BMJ  2005;330:907 (16 April), doi:10.1136/bmj.330.7496.907-a

Letter

Rising healthcare costs, equity, and electoral success constitute trio of tensions

EDITOR—All governments are seeking to find healthcare strategies that tackle the challenge of rising costs and patients' expectations while retaining popularity with their voters. Both UK and Australian governments have developed policies to reduce long waiting times in state funded hospitals. In their analysis of the effects of increasing use of private insurance on the Australian healthcare system Hall and Maynard identify that the strategy of subsidising insurance premiums has been expensive but electorally successful.¹ The UK government has chosen to buy increased capacity from the independent sector while not specifically encouraging individuals to take out private insurance.

An important downside of the Australian government's health policy, as Hall and Maynard observe, is that it has differentially favoured rich people. In the United States, private medical insurance, the predominant vehicle for funding health care, has disadvantaged poor people.² This is not the case in Canada, which has maintained a tax funded, universal healthcare system. A comparison with the United States showed no significant association between income inequality and mortality in Canada at provincial or metropolitan level.³ In the United Kingdom there is evidence of a growing divide in cancer outcomes between rich and poor.⁴ The Australian experience may serve a timely caution to overdependence on the independent sector.

Western General Hospital, Edinburgh EH4 2XU i.kunkler{at}ed.ac.uk

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Competing interests: None declared.

References

1. Hall J, Maynard A. Healthcare lessons from Australia: what can Michael Howard learn from John Howard? BMJ 2005;330: 357-9. (12 February.)[Free Full Text]
2. US health care: a state lottery? Lancet 2004;364: 1829-30.[Medline]
3. Ross NA, Wolfson MC, Dunn JD, Berthelot J-M, Kaplan GA. Relation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics. BMJ 2000;320: 898-902.[Abstract/Free Full Text]
4. Coleman MP, Rachet B, Woods LM, Mitry E, Riga M, Cooper N, et al. Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001. Br J Cancer 2004;90: 1367-73.[CrossRef][ISI][Medline]

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