Home' Australian Pharmacist : Australian Pharmacist July 2014 Contents Australian Pharmacist July 2014 I ©Pharmaceutical Society of Australia Ltd.
The reality of universal
Behind the notion of universal health
coverage (UHC) is access to affordable
services, with affordability being
the key. World Health Organization
statistics show 100 million people are
impoverished by medical costs annually
and the costs of accessing health services
has been high on the Australian and
international agendas for some time.
In line with this, the debate in Australia
centres on whether the introduction of
a co-payment would signal the death
of Medicare, the driving vehicle of
universal health coverage in
was introduced in 1984
on the philosophy that all Australians
should have equal access to healthcare
but as costs have risen, so too have
the pressures on how to maintain the
availability of healthcare to all members
of the community.
These pressures include a rapidly
growing ageing population, increased
costs and a wider availability of drugs
and medical procedures.
The Government's decision to introduce
a co-payment follows the Commission
of Audit report which some feel
opened the door for the Government to
But the commission justifies its
recommendations as trying to ensure
the sustainability of UHC.
'The commission consider that in a
civilised, affluent and modern country
like ours, universal health coverage
is absolutely necessary for everyone,'
the Commission of Audit report states.
'The combination of demographic
trends, income growth and new
technologies mean that demand for
healthcare in Australia will increase
strongly. The reality is older people
tend to use more healthcare services
and the increasing population of older
Australians will raise healthcare costs.
The cost of health
'Recent Productivity Commission
Commonwealth Government spending
on health will rise from around 4% of
GDP in 2011--12 to 7% in 2059--60.
'Health expenditure by State
governments is projected to rise
from around 2.5% of GDP to almost
4% of GDP over the same period.
Other research projects similar trends.'
The report goes on to state: 'Australia's
health system is not equipped to
face these future challenges and a
universal health scheme is unlikely to be
sustained without reform. We need to
make the system we have to work better.'
Australia's need to make substantial
changes to its UHC is significant in the
global context, especially in light of the
World Health Organization and the World
Bank releasing in December 2013 a joint
framework for monitoring progress
toward universal health coverage with
two targets, one for financial protection
and one for service delivery.
For financial protection, the proposed
target is by 2020 to halve the number
of people who are impoverished
due to out-of-pocket health care
expenses. By 2030, the aim is that no
one should fall into poverty because of
out-of-pocket healthcare expenses thus
moving the figures from 100 million
people currently impoverished every
year to 50 million by 2020 and
then to zero by
For service delivery,
the proposed target is equally
Announcing the project, World
Bank Group President Jim Yong Kim
said: 'Today, just 40% of the poor in
developing countries have access to
basic health services such as delivering
babies in a safe environment and
vaccinating children. We propose that
by 2030 we will double that proportion
to 80% coverage. In addition, by 2030,
80% of the poor will also have access to
many other essential health services such
as treatment for high blood pressure,
diabetes, mental health and injuries.'
The quest for universal
Mr Kim said the quest for universal
coverage was not only a demand
for better health -- it was a demand
for equity and the World Bank saw
achieving UHC and equity in health as
BY PETER WATERMAN
The Federal Government's budget decision to impose a co-payment on
visits to general practitioners has raised awareness of the concept of
universal health coverage and its future. Peter Waterman take a global look
at just how universal health coverage is.
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