Implementing Universal and Targeted Policies for Health Equity: Lessons From Australia

Document Type : Original Article

Authors

1 Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia

2 Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia

3 College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

4 The George Institute for Global Health, Sydney, NSW, Australia

5 School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia

6 RegNet School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia

Abstract

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.

Highlights

 

Commentaries Published on this Paper

  • Resisting the Effects of Neoliberalism on Public Policy; Comment on “Implementing Universal and Targeted Policies for Health Equity: Lessons From Australia”

        Abstract | PDF

 

  • Policies for Social and Health Equity: The Case for Equity Sensitive Universalism; Comment on “Implementing Universal and Targeted Policies for Health Equity: Lessons From Australia”

        Abstract | PDF

 

Authors' Response to the Commentaries

  •   Universal and Targeted Policy for Health Equity in the Neoliberal Era

         Abstract | PDF

 

Keywords

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International Journal of Health Policy and Management
Volume 11, Issue 10
October 2022
Pages 2308-2318

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History

  • Receive Date: 28 May 2021
  • Revise Date: 05 November 2021
  • Accept Date: 08 November 2021
  • First Publish Date: 09 November 2021

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