Book Reviews
Health Policy in Australia
Heather Gardner and Simon Barraclough (eds)
ISBN: 0-195513-48-7 2004 PB 362 pages Oxford: Oxford University Press Australia and New Zealand
Anna Donald
Honorary Senior Fellow, School of Public Policy, University College, London, UK
Australian health policy is interesting for anyone studying health systems, because of its unique mix of private and public insurance and care institutions; dramatic political history; high overall standards of care despite a remote rural population (rivalled only by Canada's), and manifestation of Australia's particular version of federalism.
Taking such issues into account, this book is a must-have for anyone interested in the current state of health policy in Australia. It is scholarly and covers a wide range of pertinent issues facing policy makers in most countries. These include Australia's institutional and financial responses to cost pressures from ageing populations and technology inflation, growing tension between the public and private provision of health insurance and care, changes in demand and to the culture of consumption of health care, and responses to the growth of digital technologies. The opening chapter, in particular, gives an excellent overview of the structure and finance of Australia's health system. Hancock's chapter also gives a lucid account of the results of how healthcare is organised and financed between Australia's federal and state governments. This will be of interest to policy makers in other federal or quasi-federal systems, and no doubt to the architects of the new Europe (the current impasse not withstanding).
That said, the book is predominantly written from an insider's point of view rather than from an international perspective. This makes it highly relevant for readers seeking detailed explanations of how Australia's health system actually works now, rather than for those seeking direct comparisons of Australia with other countries. For example, most chapters describe in some detail the scope of recent institutional organisations relevant to each topic, such as COAG (Council of Australian Governments), NHIMAC (National Health Information Management Advisory Council) and NEHPC (North East Health Promotion Centre). While this leads one to feel the need for some kind of ban on acronym testing in the Pacific, it does enable even the distant reader to feel confident in their grasp of the big changes - and many of the smaller ones - to Australia's policy landscape in recent years. Many chapters helpfully include case studies of policy and institutional reforms.
A further feature of the book is its inclusion of more specialist topics that are often difficult to appraise, particularly from overseas. These include changes to Australia's environmental health policies; to the changing role of, and alliances within, public health; workplace reform; the promotion of health industry exports; the role of complementary medicines within an increasingly consumerist population; and progress towards a national policy on food safety.
The very strength of the book - its level of detail and chapter-by-chapter authoring by people obviously closely involved with each topic - leave it slightly wanting of a broader, coherent overview of 'the state we're in.' Few of its chapters put policies in an historical context and some assume a degree of local knowledge. Most of all, while well edited, the book is very much a compilation of individual authors' chapters on a range of important topics. It is left to readers to make sense of what each chapter might mean for the Australian health body politic as a whole. This is not so much a criticism of the book as a clarification of its purpose. I, for one, will be packing it in my luggage on my next policy trip home.
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