Achieving equity in the Australian healthcare system

Abstract

IN 1988, I ATTENDED A WORKSHOP of healthcare service managers sponsored by the King’s Fund of London. Participants included such managers and the odd academic from the United Kingdom, the United States, Canada, Australia and New Zealand. We were discussing resource allocation, and frustration mounted during the first 2 days. Ideologically, participants had divided into two teams — the US and the Rest. On the third day, the leader of the US team said, “The difference between us is that you guys believe in equity and we don’t. In the US, people are less interested in making sure everyone gets care than that those who can get it get great care. They accept not getting care now if they can see the opportunity to improve their position and succeed, so that, when they get the money, they will be able to buy great care the minute they want it. It is all about opportunity. People in the US want opportunity, not equity. That’s what they think is fair.” It was important that the US delegate said what he did. It cleared the air. It reminded us that not all societies, and not all people within a society, share a common view of what is fair. In the US, fairness means that you will be encouraged to seek personal success without having to worry much about anyone else. In the UK, Canada, New Zealand and Australia, there is a general interest in the well-being of others. I doubt that Robert Putnam could have written his book Bowling alone 1 about Australia. Putnam’s book mourns the loss of social capital, a resource that grows from community trust and participation. Putnam especially laments its replacement with a fierce individualism. The meaning of equity