OECD data shows that since 2018, Australia’s annual total health spend in US dollars per capita has been under $6,000, against figures exceeding $10,000 per year in the USA.
Consumer website Compare The Market cites that 73.4% of Australians are satisfied with their healthcare, compared with 54.2% of Americans. Their survey showed that affordability was the biggest factor in satisfaction, and they cited that 64% of Australians found healthcare affordable versus 33% of Americans.
Universal Health Care and Subsidised Medications
On top of cheaper overall health care costs (made up of both government and personal funds) in Australia, services such as Medicare, touted as the nation’s universal health care system, and the Pharmaceutical Benefits Scheme, which provides access to subsidised medicines in Australia, provide a health care safety net for Australians. The US government doesn’t directly regulate drug prices nor subsidise them. As a result, pharmaceutical companies can price their drugs more freely while the citizens essentially pay for commercialised medicines.
In a 2020 article published by the Grattan Institute, health economist Dr Stephen Duckett described the US health system as “more expensive but less effective”. He cited multiple health systems with no coherence as the main issue, and gave examples:
- Armed services veterans have access to a comprehensive, centralized, government-run health service
- Those over 65 are covered by Medicare which is federally funded
- Those with low financial means will receive income-threshold tested health care through the federally funded, state-run Medicaid system
- Those who are employed may have an employment package which includes health insurance
- Those without other coverage are able to access federal and state marketplaces for insurance via the Affordable Care Act
Even though there are a range of options available in the US, an Office of Health Policy document titled National Uninsured Rate Reaches All-Time Low in Early 2022 states that there are still over 26 million Americans who do not have insurance. In October 2022 the American Academy of Family Physicians reported on their advocacy being involved in more than 1 million previously ineligible Americans being able to receive primary care in the Patient Protection and Affordable Care Act.
Dr Stephen Duckett also pointed out the inequities of more than half of US hospitals being not-for-profit and negotiating contracts with multiple insurers for their income, which health insurers limiting the number of service providers covered by their plans.
The American health care system is primarily based around specialty care for individual medical issues. In Australia, the first port of call for all medical conditions, regardless of age, has traditionally been a general practitioner (GP). Roles of the general practitioner include patient care continuity, patient advocacy, and appropriate referral to specific medical specialists when required. Importantly, GPs manage a patient’s overall health.
However, according to the Royal Australian College of General Practitioners, “significant funding for general practice care is urgently needed to address the GP crisis”. The RACGP states:
“The (October 2022-2023) Budget includes a re-commitment to $250 million per year in GP funding over three years following the Strengthening Medicare Taskforce Report which is due later this year, as well as $143.3 million for rural and remote healthcare, and $229.7 million in general practice support grants to build better infrastructure. However, it does not address the immediate challenges facing general practice care, including a lack of funding following years of Medicare freezes and inadequate indexation of patient rebates.
The RACGP holds grave concerns that without major investment into general practice care by the federal Government the current shortage of GPs being felt by communities throughout Australia will intensify, waiting times to see a doctor will increase, and the health and wellbeing of Australians will suffer.”
Australian General Practitioner Dr Louise Stone has taken to Twitter to express concern about the potential flow-on effects of fragmentation to patient care with fewer GPs (click the “Read full conversation on Twitter” button to access the full thread of 14 tweets):
@stephenjduckett @markbutler @SophieScamps @brookmanknight a genuine question. Let’s say the system behaves like it’s designed to do & GP dies. We are endangered now, with not enough replacements coming in to keep the species alive for long 1/
— Louise stone (@GPswampwarrior) October 14, 2022
Reducing Health Care Costs to Individuals in the US
Medical costs, insurance premiums, out-of-pocket costs, and copays are all part of the health care system in the US. Americans can reduce these expenses with supplemental insurance typically offered by Medicare-approved private insurers. For example, Americans can opt for Medicare G plans if they want to reduce out-of-pocket costs. It’s among the complete Medigap plans available to new Medicare beneficiaries because it nearly covers 100% of the Medicare gaps. However, it doesn’t cover the Part B deductible, which is $233 per year as of 2022.