it difficult to agree on where improvements are needed, what trade offs we are prepared to make in order to gain these improvements, and what changes will deliver the results we seek. Hence the presence of as many, if not more, solutions in the debate as there are stakeholders. This series of papers coming out of the Department s Health Financing Project is intended to contribute to the debate by providing data and analysis that is not generally easily accessible. This first part of the series sheds light on issues surrounding what should be some of the broad objectives of health systems, and the roles and responsibilities for health care under the current arrangements in Australia. The papers are by no means the last words on these subjects; they do not seek to cover all perspectives, for that would be too big a task. Later papers in the series will consider particular aspects of health financing and related issues. We hope that you will find these papers a useful contribution to the debate. David Borthwick Deputy Secretary December 1999

4 Contents The Objectives of Health Financing Arrangements Introduction... 1 The role of government in health... 3 The objectives of the health system... 7 Good health...7 Low cost...9 Equity...10 Satisfaction...12 Prioritising the objectives...13 Conclusion Bibliography The Health Care System - Its Players and Their Roles and Responsibilities Introduction Overview...19 Background...19 Who finances health?...20 How expenditure is apportioned...21 Roles and responsibilities Funders...23

5 Intermediate funders...23 Does the funder matter?...24 Purchasers...25 Regulators...27 Providers...27 Consumers...28 Leaders...29 The players and their roles Commonwealth...31 State Governments...32 Local governments...33 Private health insurers...33 Service providers...34 Consumers...35 Implications of current roles and responsibilities Cost-shifting...37 Control of expenditure...38 Funding of services, not needs...39 Commonwealth State relations...40 Inability to direct from the centre...41 Conclusion Acronyms Bibliography... 47

6 The Objectives of Health Financing Arrangements Introduction In Australia, and internationally, health care is recognised as a basic right and an important contributor to economic and social well-being. Commensurately, significant public and private resources are devoted to maintaining and improving the health status of the individual, families and the population. Australia spends about 8.5 per cent of gross domestic product (GDP) on health; that is, one dollar out of every 12 is spent on health goods and services. Accompanying this level of health spending is ongoing concern that resources be well spent and that the health sector be neither over-resourced nor under-resourced. While this concern is shared internationally, along with general agreement that health care should achieve good health, low cost, equity and satisfaction, there is no consensus on how best to allocate the available resources. This is one reason at least at the broad systemic level why countries health care systems appear quite different, despite having the same broad objectives. These differences derive from a combination of factors, including: the high importance and complexity of health care funding and delivery; the lack of an optimal model for health care funding and delivery; the different starting point and history of each health system; and the cultural differences between nations which place different emphases on the various health objectives. It is these different emphases that are the subject of this paper. Within and among the four broad areas of good health, low cost, equity and satisfaction, a number of significant choices and trade-offs can be made and, ultimately, it is these choices that produce the nature of the health system. The purpose of this paper is to elucidate these choices as a basis for informing debate about changes that might be made to Australia s health system. This paper begins with an examination of the role of government in health systems and the rationale for that involvement. It then examines the objectives of the health system, looking in more detail at the four aspects of good health, low cost, equity and satisfaction, the relationships between them and the trade-offs that arise. The paper then discusses the different perspectives and competing preferences of various stakeholders. The paper closes by noting that while there may be broad acknowledgment of the value of the four objectives mentioned above, conflicting preferences make it impossible to satisfy all stakeholders in the process of reform. 1

7 Occasional Papers: Health Financing Series 2

8 The Objectives of Health Financing Arrangements The role of government in health All governments in developed countries (and many developing countries) intervene in their nations health systems. These interventions take the form of regulation, funding and provision of services, but vary substantially in their nature and extent. Governments become involved in health systems for reasons ranging from a desire to address market failure to the securing of broader social and political objectives. Market failures that governments seek to address include, for example, the availability of authoritative health information to consumers and the provision of public health services (for example, by encouraging the immunisation of children). A key social policy reason for government intervention is the provision of cost-effective, quality health services to those who cannot afford even basic health services, as this is recognised as an effective and socially acceptable way of ameliorating disadvantage. Other areas of government involvement are aimed at addressing issues such as consumer satisfaction and coordination in service delivery. Government intervention can help ensure that funds for health services are used to maximise health outcomes, subject to constraints imposed by the capacity of the health system to affect the health status of the population and the nature of the products of the health system. It is often overlooked that the health system is only one contributor to health status albeit an important one. GDP per capita is positively correlated with health status. This reflects the fact that a higher national income enables societies to provide a whole range of services that are beneficial to health, such as: social infrastructure (for example, access to potable water and good sewerage systems), socioeconomic status (for example, education levels and poverty) and social cohesion (for example, income differentials). 1 In fact, while overall health expenditure is very high in absolute dollar terms, the amount of additional health outcomes achieved for each additional dollar spent is quite low. 2 That is, health expenditure in terms of the broad population measures has a low marginal value. This is not to suggest that Australia s health system is not of crucial importance clearly health services make a difference to individual health outcomes, and those of particular population groups or disease categories. It does, however, highlight the importance of considering the opportunity cost of that expenditure; that is, the benefits that might be gained by redirecting this money to areas other than health. Considering the health sector competes with other areas of the economy for resources and that it is not the only determinant of population health status, it is clearly important that resources devoted to the health sector are used as effectively and efficiently as possible. While the focus of these concerns generally lies with government 1 See, for example, Wilkinson,

9 Occasional Papers: Health Financing Series spending, the same concerns apply to all health-related expenditure. Reflecting this, international comparisons include those based on total, not just government, health expenditure. The effective and efficient use of resources is particularly important because there is no natural limit to health expenditure. Not only are health services luxury goods (that is, consumption increases more than proportionately with income), 3 but a range of factors drive increases in health expenditure. These include new technology, population growth and ageing of the population, excess supply and increased and increasing expectations, especially as well-educated and assertive groups move into the high-use age groups. Most OECD countries anticipate that their health expenditure will increase as a proportion of GDP in coming years. This is despite diminishing marginal returns. As suggested above, governments become involved in the health system to address various forms of market failure. One major rationale for government involvement in health care is that some aspects of health are public goods. A public good is a commodity or service whose benefits are not depleted by an additional user, and for which it is generally difficult or impossible to exclude people from its benefits, even if they are unwilling to pay for them. Without government intervention, public goods simply would not be provided (Baumol et al, 1992, pp ). An example of a public good in health is the control of contagious diseases; for example, spraying mosquitos to reduce the incidence of Ross River fever within the population. 4 Further, an individual s health status is not an isolated matter. It is subject to externalities (that is, factors caused by others) which may increase or decrease the welfare of individuals without an appropriate flow of compensation (for example, allowing smoking in restaurants increases the chance that patrons will suffer from lung cancer). Government intervention seeks to minimise negative externalities (for example, by banning smoking in public places) and to maximise positive externalities (for example, by promoting immunisation since high immunisation rates confer greater protection for the whole community). Governments also intervene where they consider that health goods and services are under-consumed if left to individuals willingness to pay. These are goods and services that governments deem to have intrinsic value that will improve both the social and economic well-being of society. Programs that promote healthy eating habits, safe sex practices and cessation of smoking are all examples of instances where governments urge the consumption of health care products that they regard as merit goods. 2 See Kim and Moody (1992, pp ) for a discussion of the relative importance of health system resources and socioeconomic resources in improving infant mortality. 3 The income elasticity of demand for health goods varies according to whether the analysis examines individuals or whole nations. For individuals, most studies find elasticities between 0 and +1, classifying health care as a necessity rather than a luxury good. Cross-national studies, however, indicate that health care is a luxury good, showing estimates of elasticities ranging between 1.15 and See Folland et al (1993, pp ) for a discussion as to how these two classifications of the same good are not inconsistent. 4 Were control of contagious disease left to the market, with individuals purchasing products related to control, a free rider problem would arise: some individuals would choose to rely on the protection conferred by the purchases of others. To some degree, Australia s recent low immunisation rates are a product of free rider behaviour. 4

10 The Objectives of Health Financing Arrangements The market for health care is particularly subject to information asymmetry; that is, consumers generally know less about their medical condition, possible treatments and likely effects than do providers. Consequently, consumers are often not in a position to judge the quality or necessity of the services that providers recommend and, to some degree, have to accept providers advice implicitly. This also leaves them vulnerable to supplierinduced demand. Government interventions in this area include regulation to ensure minimum safety standards (for example, through the Therapeutic Goods Administration), and incentives and subsidies to promote some choices over others (for example, among other factors the Pharmaceutical Benefits Scheme subsidises drugs on the basis of cost-effectiveness). Where a third party (generally either government or an insurer) is paying for a service, moral hazard can lead providers and consumers, together and individually, to instigate more services than would otherwise be demanded. Income considerations and concerns about the legal consequences of not covering all possible bases (defensive medicine) can lead providers to instigate additional services. Consumers, seeking the best possible care and not faced with the costs of these services, have little incentive to question their necessity. This is exacerbated by information asymmetry, described above. As a significant payer for health services, governments want to reduce the effect of moral hazard. The most common mechanism for addressing moral hazard in health consumption is to apply a price signal to the consumer; that is, to insist that they pay at least a part of the care that they receive. Where price signals are used as a means of addressing moral hazard, the challenge is to balance the benefits with the risk that necessary services will be excluded along with the unnecessary. Along with moral hazard, the health insurance market also experiences adverse selection; that is, only those most likely to use health services sign up for the insurance. This reduces the degree to which risks are spread and increases the cost of insurance. The situation is exacerbated in countries like Australia where voluntary insurance sits alongside universal health care provision those with low risk of health service utilisation may feel comfortable that the public system will provide an adequate level of service should they need it. Finally, governments intervene to ensure that services are provided where they would otherwise be unavailable. For example, governments facilitate the availability of services to some small rural communities where such services would not otherwise be economically viable. Whilst governments become involved in the health system for good reason, they do not always intervene successfully. As Baumol et al (1992, p694) observe, governments are inherently imperfect, like the humans who compose them. The political process leads to compromises that sometimes bear little resemblance to rational decisions. Yet, often the problems engendered by a laissez faire economy are too serious to be left to the free market. 5

11 Occasional Papers: Health Financing Series 6

12 The Objectives of Health Financing Arrangements The objectives of the health system Internationally there is a high degree of commonality on the high level objectives of health systems. Musgrove (1996), for example, observed that the four main general results that people appear to want from a health care system [are]: good health, low cost, satisfaction on the part of both consumers and providers, and equity, both medical and financial. As governments and health administrators work towards these objectives, they must work within the constraints described above, cultural preferences and the systems that are already established. As a result, many international health systems exhibit significant differences. The scope for these differences lies in both the breadth of the objectives themselves and the necessity, within an environment of limited resources, for some trade-off between competing objectives. The following discussion examines the choices and trade-offs that could be said to be inherent in all health systems. Good health Within the health system, good health is derived from a combination of preventative measures, delivered both to individuals and populations, and curative interventions. It follows that a health system should: value prevention and encourage health by promoting individual and population well-being and early intervention; and when we do fall ill, provide timely, high-quality diagnosis, treatment, rehabilitation and palliation. These two aspects contributing to good health (that is, prevention and cure) compete for resources. Decisions allocating resources between these competing needs are informed by a combination of cost-effectiveness, quality of life and cultural considerations. For example: it is more effective in terms of cost and quality of life to provide clean water and sewage disposal than to cure diseases such as diphtheria and typhoid that would otherwise result; a society characterised by a low incidence of a disease (for example, tuberculosis) would likely rely mostly on curative interventions, whereas one characterised by a greater incidence of the disease would likely emphasise preventive interventions at the population level. The balance between the two approaches would depend upon their relative cost-effectiveness, the nature of the disease (including risk of transmission, mortality rates and long-term consequences), and the social acceptability of population health measures related to the disease; and there is a trade-off between expenditure on improving current health (for example, expenditure on acute care services in hospitals) and future health (for example, expenditure on population-level interventions, such as promoting changes in diet designed to improve individual health in the future). With noncommunicable diseases having been identified as a major source of current and projected demand on the 7

13 Occasional Papers: Health Financing Series health system, the balance of resources between current and future interventions will become increasingly important. This may indicate a need for a change in focus from a health system that places a heavy emphasis on curative services to one that places greater emphasis on individual and community responsibility for good health. Government involvement in decisions regarding preventive health products is aimed at addressing market failures associated with externalities. Generally, these preventive health products are either proclaimed to be merit goods (particularly in relation to interventions designed to improve individuals future health) or are themselves public in nature (for example, clean air). Even without these properties, the relative immediacy of curative services, coupled with the tendency for the demand for these services to grow (driven by information asymmetry and moral hazard), would tend to skew expenditure away from preventive health measures. This has arguably been the case in Australia. Just as there are trade-offs between population-level and individual-level interventions, in the context of limited resources there are also trade-offs between other areas that contribute to good health. These occur between: volume, in the sense of access (how many people are able to access services) and intensity (the level of service that is provided); quality, in terms of how well services are performed (quality control) and the choice of services available (the level of success associated with chosen interventions); and future capacity, in terms of the maintenance of skills and workforce capacity and the development of new techniques and technologies. As with choices between curative and population-level interventions, the trade-offs between and within the various aspects of volume, quality and future capacity are driven by a variety of criteria, including equity, costeffectiveness and cultural values or preferences. The trade-offs involved with future capacity share properties with the choice between curative and population health interventions. Therefore, the basis of the choice involves a judgment about the likely value of future developments relative to a continuation of existing methods. Whereas some decisions can be rigorously informed, others depend on value judgments. For example, in the comparison of two interventions directed at addressing the same condition, greater cost-effectiveness automatically implies best use of resources (and hence greatest coverage), although not necessarily greatest possible quality. When comparing interventions for two different conditions, a judgment is necessarily made about the relative value of two dissimilar outcomes. To take a hypothetical example, a decision may need to be made as to how many hip replacement operations it is reasonable to forgo to enable a heart bypass operation to be afforded. Such a decision will vary with the likelihood of success of each of the procedures. Decisions of this nature are rarely, if ever, so explicit or stark. Interventions are more likely to be rationed through queues or pricing than by having particular services absolutely unavailable. Nevertheless, resource 8

14 The Objectives of Health Financing Arrangements allocation decisions affect, at least indirectly, the relative availability of various interventions. This is not necessarily undesirable. Without rationing of some kind, resource allocation would be left solely to individual practitioner and patient preferences. This would make allocation decisions vulnerable to the consequences of information asymmetry, both at an individual level (with patients not receiving the most appropriate intervention) and more broadly (where the patient receiving the intervention may not be the patient with greatest need). Thus far this discussion has assumed limited overall resources, distributed amongst competing sectors and demands. The following section considers what resources are available and how they are managed more broadly. Low cost Interest in the cost of the health system relates to three areas: overall cost the proportion of total available resources devoted to health; cost to government the proportion of the resources available to government devoted to health; and cost to individuals, both through insurance contributions and at the point of service. In terms of overall expenditure, there is neither a benchmark for what should be spent on the health system nor a methodology for determining what is low or reasonable cost. Compared to other OECD countries, Australia s spending on health is about average. 5 In relation to overall expenditure, there are two main objectives: resources allocated to the health sector should represent value for money in the sense of their opportunity cost (that is, they should not be at the expense of better use elsewhere in the economy); and resources should be well utilised within the health sector to maximise health outcomes. Determining the best use of public resources and the appropriate level of resourcing for the health sector is essentially a political process and thus ultimately depends on community preferences. Debate over the length of hospital waiting lists and the need for additional resources to shorten those lists is one example of the political process acting to produce the most appropriate allocation of resources between the health and other sectors as measured by individuals preferences. By allocating resources efficiently across and within all sectors of the economy, properly functioning markets will result in the average marginal dollar in each sector returning the same amount of benefit. However, for reasons discussed above, the market does not necessarily deliver allocative efficiency in the health sector either at an individual or population level. To improve allocative efficiency, other decision-making criteria are 5 Some caution is required in the interpretation of statistics quoted because they are not always directly comparable between countries (notably due to differences in what is included as health expenditure). It should also be noted that the Australian population is younger than that of many European countries and therefore the cost of our health system is probably underrepresented in this comparison. 9

15 Occasional Papers: Health Financing Series substituted for individual and practitioner preferences. An example is evidence-based decision making where clinical and cost effectiveness are used as a criteria for determining the availability and/or subsidisation of particular interventions. Efforts to achieve allocative efficiency often involve trading-off the satisfaction of stakeholders in return for better system-wide outcomes. 6 Concerns for allocative efficiency cannot be addressed in a vacuum. Acting to improve the allocative efficiency of a health system has implications for the structural arrangements within that system. For example, allocatively efficient funding would follow the patient (as opposed to being tied to existing institutional structures) and would be allocated on the basis of greatest marginal benefit (as opposed to diagnosis). Further, technical efficiency (maximising outputs for a given level of inputs) is a necessary but not sufficient condition for allocative efficiency. The objectives in relation to overall expenditure also apply, of course, to government expenditure on health. However, an additional question also arises: the degree to which government should participate in financing the health system and the impact that this has on overall cost. Some international comparative studies suggest that a high level of public funding and a small number of payers lead to more successful cost containment (Gerdham et al, 1992, pp ). As with those of governments, the manner and amount of health expenditures made by individuals have implications for the overall cost of the health system. Individuals pay for health care both indirectly (for example, through tax and/or insurance premiums) and directly (at the time of receiving a service, assuming the full cost is not covered by insurance arrangements). The objectives in relation to individual expenditure are that health care should be affordable (the tax and/or premium burden is not excessive and the sick can afford the care they require), represent value for money and be accessible regardless of the ability to pay. The extent to which these objectives are met depends on decisions made by governments and other insurers concerning the services covered and the degree to which costs are shared with individuals. Decisions to restrict the availability of services on the basis of efficiency and cost-effectiveness may increase overall health outcomes, but at the cost of individual satisfaction and health even though, by some measure, those resources were put to better use elsewhere. Where health care systems share costs with consumers (through copayments or by requiring that consumers pay the whole cost of some services), they balance overall outcomes beyond the health sector against individual satisfaction, access and equity and hence health. This is discussed further in the following section. Equity Pursuing equity through the health system is one way of achieving a redistribution of resources without actually redistributing income. Pursuing equity as a social good through the health system generates additional benefits; 6 For example, the Pharmaceutical Benefits Scheme limits subsidised drugs to those that are judged to be cost-effective. 10

16 The Objectives of Health Financing Arrangements for example, undertaking activities that change the health profile of society at large or improve the health status of those around us will impact on our own health and happiness. Equity in the health system is normally considered against various measures of access, although it is generally acknowledged that access is being used as a proxy for outcomes and that this is a poor proxy because factors outside the health system, such as poverty, can undermine health status. Barriers to access include cost, location and cultural factors. The equity objective for the health system is generally to address these barriers, and can be achieved by: addressing vertical equity, attributing the burden of payment according to the capacity to pay; addressing horizontal equity, making services available on the basis of need; and ensuring that service delivery meets the cultural and social, as well as health, needs of the community. Funding a universal health system through progressive tax arrangements is the most common way of addressing vertical equity. Historically, a similar result has been achieved through less formal channels, such as practitioners offering free care or care at reduced prices based on some notion of capacity to pay. Imposing vertical equity means that the cost of care is borne by those who can afford to pay, irrespective of their use of the system. However, as with risk pooling (insurance) arrangements, this redistribution of costs is likely to be associated with increased moral hazard and a corresponding reduction in allocative efficiency which, in turn, could undermine both public and political support for the system. Further, there is a tension between vertical equity (which is addressed) and the cost burden placed on taxpayers as a whole. This tension may be resolved by refining the extent of services available through the health system and measuring equity against access to a particular set of services. Concerns of this nature are commonly addressed through some form of cost sharing between the taxpayer and the individual by way of some form of consumer contribution such as copayments. While consumer contributions may only be small, they are, however, associated with indiscriminately reduced access to care (that is, essential as well as discretionary services may be forgone) giving rise to concerns about horizontal equity. Another area of concern for horizontal equity relates to shortfalls in the supply of services, such as the relative lack of medical services in rural and remote communities. In principle, many of these concerns could be addressed with additional funding, but the benefit derived may be considered too small to justify the use of the resources required. Hence, for example, efforts are made to increase the number of rural general practitioners but not to create rural tertiary hospitals. In practice, this means that for some communities there is a shortfall in equity of access to services that cannot, or at least is unlikely to, be addressed. In these cases the trade-off shifts from a choice made by society, balancing a level of equity with a degree of cost, to an individual lifestyle choice at the expense of access to health services. Thus, the use of very expensive or unproven drugs that certain patients desire may not be subsidised. 11

17 Occasional Papers: Health Financing Series Different communities also have different health needs, which must be reflected in service provision. Perhaps more importantly, different communities interact with health services differently, to the extent that access is significantly hampered for some groups if the health service is not delivered in a way that reflects community needs. This is the case for Indigenous and some ethnic communities, as well as for services directed at homeless people. Satisfaction Satisfaction with the health system implies a range of qualities in the relationship between stakeholders and the system. For example, it implies willingness to: pay, indirectly though tax and/or insurance premiums and directly through point-of-service payments (because the system is seen as giving value for money); use the system (consumers have confidence in it and are not seeking alternative avenues of care); work as part of the system (medical practitioners and other health care workers feel supported in their work and appropriately remunerated); and invest (public sector investors taxpayers and governments and private sector investors are confident they will receive an appropriate return on their investment). As a result, a health system delivering a high degree of satisfaction will be well supported and is more likely to be politically stable. The factors determining satisfaction vary according to cultural expectations, individual experiences and the features of the system itself. The willingness to pay is linked to the identification of need (including an understanding of the products and benefits of the system and their relationship to social objectives, as well as individuals understanding of their own benefit from the arrangements), perceived effectiveness and confidence in the system. Issues for health care consumers include choice, quality and outcomes, timeliness, involvement and partnership in treatment decisions and the coordination or integration of their care. There are many issues that contribute to practitioner satisfaction with the health system. These include having professional autonomy, being valued and respected for one s skills and contribution (including not being confronted with expectations that they cannot meet), being supported through the availability of appropriate facilities and training, and receiving appropriate financial recognition. In some areas there is a strong link between consumer and professional satisfaction. Consumers, for example, are more likely to feel confident in their care, and hence the health system, when their practitioner believes the system allows them to provide the most appropriate care. Similarly, practitioners are more likely to feel satisfaction with the system if their patients feel confident that they will get the advice and care that they need. However, there are also areas where consumer and professional satisfaction have historically been at odds. For example, practitioners may feel undermined by consumers desire to participate in health care decisions, 12

18 The Objectives of Health Financing Arrangements particularly where consumers have strong views about the most appropriate course of treatment; for many consumers, however, active participation in care decisions is crucial to their sense of control and, ultimately, recovery. At a purely financial level, private sector investor confidence will be driven by the stability of the system (in particular the regulatory environment) and the return on their investment (including their capacity to control factors affecting that return) relative to other investments. Both public and private sector investors are concerned with technical efficiency and the most appropriate allocation of resources, including between service delivery, remuneration and shareholder return. Investors decisions in these areas, particularly where they instigate change, are periodically at odds with professional and consumer preferences, most notably where they are seen to compete with quality of care and the autonomy of practitioners and consumers to make care decisions. Prioritising the objectives In practice, there is likely to be significant agreement about a basic level of provision against each health care objective. Consequently, resolution between the various objectives need only occur at the margins. Individual perspectives inform preferences about the prioritisation of objectives. For example: citizens might prefer to focus on prevention and equity in access to services, ahead of the details of those services (such as quality and integration) or their cost and application; consumers (those already ill) are likely to emphasise access, quality, integration and coordination (that is, those factors directly affecting their ability to access care and the nature of that care) ahead of less immediate concerns such as cost, prevention, efficiency or appropriateness; taxpayers might be primarily concerned with affordability, efficiency and appropriateness that is, those aspects concerned with the amount and use of funds; practitioners might want to know that they are free to do the best they can for their patients, that the resources will be available when needed, that they will be supported as individuals and professionals in providing that care and that they will be appropriately remunerated; and investors will be concerned to ensure that they are able to generate an appropriate rate of return on their funds and that they can make the best possible use of their infrastructure investment without undue restrictions. The competing nature of these different perspectives means that few decisions, if any, in the health sector will please everyone. For example, a decision not to fund a treatment would decrease the satisfaction of consumers who felt they benefited from the treatment and the financial well-being of investors and practitioners who provided the treatment. Other decisions, such as those that effectively trade the benefits of one treatment against another, implicitly comparing the value of the health benefits to one person against another, are more complicated. Ultimately these 13

19 Occasional Papers: Health Financing Series decisions are a matter for the political process, either explicitly (such as used in Oregon, where the process involves community consultations in relation to the priorities for their safety net health system) or implicitly (as is the case in Australia). 14

20 The Objectives of Health Financing Arrangements Conclusion Governments intervene in the health sector of the economy for a variety of social, political, and economic reasons. Social policy can be advanced by assuring the provision of health services that are both cost-effective and of adequate quality. Making a basic level of these services available to each member of society is an effective mechanism for fostering social cohesion and maintaining the well-being and productivity of society. This brief paper has concentrated on the economic reasons for government intervention in the health sector, particularly market failure. The widely held view that, left to themselves, markets for health care fail to operate efficiently is substantiated by a considerable amount of theoretical and empirical evidence (see, for example, Rice, 1998; Evans, 1997). A widely quoted example is the juxtaposition of high overall expenditure and relatively poor coverage in the United States health system. Several characteristics of health sector markets contribute to their failure. Those health products that are public goods, for which property rights cannot be practically assigned, are frequently provided by governments. Without public intervention, it is likely that these goods would not be provided, as the profit maximisation incentive to health firms tends to be diluted by free rider behaviour. Health sector markets are also characterised by extensive externalities. Activities that generate externalities result in the transmission of incorrect price signals because the marginal private cost of the activity is not equal to its marginal social cost. This results in a sub-optimal distribution of resources if governments do not intervene. Goods and services produced in the health sector which have been classed by the government as merit goods are likely to be under-consumed if individuals are left to maximise their own preferences. Governments intervene to promote the consumption of these merit goods and ideally to increase society s preferences for them. Health sector markets are also prone to failure due to the asymmetry of knowledge and information between producers and consumers. Intervention by governments to increase the availability of high-quality health information is an active attempt to thwart supplier-induced demand and to reduce adverse selection and moral hazard in health insurance markets. Government intervention in the health sector is undertaken with a view to providing equity of access to a satisfactory system that promotes good health at a low cost. The pursuit of these four objectives good health, low cost, equity and satisfaction through any one country s health system is constrained by the history, culture, and resources of that nation. National resources can be a particularly binding constraint and this gives rise to the special nature of the relationship between the degree to which these objectives are attained and health financing. As national health expenditure is bound by the amount of resources that the nation commands, trade-offs between and within the four objectives must be made. It is not possible to satisfy all of society s wants in this context of limited resources. Given this, each possible health financing regime should be considered as a 15

The National Health Plan for Young Australians An action plan to protect and promote the health of children and young people

The National Health Plan for Young Australians An action plan to protect and promote the health of children and young people The National Health Plan for Young Australians An action plan to protect and promote the health of children and young people Copyright 1997 ISBN 0 642 27200 X This work is copyright. It may be reproduced

More information

HEALTH PREFACE. Introduction. Scope of the sector

HEALTH PREFACE. Introduction. Scope of the sector HEALTH PREFACE Introduction Government and non-government sectors provide a range of services including general practitioners, hospitals, nursing homes and community health services to support and promote

More information

Productivity Commission inquiry into a long term disability care and support scheme. Avant Mutual Group submission

Productivity Commission inquiry into a long term disability care and support scheme. Avant Mutual Group submission Productivity Commission inquiry into a long term disability care and support scheme Background Avant Mutual Group submission Avant Mutual Group Limited (Avant) is Australia's largest medical defence organisation

More information

Key Priority Area 1: Key Direction for Change

Key Priority Area 1: Key Direction for Change Key Priority Areas Key Priority Area 1: Improving access and reducing inequity Key Direction for Change Primary health care is delivered through an integrated service system which provides more uniform

More information

ACHPER NSW. PDHPE HSC Enrichment Day 2009. Core 1

ACHPER NSW. PDHPE HSC Enrichment Day 2009. Core 1 ACHPER NSW PDHPE HSC Enrichment Day 2009 Core 1 Health Priorities in Australia Concept map of syllabus What role do health care facilities & services play in achieving better health for all Australians?

More information

Health Policy, Administration and Expenditure

Health Policy, Administration and Expenditure Submission to the Parliament of Australia Senate Community Affairs Committee Enquiry into Health Policy, Administration and Expenditure September 2014 Introduction The Australian Women s Health Network

More information

To the Members of the Senate Standing Committee on Health Inquiry,

To the Members of the Senate Standing Committee on Health Inquiry, 8 Herbert Street, St Leonards NSW 2065 PO Box 970, Artarmon NSW 1570, Australia Ph: 61 2 9467 1000 Fax: 61 2 9467 1010 South Pacific 1 October 2014 Senate Standing Committee on Health Inquiry Parliament

More information

Private Health Insurance Consultations 2015 2016

Private Health Insurance Consultations 2015 2016 Submission to Private Health Insurance Consultations 2015 2016 November 2015 Lee Thomas Federal Secretary Annie Butler Assistant Federal Secretary Australian Nursing & Midwifery Federation PO Box 4239

More information

Barton Deakin: Commission of Audit Report Health. 7 May 2014

Barton Deakin: Commission of Audit Report Health. 7 May 2014 Barton Deakin: Commission of Audit Report Health 7 May 2014 The Report delivered to the Government by the National Commission of Audit contained several recommendations to reform the Australian health

More information

Consultation Response Medical profiling and online medicine: the ethics of 'personalised' healthcare in a consumer age Nuffield Council on Bioethics

Consultation Response Medical profiling and online medicine: the ethics of 'personalised' healthcare in a consumer age Nuffield Council on Bioethics Consultation Response Medical profiling and online medicine: the ethics of 'personalised' healthcare in a consumer age Nuffield Council on Bioethics Response by the Genetic Interest Group Question 1: Health

More information

WATER AND SEWERAGE FINANCIAL MANAGEMENT PLANNING

WATER AND SEWERAGE FINANCIAL MANAGEMENT PLANNING WATER AND SEWERAGE FINANCIAL MANAGEMENT PLANNING ABSTRACT Chris Adam, Cardno MBK (Qld) Pty Ltd In recent years, the utilities industries have been subject to far greater commercial scrutiny than ever before.

More information

Submission to the Health Information Authority on Risk Equalisation in the Irish Private Health Insurance Market

Submission to the Health Information Authority on Risk Equalisation in the Irish Private Health Insurance Market Submission to the Health Information Authority on Risk Equalisation in the Irish Private Health Insurance Market August 2010 IMO Submission to the Health Information Authority on Risk Equalisation in the

More information

Out of pocket costs in Australian health care Supplementary submission

Out of pocket costs in Australian health care Supplementary submission Out of pocket costs in Australian health care Supplementary submission The AMA welcomes the opportunity provided by the Senate Community Affairs References Committee to make a supplementary submission

More information

Health expenditure Australia 2011 12: analysis by sector

Health expenditure Australia 2011 12: analysis by sector Health expenditure Australia 2011 12: analysis by sector HEALTH AND WELFARE EXPENDITURE SERIES No. 51 HEALTH AND WELFARE EXPENDITURE SERIES Number 51 Health expenditure Australia 2011 12: analysis by sector

More information

SUBMISSION TO THE SENATE INQUIRY INTO OUT-OF- POCKET COSTS IN AUSTRALIAN HEALTHCARE. Prepared by National Policy Office

SUBMISSION TO THE SENATE INQUIRY INTO OUT-OF- POCKET COSTS IN AUSTRALIAN HEALTHCARE. Prepared by National Policy Office SUBMISSION TO THE SENATE INQUIRY INTO OUT-OF- POCKET COSTS IN AUSTRALIAN HEALTHCARE Prepared by National Policy Office May 2014 COTA Australia Authorised by: Ian Yates AM Chief Executive iyates@cota.org.au

More information

Policy Paper: Enhancing aged care services through allied health

Policy Paper: Enhancing aged care services through allied health Policy Paper: Enhancing aged care services through allied health March 2013 Contents Contents... 2 AHPA s call to action... 3 Position Statement... 4 Background... 6 Enhancing outcomes for older Australians...

More information

Aligning action with aims: Optimising the benefits of workplace wellness

Aligning action with aims: Optimising the benefits of workplace wellness Aligning action with aims: Optimising the benefits of workplace wellness Dr Michael McCoy Medibank Health Solutions Strategy & Corporate Development Health & Wellbeing September 2011 Aligning action with

More information

COOPERATIVE RESEARCH CENTRES PROGRAMME REVIEW

COOPERATIVE RESEARCH CENTRES PROGRAMME REVIEW COOPERATIVE RESEARCH CENTRES PROGRAMME REVIEW Submission by November 2014 Page 1 ABOUT RESEARCH AUSTRALIA is an alliance of 160 members and supporters advocating for health and medical research in Australia.

More information

An outline of National Standards for Out of home Care

An outline of National Standards for Out of home Care Department of Families, Housing, Community Services and Indigenous Affairs together with the National Framework Implementation Working Group An outline of National Standards for Out of home Care A Priority

More information

Payroll Tax in the Costing of Government Services

Payroll Tax in the Costing of Government Services Payroll Tax in the Costing of Government Services Research Paper Steering Committee for the Review of Commonwealth/State Service Provision Commonwealth of Australia 1999 ISBN: 1 74037 006 6 This paper

More information

Submission to the National Health and Hospitals Reform Commission (nhhrc).

Submission to the National Health and Hospitals Reform Commission (nhhrc). Submission to the National Health and Hospitals Reform Commission (nhhrc). A New Health Savings Based System for Australia. A new health savings based system is proposed based on the best aspects of the

More information

Optus Submission to Productivity Commission Inquiry into National Frameworks for Workers Compensation and Occupational Health and Safety

Optus Submission to Productivity Commission Inquiry into National Frameworks for Workers Compensation and Occupational Health and Safety Optus Submission to Productivity Commission Inquiry into National Frameworks for Workers Compensation and Occupational Health and Safety June 2003 Overview Optus welcomes the opportunity to provide this

More information

Inquiry into the out-of-pocket costs in Australian healthcare

Inquiry into the out-of-pocket costs in Australian healthcare Submission to the Senate Standing Committee on Community Affairs - References Committee Inquiry into the out-of-pocket costs in Australian healthcare May 2014 Out-of-pocket costs in Australian healthcare

More information

NATIONAL INSURANCE BROKERS ASSOCIATION OF AUSTRALIA (NIBA) SUBMISSION TO THE ECONOMIC REGULATION AUTHORITY

NATIONAL INSURANCE BROKERS ASSOCIATION OF AUSTRALIA (NIBA) SUBMISSION TO THE ECONOMIC REGULATION AUTHORITY NATIONAL INSURANCE BROKERS ASSOCIATION OF AUSTRALIA (NIBA) SUBMISSION TO THE ECONOMIC REGULATION AUTHORITY INQUIRY INTO WESTERN AUSTRALIA S HOME INDEMNITY INSURANCE ARRANGEMENTS ABOUT NIBA 16 August 2012

More information

Australia s primary health care system: Focussing on prevention & management of disease

Australia s primary health care system: Focussing on prevention & management of disease Australia s primary health care system: Focussing on prevention & management of disease Lou Andreatta PSM Assistant Secretary, Primary Care Financing Branch Australian Department of Health and Ageing Recife,

More information

Early childhood education and care

Early childhood education and care Early childhood education and care Introduction This policy brief provides an overview of the national policy and advocacy priorities on early childhood education and care. These include: access to services

More information

Submission to the Private Health Insurance

Submission to the Private Health Insurance Submission to the Private Health Insurance Consultations 2015-16 The AMA welcomes the opportunity to provide a submission to the Private Health Insurance Consultations 2015-16. The Review will no doubt

More information

Public / private mix in health care financing

Public / private mix in health care financing Public / private mix in health care financing Dominique Polton Director of strategy, research and statistics National Health Insurance, France Couverture Public / private mix in health care financing 1.

More information

Self Care in New Zealand

Self Care in New Zealand Self Care in New Zealand A roadmap toward greater personal responsibility in managing health Prepared by the New Zealand Self Medication Industry Association. July 2009 What is Self Care? Self Care describes

More information

RURAL DOCTORS ASSOCIATION OF AUSTRALIA. Submission to the Private Health Insurance Consultation

RURAL DOCTORS ASSOCIATION OF AUSTRALIA. Submission to the Private Health Insurance Consultation RURAL DOCTORS ASSOCIATION OF AUSTRALIA Submission to the Private Health Insurance Consultation Via email: PHI Consultations 2015-16 Contact for RDAA: Jenny Johnson Chief Executive Officer Email: ceo@rdaa.com.au

More information

Note that the following document is copyright, details of which are provided on the next page.

Note that the following document is copyright, details of which are provided on the next page. Please note that the following document was created by the former Australian Council for Safety and Quality in Health Care. The former Council ceased its activities on 31 December 2005 and the Australian

More information

Position Statement #37 POLICY ON MENTAL HEALTH SERVICES

Position Statement #37 POLICY ON MENTAL HEALTH SERVICES THE ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF PSYCHIATRISTS Position Statement #37 POLICY ON MENTAL HEALTH SERVICES Mental disorder is a major cause of distress in the community. It is one of the remaining

More information

Impact of Genetic Testing on Life Insurance

Impact of Genetic Testing on Life Insurance Agenda, Volume 10, Number 1, 2003, pages 61-72 Impact of Genetic Testing on Life Insurance he Human Genome project generates immense interest in the scientific community though there are also important

More information

Project Evaluation Guidelines

Project Evaluation Guidelines Project Evaluation Guidelines Queensland Treasury February 1997 For further information, please contact: Budget Division Queensland Treasury Executive Building 100 George Street Brisbane Qld 4000 or telephone

More information

Contents. What is an intergenerational report?

Contents. What is an intergenerational report? What is an intergenerational report? An intergenerational report assesses the long term sustainability of Commonwealth finances. It examines the impact of current policies and trends, including population

More information

Demand for Health Insurance

Demand for Health Insurance Demand for Health Insurance Demand for Health Insurance is principally derived from the uncertainty or randomness with which illnesses befall individuals. Consequently, the derived demand for health insurance

More information

Clinical Governance for Nurse Practitioners in Queensland

Clinical Governance for Nurse Practitioners in Queensland Office of the Chief Nursing Officer Clinical Governance for Nurse Practitioners in Queensland A guide Clinical Governance for Nurse Practitioners in Queensland: A guide Queensland Health Office of the

More information

PRACTICE FRAMEWORK AND COMPETENCY STANDARDS FOR THE PROSTATE CANCER SPECIALIST NURSE

PRACTICE FRAMEWORK AND COMPETENCY STANDARDS FOR THE PROSTATE CANCER SPECIALIST NURSE PRACTICE FRAMEWORK AND COMPETENCY STANDARDS FOR THE PROSTATE CANCER SPECIALIST NURSE MARCH 2013 MONOGRAPHS IN PROSTATE CANCER OUR VISION, MISSION AND VALUES Prostate Cancer Foundation of Australia (PCFA)

More information

Principles on Health Care Reform

Principles on Health Care Reform American Heart Association Principles on Health Care Reform The American Heart Association has a longstanding commitment to approaching health care reform from the patient s perspective. This focus including

More information

Priority Areas of Australian Clinical Health R&D

Priority Areas of Australian Clinical Health R&D Priority Areas of Australian Clinical Health R&D Nick Pappas* CSES Working Paper No. 16 ISSN: 1322 5138 ISBN: 1-86272-552-7 December 1999 *Nick Pappas is a Henderson Research Fellow at the Centre for Strategic

More information

NATIONAL HEALTHCARE AGREEMENT 2012

NATIONAL HEALTHCARE AGREEMENT 2012 NATIONAL HEALTHCARE AGREEMENT 2012 Council of Australian Governments An agreement between the Commonwealth of Australia and the States and Territories, being: t t t t t t t t the State of New South Wales;

More information

The Society of Actuaries in Ireland

The Society of Actuaries in Ireland The Society of Actuaries in Ireland Briefing Statement on Insurance provisions in the Disability Bill 2004 Introduction The Disability Bill published in September 2004 provides for certain restrictions

More information

Australian Work Health and Safety Strategy 2012 2022. Healthy, safe and productive working lives

Australian Work Health and Safety Strategy 2012 2022. Healthy, safe and productive working lives Australian Work Health and Safety Strategy 2012 2022 Healthy, safe and productive working lives Creative Commons ISBN 978-0-642-78566-4 [PDF online] ISBN 978-0-642-78565-7 [Print] With the exception of

More information

Promoting private health insurance in Ukraine

Promoting private health insurance in Ukraine Institute for Economic Research and Policy Consulting in Ukraine German Advisory Group on Economic Reform Reytarska 8/5-A, 01034 Kyiv, Tel. (+38044) 278-6342, 278-6360, Fax 278-6336 E-mail: institute@ier.kiev.ua,

More information

Health Care Systems: Efficiency and Policy Settings

Health Care Systems: Efficiency and Policy Settings Health Care Systems: Efficiency and Policy Settings Summary in English People in OECD countries are healthier than ever before, as shown by longer life expectancy and lower mortality for diseases such

More information

UHI Explained. Frequently asked questions on the proposed new model of Universal Health Insurance

UHI Explained. Frequently asked questions on the proposed new model of Universal Health Insurance UHI Explained Frequently asked questions on the proposed new model of Universal Health Insurance Overview of Universal Health Insurance What kind of health system does Ireland currently have? At the moment

More information

Building a 21st Century Primary Health Care System. A Draft of Australia s First National Primary Health Care Strategy

Building a 21st Century Primary Health Care System. A Draft of Australia s First National Primary Health Care Strategy Building a 21st Century Primary Health Care System A Draft of Australia s First National Primary Health Care Strategy Building a 21st Century Primary Health Care System A Draft of Australia s First National

More information

Submission The Health Workforce Productivity Commission Issues Paper

Submission The Health Workforce Productivity Commission Issues Paper Submission The Health Workforce Productivity Commission Issues Paper Introduction About CCI The Chamber of Commerce and Industry of Western Australia (CCI) is one of Australia s largest multi industry

More information

Response to Submissions

Response to Submissions Response to Submissions National Claims and Policies Database Access to data 28 May 2010 www.apra.gov.au Australian Prudential Regulation Authority Disclaimer and copyright While APRA endeavours to ensure

More information

Optometry Australia submission to the Commonwealth s Private Health insurance Consultations

Optometry Australia submission to the Commonwealth s Private Health insurance Consultations Optometry Australia submission to the Commonwealth s Private Health insurance Consultations Optometry Australia welcomes the opportunity to input to the Commonwealth s review of Private Health Insurance.

More information

NATIONAL WORKERS COMPENSATION AND OCCUPATIONAL HEALTH AND SAFETY FRAMEWORKS

NATIONAL WORKERS COMPENSATION AND OCCUPATIONAL HEALTH AND SAFETY FRAMEWORKS NATIONAL WORKERS COMPENSATION AND OCCUPATIONAL HEALTH AND SAFETY FRAMEWORKS SUBMISSION TO THE PRODUCTIVITY COMMISSION FROM THE BUSINESS COUNCIL OF AUSTRALIA 1 INTRODUCTION SUBMISSION The BCA makes the

More information

CHEMIST WAREHOUSE SUBMISSION TO THE COMPETITION POLICY REVIEW

CHEMIST WAREHOUSE SUBMISSION TO THE COMPETITION POLICY REVIEW CHEMIST WAREHOUSE SUBMISSION TO THE COMPETITION POLICY REVIEW MAY 2014 Table of contents 1. Introduction... 3 2. Outlet location decision-making... 3 3. Discounting... 4 4. The true cost of regulation...

More information

Health Care Challenges for the 21 st Century

Health Care Challenges for the 21 st Century Health Care Challenges for the 21 st Century Between 1992 and 2002, overall health care spending rose from $827 billion to about $1.6 trillion; it is projected to nearly double to $3.1 trillion in the

More information

Limitation of Liability

Limitation of Liability Limitation of Liability Submission to the Attorney-General (Western Australia) July 2000 The Institution of Engineers, Australia Institution of Engineers, Australia 11 National Circuit, Barton, ACT, 2604

More information

Response to the New Brunswick Government Consultation on a Prescription Drug Plan for Uninsured New Brunswickers

Response to the New Brunswick Government Consultation on a Prescription Drug Plan for Uninsured New Brunswickers Response to the New Brunswick Government Consultation on a Prescription Drug Plan for Uninsured New Brunswickers Brief submitted by The New Brunswick Nurses Union April 2012 Background The New Brunswick

More information

National Disability Long term Care and Support Scheme

National Disability Long term Care and Support Scheme National Disability Long term Care and Support Scheme Submission to the Productivity Commission Richard Madden, BSc, PhD, FIAA Professor of Health Statistics, University of Sydney August 2010 Outline This

More information

Food & Farming. Focus on Market Safety Nets. December 2015. Agriculture and Rural Development

Food & Farming. Focus on Market Safety Nets. December 2015. Agriculture and Rural Development Food & Farming Focus on Market Safety Nets December 215 Agriculture and Rural Development 1 AGRICULTURAL MARKETS AS A DRIVER FOR EUROPEAN AGRICULTURE The agricultural markets and their prices have evolved

More information

SUBMISSION TO INQUIRY INTO AFFORDABLE HOUSING. Prepared by National Policy Office

SUBMISSION TO INQUIRY INTO AFFORDABLE HOUSING. Prepared by National Policy Office SUBMISSION TO INQUIRY INTO AFFORDABLE HOUSING Prepared by National Policy Office March 2014 COTA Australia Authorised by: Ian Yates AM Chief Executive iyates@cota.org.au 0418 835 439 Prepared by: Jo Root

More information

Health expenditure Australia 2010 11

Health expenditure Australia 2010 11 Health expenditure Australia 2010 11 HEALTH AND WELFARE EXPENDITURE series No. 47 HEALTH AND WELFARE EXPENDITURE SERIES Number 47 Health expenditure Australia 2010 11 Australian Institute of Health and

More information

NATIONAL FRAMEWORK FOR RURAL AND REMOTE EDUCATION

NATIONAL FRAMEWORK FOR RURAL AND REMOTE EDUCATION NATIONAL FRAMEWORK FOR RURAL AND REMOTE EDUCATION DEVELOPED BY THE MCEETYA TASK FORCE ON RURAL AND REMOTE EDUCATION, TRAINING, EMPLOYMENT AND CHILDREN S SERVICES 1 CONTENTS Introduction... 3 Purpose...

More information

11 August 2014. Review of Australia s Welfare System CANBERRA ACT 2600. Dear Sir/Madam. Welfare Review Submission

11 August 2014. Review of Australia s Welfare System CANBERRA ACT 2600. Dear Sir/Madam. Welfare Review Submission 11 August 2014 Review of Australia s Welfare System CANBERRA ACT 2600 Dear Sir/Madam Welfare Review Submission The Financial Services Council (FSC) represents Australia's retail and wholesale funds management

More information

Policy Paper: Accessible allied health primary care services for all Australians

Policy Paper: Accessible allied health primary care services for all Australians Policy Paper: Accessible allied health primary care services for all Australians March 2013 Contents Contents... 2 AHPA s call to action... 3 Position Statement... 4 Background... 6 Healthier Australians

More information

Superannuation funds and alternative asset investment: issues for policy makers

Superannuation funds and alternative asset investment: issues for policy makers Superannuation funds and alternative asset investment: issues for policy makers As Australia s pool of superannuation assets continues to grow rapidly, many funds are allocating a growing share of their

More information

The economic contribution of sport to Australia

The economic contribution of sport to Australia January 2010 Frontier Economics 1 The economic contribution of sport to Australia This note summarises the findings of the longer Frontier Economics report Why is it important to understand the economic

More information

AUDITORS LIABILITY AND ITS IMPACT ON THE EUROPEAN CAPITAL MARKETS ABI RESPONSE TO EUROPEAN COMMISSION DG INTERNAL MARKET CONSULTATION PAPER

AUDITORS LIABILITY AND ITS IMPACT ON THE EUROPEAN CAPITAL MARKETS ABI RESPONSE TO EUROPEAN COMMISSION DG INTERNAL MARKET CONSULTATION PAPER AUDITORS LIABILITY AND ITS IMPACT ON THE EUROPEAN CAPITAL MARKETS ABI RESPONSE TO EUROPEAN COMMISSION DG INTERNAL MARKET CONSULTATION PAPER INTRODUCTION In January 2007 the EU Commission published a consultation

More information

19 May 2010. Dear Mr Hawkins

19 May 2010. Dear Mr Hawkins Caltex Australia 2 Market Street Sydney NSW 2000 Tel: (02) 9250 5000 Fax: (02) 9250 5742 GPO Box 3916 Sydney NSW 2001 www.caltex.com.au 19 May 2010 Mr John Hawkins Committee Secretary Senate Standing Committee

More information

Questions and Answers on Universal Health Coverage and the post-2015 Framework

Questions and Answers on Universal Health Coverage and the post-2015 Framework Questions and Answers on Universal Health Coverage and the post-2015 Framework How does universal health coverage contribute to sustainable development? Universal health coverage (UHC) has a direct impact

More information

Commonwealth of Australia 2008

Commonwealth of Australia 2008 Commonwealth of Australia 2008 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Commonwealth.

More information

REGULATION OF SERVICE PROVIDERS IN THE NSW WORKERS COMPENSATION SYSTEM. Submission to WorkCover March 2011

REGULATION OF SERVICE PROVIDERS IN THE NSW WORKERS COMPENSATION SYSTEM. Submission to WorkCover March 2011 REGULATION OF SERVICE PROVIDERS IN THE NSW WORKERS COMPENSATION SYSTEM Submission to WorkCover March 2011 Executive Summary In many regards, the interests of employers and workers as key stakeholders in

More information

PRODUCTIVITY COMMISSION DRAFT REPORT ON CHILDCARE AND EARLY CHILDHOOD LEARNING VICTORIAN GOVERNMENT SUBMISSION

PRODUCTIVITY COMMISSION DRAFT REPORT ON CHILDCARE AND EARLY CHILDHOOD LEARNING VICTORIAN GOVERNMENT SUBMISSION PRODUCTIVITY COMMISSION DRAFT REPORT ON CHILDCARE AND EARLY CHILDHOOD LEARNING VICTORIAN GOVERNMENT SUBMISSION 1. INTRODUCTION Victoria welcomes the opportunity to respond to the draft report of the Productivity

More information

Re: Productivity Commission Inquiry into the Economic Implications of an Ageing Australia

Re: Productivity Commission Inquiry into the Economic Implications of an Ageing Australia 11 February 2005 Chair Productivity Commission Economic Implications of an Ageing Australia PO Box 80 Belconnen ACT 2616 Email: ageing@pc.gov.au Re: Productivity Commission Inquiry into the Economic Implications

More information

NATIONAL INSURANCE BROKERS ASSOCIATION OF AUSTRALIA (NIBA) SUBMISSION ON NSW WORKERS COMPENSATION SCHEME INQUIRY. 17 May 2012

NATIONAL INSURANCE BROKERS ASSOCIATION OF AUSTRALIA (NIBA) SUBMISSION ON NSW WORKERS COMPENSATION SCHEME INQUIRY. 17 May 2012 NATIONAL INSURANCE BROKERS ASSOCIATION OF AUSTRALIA (NIBA) SUBMISSION ON NSW WORKERS COMPENSATION SCHEME INQUIRY 17 May 2012 ABOUT NIBA NIBA is the voice of the insurance broking industry in Australia.

More information

CHAPTER 8: Organisational objectives, growth and scale

CHAPTER 8: Organisational objectives, growth and scale CHAPTER 8: Organisational objectives, growth and scale The Objectives of Organisations Key Revision Points Organisational goals can be classified into a number of categories: Those that aim to make a profit

More information

VOLUNTARY HEALTH INSURANCE FOR RURAL INDIA* GYAN SINGH** ABSTRACT

VOLUNTARY HEALTH INSURANCE FOR RURAL INDIA* GYAN SINGH** ABSTRACT Health and Population - Perspectives and Issues 24(2): 80-87, 2001 VOLUNTARY HEALTH INSURANCE FOR RURAL INDIA* GYAN SINGH** ABSTRACT The rural poor suffer from illness are mainly utilising costly health

More information

BUSINESS REGULATION BENCHMARKING: PLANNING, ZONING AND DEVELOPMENT ASSESSMENTS

BUSINESS REGULATION BENCHMARKING: PLANNING, ZONING AND DEVELOPMENT ASSESSMENTS 42/120 Collins Street GPO Box 1472 Telephone +613 8664 2664 Melbourne 3000 Melbourne 3001 Facsimile +613 8664 2666 www.bca.com.au 31 August 2010 Ms Christine Underwood Business Regulation Benchmarking

More information

SUBMISSION TO THE SENATE COMMUNITY

SUBMISSION TO THE SENATE COMMUNITY SUBMISSION TO THE SENATE COMMUNITY AFFAIRS LEGISLATION COMMITTEE INQUIRY INTO THE MEDICAL RESEARCH FUTURE FUND BILL (2015) AND THE MEDICAL RESEARCH FUTURE FUND (CONSEQUENTIAL AMENDMENTS) BILL 2015 FROM

More information

3. The first stage public consultation conducted from March to June 2008 aimed at consulting the public on

3. The first stage public consultation conducted from March to June 2008 aimed at consulting the public on EXECUTIVE SUMMARY The Government published the Healthcare Reform Consultation Document Your Health, Your Life (the Consultation Document ) on 13 March 2008 to initiate the public consultation on healthcare

More information

19 September 2014 Senate Select Committee on Health PO Box 6100 Parliament House Canberra ACT 2600 health.sen@aph.gov.au

19 September 2014 Senate Select Committee on Health PO Box 6100 Parliament House Canberra ACT 2600 health.sen@aph.gov.au 19 September 2014 Senate Select Committee on Health PO Box 6100 Parliament House Canberra ACT 2600 health.sen@aph.gov.au Thank you for the opportunity to provide a submission to the Senate Select Committee

More information

Consultation on Re-Building Health Care Together. Brief submitted by The New Brunswick Nurses Union

Consultation on Re-Building Health Care Together. Brief submitted by The New Brunswick Nurses Union Consultation on Re-Building Health Care Together Brief submitted by The New Brunswick Nurses Union July 2012 Introduction The New Brunswick Nurses Union (NBNU) is a labour organization, representing over

More information

Superannuation and high account balances

Superannuation and high account balances ASFA Research and Resource Centre Superannuation and high account balances April 2015 Ross Clare Direcr of Research The Association of Superannuation Funds of Australia Limited (ASFA) Level 6, 66 Clarence

More information

Submission to the National Commission of Audit (Health and related expenditure) December 2013

Submission to the National Commission of Audit (Health and related expenditure) December 2013 Submission to the National Commission of Audit (Health and related expenditure) December 2013 Introduction Private Healthcare Australia is the industry association representing the 23 leading private health

More information

Retention of Nursing and Allied Health Professionals in Rural and Remote Australia summary report

Retention of Nursing and Allied Health Professionals in Rural and Remote Australia summary report Retention of Nursing and Allied Health Professionals in Rural and Remote Australia summary report March 2014 1 Health Workforce Australia. This work is copyright. It may be reproduced in whole or part

More information

COMPETITION IN THE AUSTRALIAN PRIVATE HEALTH INSURANCE MARKET

COMPETITION IN THE AUSTRALIAN PRIVATE HEALTH INSURANCE MARKET COMPETITION IN THE AUSTRALIAN PRIVATE HEALTH INSURANCE MARKET Page 1 of 11 1. To what extent has the development of different markets in the various states had an impact on competition? The development

More information

Maternal and Child Health Service. Program Standards

Maternal and Child Health Service. Program Standards Maternal and Child Health Service Maternal and Child Health Service Program Standards Contents Terms and definitions 3 1 Introduction 6 1.1 Maternal and Child Health Service: Vision, mission, goals and

More information

National Disability Insurance Scheme.

National Disability Insurance Scheme. National Disability Insurance Scheme. May 2012 Chamber of Commerce and Industry of Western Australia (Inc) Contents Executive summary 3 Background 4 Western Australia current disability services 6 Funding

More information

Foreword. Closing the Gap in Indigenous Health Outcomes. Indigenous Early Childhood Development. Indigenous Economic Participation.

Foreword. Closing the Gap in Indigenous Health Outcomes. Indigenous Early Childhood Development. Indigenous Economic Participation. National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework 2011 2015 Prepared for The Australian Health Ministers Advisory Council by the Aboriginal and Torres Strait Islander

More information

Framework. Australia s Aid Program to Papua New Guinea

Framework. Australia s Aid Program to Papua New Guinea Framework Australia s Aid Program to Papua New Guinea 21 October 2002 Our Unique Development Partnership our close bilateral ties are reflected in our aid program Enduring ties bind Papua New Guinea with

More information

DEVELOPMENT OF A QUALITY FRAMEWORK FOR THE MEDICARE BENEFITS SCHEDULE DISCUSSION PAPER

DEVELOPMENT OF A QUALITY FRAMEWORK FOR THE MEDICARE BENEFITS SCHEDULE DISCUSSION PAPER DEVELOPMENT OF A QUALITY FRAMEWORK FOR THE MEDICARE BENEFITS SCHEDULE DISCUSSION PAPER This paper has been prepared by the Department of Health and Ageing (the Department) as a basis for further consultation

More information

NATIONAL INSURANCE BROKERS ASSOCIATION OF AUSTRALIA (NIBA) SUBMISSION TO THE NEW SOUTH WALES GOVERNMENT NSW FAIR TRADING DISCUSSION PAPER:

NATIONAL INSURANCE BROKERS ASSOCIATION OF AUSTRALIA (NIBA) SUBMISSION TO THE NEW SOUTH WALES GOVERNMENT NSW FAIR TRADING DISCUSSION PAPER: NATIONAL INSURANCE BROKERS ASSOCIATION OF AUSTRALIA (NIBA) SUBMISSION TO THE NEW SOUTH WALES GOVERNMENT NSW FAIR TRADING DISCUSSION PAPER: REFORM OF THE HOME BUILDING COMPENSATION FUND February 2016 The

More information

Guidelines approved under Section 95A of the Privacy Act 1988. December 2001

Guidelines approved under Section 95A of the Privacy Act 1988. December 2001 Guidelines approved under Section 95A of the Privacy Act 1988 December 2001 i Commonwealth of Australia 2001 ISBN Print: 1864961074 Online: 1864961139 This work is copyright. Apart from any use as permitted

More information

Clean Energy Council submission to Queensland Competition Authority Regulated Retail Electricity Prices for 2014-15 Interim Consultation Paper

Clean Energy Council submission to Queensland Competition Authority Regulated Retail Electricity Prices for 2014-15 Interim Consultation Paper Clean Energy Council submission to Queensland Competition Authority Regulated Retail Electricity Prices for 2014-15 Interim Consultation Paper Executive Summary The Clean Energy Council (CEC) supports

More information

Rule change request. 18 September 2013

Rule change request. 18 September 2013 Reform of the distribution network pricing arrangements under the National Electricity Rules to provide better guidance for setting, and consulting on, cost-reflective distribution network pricing structures

More information

4 th December 2015. Private Health Insurance Consultations 2015-16 Department of Health. Via email: PHIconsultations2015-16@health.gov.

4 th December 2015. Private Health Insurance Consultations 2015-16 Department of Health. Via email: PHIconsultations2015-16@health.gov. 4 th December 2015 Private Health Insurance Consultations 2015-16 Department of Health Via email: PHIconsultations2015-16@health.gov.au Re: Private Health Insurance Consultations 2015-16 Dear Private Health

More information

Health expenditure Australia 2013 14

Health expenditure Australia 2013 14 Health expenditure Australia 2013 14 Health and welfare expenditure series No. 54 HEALTH AND WELFARE EXPENDITURE SERIES Number 54 Health expenditure Australia 2013 14 Australian Institute of Health and

More information

NATIONAL STRATEGY FOR FOOD SECURITY IN REMOTE INDIGENOUS COMMUNITIES

NATIONAL STRATEGY FOR FOOD SECURITY IN REMOTE INDIGENOUS COMMUNITIES NATIONAL STRATEGY FOR FOOD SECURITY IN REMOTE INDIGENOUS COMMUNITIES Council of Australian Governments A Strategy agreed between: the Commonwealth of Australia and the States and Territories, being: the

More information

HSE Transformation Programme. to enable people live healthier and more fulfilled lives. Easy Access-public confidence- staff pride

HSE Transformation Programme. to enable people live healthier and more fulfilled lives. Easy Access-public confidence- staff pride HSE Transformation Programme. to enable people live healthier and more fulfilled lives Easy Access-public confidence- staff pride The Health Service Executive 4.1 Chronic Illness Framework July 2008 1

More information

An Overview of Reasons for Public- Private Partnerships to Fund Healthcare Systems

An Overview of Reasons for Public- Private Partnerships to Fund Healthcare Systems IAA Health Section Colloquium Cape Town, Republic of South Africa May 13-16, 2007 An Overview of Reasons for Public- Private Partnerships to Fund Healthcare Systems Howard J. Bolnick, FSA, MAAA, HonFIA

More information

PRIMARY HEALTH CARE POLICY

PRIMARY HEALTH CARE POLICY PRIMARY HEALTH CARE POLICY The Public Health Association of Australia recognises that: 1. Universal access to primary health care based on need and not on the ability to pay, is a fundamental human right.

More information

Position paper on the Federal Budget 2015

Position paper on the Federal Budget 2015 Position paper on the Federal Budget 2015 Context Closing the gap in health equality between Aboriginal and Torres Strait Islander peoples and other Australians is an agreed national priority. On this

More information