HEALTH-CARE IN AUSTRALIA - LESSONS FROM DOWN UNDER

Australia's approach to the financing of health care, as in most industrialized nations, rests on an important but ever-changing dynamic between the public and private sectors. While publicly financed care dominates, the ready availability of private insurance provides a counterpoint that compels the government to be accountable for its policy actions. As authors Stuart Altman and Terri Jackson underscore in this paper, government must demonstrate in its efforts to restrict spending for health services that it is not imposing excessive restrictions on access to care. Australia, given its geographic distance from the United States, is not a country to which close attention has been paid on these matters. But its health care reform story is a fascinating one, given that it has reflected changing opinions about what its system should ultimately be. Altman, an American economist, and Jackson, a doctoral student, teamed up to provide a glimpse of reform developments Down Under. Politically, both Australia and the United States have strong private physician communities and private health insurance lobbies, and federal and state government interests that often conflict. Within this framework, Australia has managed to construct a publicly financed health insurance system with a privately financed alternative. Altman is dean of the Florence Heller Graduate School for Advanced Studies in Social Welfare at Brandeis University. He studied the Australian system during several extended visits to that country. Altman has been an active player on the U.S. national health policy stage for two decades. He was an architect of the Republican Nixon administration's national health insurance proposal, which featured a requirement that employers provide their workers financial protection against illness, an approach that now resonates with Democrats. Jackson, an Australian resident, is currently a Pew Charitable Trusts Scholar at Brandeis working on a doctoral degree.