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When healthcare is a remedy for cruelty

  • 30 July 2018


Earlier this month the UK National Health Service (NHS) celebrated its 70th birthday. When I lived in London over a decade ago, I didn't take the free care from the NHS for granted; however, I did wonder if the suboptimal care I received was in part due to a health system under pressure.

Was this a glimpse of Australia's own future? As it is, our healthcare system is far from perfect and requires improvement, as El Gibbs recently described. Lately there's been much critique about the need to improve our care coordination.

The NHS launched a few years after the end of World War II with three core principles: that it meet the needs of everyone, that it be free at the point of delivery, and that it be based on clinical need, not ability to pay. At the time, such a service was almost unprecedented because few nations had universal health coverage.

As a colonial outpost, Australia often looked to the UK when it came to national matters — though not when it came to healthcare. It took us several more decades until we had a comparable universal healthcare system. This was mainly due to opposition from the medical profession, which seems surprising now.

To briefly recap the history of Australian healthcare as Jeffrey Braithwaite tells it: 'hospitals slowly emerged in the 19th century, financed chiefly by subscription fees. Doctors, like their counterparts in England and Canada, offered services as entrepreneurs, largely to the wealthy. Charity hospitals were initiated and run by religious institutions, with a charter to treat the sick poor.'

It's no wonder Australia was not spared in an essay by Atul Gawande in The New Yorker, 'Getting there from here'. Gawande discusses how 'in every industrialised nation, the movement to reform health care has begun with stories about cruelty'. He recalls a 1954 letter to the Sydney Morning Herald written by a young woman with lung disease who couldn't afford to refill her oxygen tank. It's a scenario in Australia that now seems unconscionable, yet it occurred in living memory.

Australia has the rare distinction of being the only industrialised country in the world to introduce universal health coverage (1974), abolish it (1978), then resurrect it (1984), as outlined in this parliamentary brief. These immense changes occurred during a turbulent decade under the Whitlam, Fraser and Hawke governments.


"Such a reality partly illustrates how our social circumstances determine our health-related burdens, and how communitarian