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Financing options to sustain Medicare: are we committed to universalism?

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Policies addressing health care financing should reinforce Australia’s commitment to the principle of universalism

The United Nations-initiated Sustainable Development Solutions Network (SSDN) has recently proposed the inclusion of universal health coverage (UHC) as a priority of the 2015–2030 Sustainable Development Goals to alleviate global poverty.1 Australia has established itself over a number of decades as a member of an elite group of mainly high-income countries that have been declared to have achieved UHC. Since 1975, through the social-national insurance programs, Medibank (1975–1981) and Medicare (since 1984), universal access based on need for medical services and pharmaceuticals has been the bedrock of Australian health policy. One therefore wonders whether the current SSDN discussions are relevant to Australia?

In addressing this question, UHC should be viewed as part of a continuum of levels of financial protection, in which population coverage, the type of services covered and levels of reimbursement are, in practice, never fully comprehensive.2 In Australia, the lack of coverage for dental services is a case in point, where, in an ostensibly universal health system, there has been long-term persistence of health inequities resulting from a lack of access to dental services, resulting in significant disadvantage, particularly in…