Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Implementing Universal and Targeted Policies for Health Equity: Lessons From Australia 2308 2318 4164 10.34172/ijhpm.2021.157 EN Matthew Fisher Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia 0000-0003-3756-1146 Patrick Harris Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia 0000-0002-4649-4013 Toby Freeman Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia 0000-0002-2787-8580 Tamara Mackean College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia The George Institute for Global Health, Sydney, NSW, Australia Emma George School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia Sharon Friel RegNet School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia 0000-0002-8345-5435 Fran Baum Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia 0000-0002-2294-1368 Journal Article 2021 05 28 Background Debate continues in public health on the roles of universal or targeted policies in providing equity of access to health- related goods or services, and thereby contributing to health equity. Research examining policy implementation can provide fresh insights on these issues. Methods We synthesised findings across case studies of policy implementation in four policy areas of primary healthcare (PHC), telecommunications, Indigenous health and land use policy, which incorporated a variety of universal and targeted policy structures. We analysed findings according to three criteria of equity in access – availability, affordability and acceptability – and definitions of universal, proportionate-universal, targeted and residual policies, and devolved governance structures. Results Our analysis showed that existing universal, proportionate-universal and targeted policies in an Australian context displayed strengths and weaknesses in addressing availability, affordability and acceptability dimensions of equity in access. Conclusion While residualist policies are unfavourable to equity of access, other forms of targeting as well as universal and proportionate-universal structure have the potential to be combined in context-specific ways favourable to equity of access to health-related goods and services. To optimise benefits, policies should address equity of access in the three dimensions of availability, affordability and acceptability. Devolved governance structures have the potential to augment equity benefits of either universal or targeted policies.

https://www.ijhpm.com/article_4164_861578d797aeb0634f77aff3f488cca2.pdf