Slaves to economists? A Canadian's view of the Australian health care system

Abstract

AN EXPERT IS DEFINED as someone from out of town ? with slides. In health care, such experts also have a tendency to make cross-national comparisons on the basis of a short visit, a few conversations, and a desire to indicate ?lessons learned?.1 In that time-honoured tradition, on the basis of a visit to Melbourne to address the Victorian Healthcare Association, coupled with visits to several local hospitals, this Canadian identified several potential problems arising from Australia?s approach to the public?private mix of hospital services. As Keynes noted, ?The ideas of economists and political philosophers, both when they are right and when they are wrong, are more powerful than is commonly understood. Indeed the world is ruled by little else. Practical men, who believe themselves to be quite exempt from any intellectual influence, are usually the slaves of some defunct economist.?2 Over the past decades, many health care reformers have urged change ? with varying degrees of success ? based on a set of ideas that markets are always right, that competition is both necessary and sufficient for efficiency, and that private is superior to public. One consequence has been a push for a greater role for private delivery of health care services. This is currently hotly contested in Canada, with Australia providing either an exemplary example or a cautionary tale, depending upon ideological proclivities. I was therefore interested in learning more from Australians as to areas of success or failure of the public?private mix in Australia, and this paper highlights my observations.