Abstract

This presentation describes the Australian Health care system which is positioned as one of the best performing health systems across the range of OECD countries. The Australian health system is complicated as there is shared funding and service delivery between the States and the Commonwealth (National government). While we have a national health insurance system we do not have a simply structured national health system. The system has experienced continuous health reform focused on structure and restructure. Demand and utilization of services are high while health expenditure has risen faster than either population growth or ageing. The challenges for the Australian health system are identified as managing downward fiscal pressure and increasing capacity and demand for services; ensuring we deliver the right mix of care for the chronically ill, frail aged by allocating resources optimally and a continued concern for improved quality and safety of care. The responses to these challenges are likely to be a focus on improving the effectiveness of care; greater investment to address social determinants of health and sustainable development goals (SDGs) and perhaps harmonizing health insurance systems. The article is developed from the contemporary literature about the Australian health system and the future directions are identified from invited expert papers in the current issue of APJHM 3(11). The article describes possible responses to the challenges described and suggests emerging themes and approaches to health reform that are likely to move the emphasis of reform from structure to an emphasis on health outcomes through the use of knowledge, research and social movement to improve collaborative and networked practice. The presentation concludes by suggesting possible future directions from an analysis of the language of health reform.