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Education And Debate

Healthcare lessons from Australia: what can Michael Howard learn from John Howard?

BMJ 2005; 330 doi: (Published 10 February 2005) Cite this as: BMJ 2005;330:357

Rapid Response:

Rising healthcare costs, equity and electoral success: a trio of tensions

All governments are seeking to find health care strategies that address 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. Jane Hall and Alan Maynard (1) identify in their analysis of the effects of increasing use of the private insurance on the Australian health care system that the strategy of subsidising insurance premiums has been expensive but electorally successful. 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 the rich. In the United States private medical insurance, the predominant vehicle for funding health care, has disadvantaged the poor (2). This is not the case in Canada which has maintained a tax funded universal health care system. A comparison with the USA showed no significant association between income inequality and mortality in Canada at either provincial or metropolitan level(3. In the UK 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.


1.Hall J and Maynard A. Healthcare lessons from Australia: what can Michael Howard learn from John Howard? BMJ 2005;330:357-9.

2.US health care: a state lottery? Editorial. Lancet 2004; 364:1829- 30.

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.

4.Coleman MP, Rachet B, Woods LM et al. Trends and socioeconomic inequalities in cancer survival in England and Wales up to 2001. Br J Cancer; 90:1367-73.

Competing interests: None declared

Competing interests: No competing interests

16 February 2005
Ian H Kunkler
Consutltant and Senior Lecturer in Clinical Oncology
Western General Hospital,Edinburgh,EH4 2XU