Document Type : Original Article
Authors
1
Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
2
College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
3
The George Institute for Global Health, Sydney, NSW, Australia
4
RegNet School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
Abstract
Background
Universal health coverage (UHC) is central to current international debate on health policy. The primary healthcare (PHC) system is crucial to achieving UHC, in order to address the rising incidence of non-communicable diseases (NCDs) more effectively and equitably. In this paper, we examine the Australian case as a mature system of UHC and identify lessons for UHC policy to support equity of access to PHC and reduce NCDs.
Methods
Our qualitative research used policy mapping and monitoring and 30 key informant interviews, and applied policy theory, to investigate the implementation of Australian PHC policy between 2008 and 2018.
Results
Although the Australian PHC system does support equity of access to primary medical care, other ideational, actor-centred and structural features of policy detract from the capacities of the system to prevent and manage NCDs effectively, deliver equity of access according to need, and support equity in health outcomes. These features include a dominant focus on episodic primary medical care, which is a poor model of care for NCDs, and an inequitable distribution of these services. Also, a mixed system of public and private insurance coverage in PHC contributes to inequities in access and health outcomes, driving additional NCD demand into the health system.
Conclusion
Countries aiming to achieve UHC to support health equity and reduce NCDs can learn from strengths and weaknesses in the Australian system. We recommend a range of ideational, actor-centred and structural features of UHC systems in PHC that will support effective action on NCDs, equity of access to care according to need, and equity in health outcomes across geographically and ethnically diverse populations.
Highlights
Commentaries Published on this Paper
- Universal Health Coverage, Non-communicable Disease, and Equity: Challenges to Implementation; Comment on “Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare”
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- Which UHC? Features for Equity and Universalism; Comment on “Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare”
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- Learning by Doing: Accelerate Towards the NCD Target in SDG Through Primary Healthcare; Comment on “Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare”
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- Aiming for Health Equity: The role of Public Health Policy and Primary Healthcare; Comment on “Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare
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- Primary Healthcare Policy Research: Including Variables Associated With the Social Determinants of Health Matters; Comment on “Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare”
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- Universal Health Coverage for Non-communicable Diseases and Health Equity: Reflections on the Role of Ideas and Democratic DecisionMaking; Comment on “Universal Health Coverage for NonCommunicable Diseases and Health Equity: Lessons from Australian Primary Healthcare”
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- Reiterating the Importance of Publicly Funded and Provided Primary Healthcare for Non-communicable Diseases: The Case of India; Comment on “Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare”
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- Changing the Discourse in Ambitions Towards Universal Health Coverage: Lessons From Australian Primary Healthcare; Comment on “Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare”
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Authors' Response to the Commentaries
- Universal Health Coverage for Health Equity: From Principle to Practice
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