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1、HealthcostsandpolicyinanageingAustralia1GaryBanksChairman,ProductivityCommissionIntroductionAustraliahastraditionallybeenregardedashavingarelativelycost-effectivehealthsystem.PercapitaspendinghasbeenbelowtheOECDaverage,andwellbelowthatoftheUSAinparticular,forcomparableorbe
2、tterhealthsystemoutcomes.Butthereisaquestionastowhetherthisislikelytoremainthecase.Overthepastdecade,Australia’shealthexpenditurehasgrownbyabout70percentinrealterms,withprivatesectorgrowthoutpacingthatinthepublicsectorinmorerecentyears(thoughpublicexpenditureisstilltwo–thi
3、rdsofthetotal).Thisrateofgrowthhasexceededthatoftheeconomyasawhole,leadingtoa1½percentagepointriseinthehealthsector’sshareofGDPtoitspresent9percent(AIHW2007)Allcomponentsofhealthspendinghavegrown.Whileinpatientandoutpatientservicesstilldominatetotalspending,therehasbeenana
4、ccelerationinexpenditureonpharmaceuticalsandtherapeuticappliancessincethelate1990s.Thisaggregategrowthhasbeenmatchedorexceededbyothercountries,however,sothatinternationalrelativitieshavenotchangedmuch(figure1).Forexample,weremainasomewhatbiggerspenderthantheUKandamuchsmall
5、erspenderthantheUSA.Thisindicatesthattrendsacrosscountriesarebeinginfluencedbysimilarforces.Butitalsosuggeststhatsomecountriesmayhavesystemsthatcandobetterthanothers.Mostarelikelytobeseverelytestedbydevelopmentsindemographyandtechnologyincomingdecades.Itisimportanttounders
6、tandhowtheseforcesarelikelytoplayout,andtheirimplicationsforhealthpolicy,giventhesizeofthehealthcaresectoranditsimportancetocommunitywellbeing.1HealthPolicyOration2008,MenziesCentreforHealthPolicy,JohnCurtinSchoolofMedicalResearch,ANU,Canberra,26June.HEALTHCOSTSAND1POLICYF
7、igure1HealthspendingasashareofGDP(%)181614121086420UnitedStatesNewZealandAustraliaUnitedKingdomMedianOECD199520002005Thehealth‘market’Atabroadlevel,wecanconceptualisethemarketforhealthcarelikethemarketsforotherservicesintheeconomy,asbeingshapedbybothdemandandsupply-sideinf
8、luences.•Onthedemand–side,thekeydeterminantsofexpendituregrowtharechangesinthesizeandstru