EQUITY OF HEALTH-CARE IN AUSTRALIA

This paper examines the equity characteristics of health care financin g and delivery in Australia and compares its performance with recent f indings on systems in Europe and the United States. Vertical equity of finance is evaluated with income and payment concentration indices de rived from published survey data on taxes and expenditure by income de cile. Horizontal equity of health care delivery is assessed with stand ardized expenditure concentration coefficients for three measures of h ealth status and four types of health services, derived from household survey data on health care utilization, health status, income and dem ographics. Health cover is available to the entire population. Results show the financing system is slightly progressive despite the fact th at 30% of payment comes from private sources, which are regressive. Th e equity index compares favorably to many European countries and is mu ch better than the U.S. which has a regressive financing system. The A ustralian system fares less well in terms of equity of health care del ivery. Several features favor privately insured higher income persons in use of health care and this is reflected, for some health status me asures and types of service, in inequity favoring the better off. This contrasts with inequity favoring the less well off in many European c ountries and the U.S. This analysis provides a benchmark for monitorin g the equity of the Australian system and provides information on the equity of a mixed private and public financing system that covers the entire population. This is relevant to the U.S. which is moving in thi s direction by extending private cover to the uninsured and to Europea n countries that are increasing private sector involvement in health c are financing.