








































4 SIUJ  •  Volume 1, Number 1  •  October 2020 SIUJ.ORG

MOLECULAR BIOMARKERS IN UROLOGIC ONCOLOGY: ICUD-WUOF CONSULTATION

Australia’s Two-Tier Health Care  
System United Against COVID-19
Bishoy Hanna,1,2,3 Amanda Chung4,5,6,7,8

1 North Shore Urology Research Group, St Leonards, Australia, 2 Nepean Urology Research Group, Kingswood, Australia, 3 Northern Sydney Local Health District,  
St Leonards, Australia 4 Department of Urology, Macquarie University Hospital, Macquarie University, Australia, 5 The University of Sydney, Concord Repatriation General 
Hospital, Department of Urology, Concord, Australia, 6Department of Urology, Royal North Shore Hospital, St Leonards, Australia, 7Department of Urology, Northern 
Beaches Hospital, Frenchs Forest, Australia, 8Department of Urology, Sydney Adventist Hospital, Wahroonga, Australia

Soc Int Urol J. 2020;1(1):4–5

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has had and continues to have an unprecedented impact 
on health care systems worldwide. The Australian system has yet to be truly tested by the pandemic, as rapid 
implementation of public health measures has curbed infection rates. Australia’s 2-tier health care has allowed 
sufficient staffing, equipment, and beds to continue providing acute health care in the face of an exceptional and 
extreme demand. No health system is perfect and, although Australia’s has some wonderful attributes that make it the 
envy of many other countries, it faces a number of important challenges. This paper describes how Australia’s health 
care structure has adapted to respond to the COVID-19 crisis, examines the challenges involved and the lessons 
learned, and explores how this environmental pressure could lead to systemic adaptations.

The Australian Health Care System
Australia has a 2-tier system, public and private. The 
public system, Medicare, is funded by the federal 
government and is available for Australian citizens and 
permanent residents. Two percent of taxable income 
with up to a 1.5% surcharge on high earners funds this 
component, which accounts for approximately 67% of 
total health care costs [1]. Australian health care in 2017–
2018 cost $170 billion, which is 9.6% of gross domestic 
product, slightly above the Organisation of Economic 
Co-operation and Development average [1]. However, 
the health cost to GDP ratio in Australia remains behind 
those of the United States, Canada, New Zealand, and 
the United Kingdom.

Public health care in Australia is subject to limited 
resources, leading to acute health care prioritization and 
waitlisting for non-urgent care. The general practitioner 
(GP) determines the medical treatment required, 
making referrals to public clinics before specialist care 
can be sought and treatment initiated. This all takes time 
and is only the beginning of the wait. If the referral is 
accepted, the patient is put on an outpatient wait list 
to see a specialist. Wait time is determined by acuity. 
If a problem is urgent, it will be attended to within 30 
days of being added to the wait list, not from initial GP 
attendance. Semi-urgent conditions have a wait time of 
90 days, and non-urgent problems wait up to 365 days. 
Patients with semi-urgent conditions wait 90 days, 
and those with non-urgent problems wait up to 365 
days. These are targets: waits may be longer or shorter, 
depending on individual public hospitals. The patient 

with an urgent bladder mass might not be assessed for  
30 days, and the cataract keeping someone from reading 
or driving might not be removed for up to a year.

A parallel and optional private system puts patients in 
control, allowing them choice of treating physician, time 
to treatment, and location. Australian private insurance 
is market-based. Consumers purchase a policy with 
an assigned premium that suits their individual needs. 
This policy predominantly covers the cost of admission 
and health care provision in private hospitals. These 
facilities are completely separate from government built 
and run public hospitals. Private hospitals are owned 
and operated by independent companies, providing 
ser vices partially Medicare funded and partially 
privately sourced, with insurance providing capped 
hospital excesses. Until very recently, public and private 
health care provision have, for the most part, remained 
separate.

United Against a Common Enemy
The Austra lian hea lt h care system has evolved 
over many years to become the world-class service 
provider it is today. However, its strength in providing 
multifaceted tailored health care for a broad range of 
societal situations has led to bureaucratic rigidity. As 
the technological world exponentially expands, many 
Australian hospitals remain without even a universal 
electronic medical records system. The system is 
cluttered with several competing agendas and litigious 
fears to the detriment of efficient health care delivery.

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5SIUJ.ORG SIUJ  •  Volume 1, Number 1  •  October 2020

Australia’s Two-Tier Health Care System United Against COVID-19

However, on April 1, 2020, a joint media release stated the 
Australian Government would partner with the private 
hospital sector to help fight the COVID-19 pandemic [2]. 
Overnight, the entire structure of Australian health care 
provision was rearranged to aid the pandemic effort. 
Private hospitals were commissioned to service public 
category 1 elective surgeries and facilitate the transfer 
of public ward and ICU patients to private facilities. Not 
only did this secure an immediate 30 000 private hospital 
beds and 105 000 skilled workers but it also significantly 
increased the supply of in-demand consumables such 
as personal protective equipment (PPE), ensuring 
public hospitals were adequately buffered to weather the 
COVID-19 storm. Medical administration collaborated 
with clinicians and ground staff to put these measures 
swiftly into action with immediate results. It is as if the 
viral enemy at the door galvanised a sense of united toil 
to overcome the barriers of bureaucratic delay [3].

The pandemic has become a catalyst for health 
care development. A more f lexible system, welding 
together public and private systems for optimal health 
care provision is merely the beginning of pandemic-
initiated improvements. The advent of telehealth and 

videoconferencing has increased access for rural and 
remote patients and facilitated multidisciplinar y 
discussion and management. Working from home has 
seen creativity and innovation replace the pretence 
of productivity imposed by the “clock in, clock out” 
mentality. Efficient technological advances, ranging 
from safe aerosol-generating procedures to vaccination 
programs, have shown development can be rapid in the 
face of adversity. Unification of public and private sectors 
was symbolic of a broader unification of politician, 
clinician, allied health, and administration to implement 
effective and efficient health care.

Conclusion
Australia’s distinct 2-tier health care system has afforded 
inherent reserve to allow for immediate pandemic-proof 
reform. Unifying the systems to respond to a common 
adversary has enabled developments in health care 
provision that would not have been possible had they 
remained separate. If the Australian system is to remain 
adaptable and innovative, this unified model must 
survive beyond the pandemic.

References

1. AIHW. Australian Institute of Health and Welfare: Australia’s health 
2018. Australia’s health series no. 16: AUS 221; 2018.

2. Department of Health - Australian Government partnership with 
private health sector secures 30,000 hospital beds and 105,000 
nurses and staff, to help fight COVID-19 pandemic 2020. April 
1, 2020. Available from: https://w w w.health.gov.au/ministers/
the-hon-greg-hunt-mp/media/australian-government-partnership-
with-private-health-sector-secures-30 0 0 0 -hospital-beds-and-
10 5 0 0 0 - nur s e s - a n d - s t a f f-t o - h elp -f ig h t- c o v id -19 - p a n d e mic . 
Accessed September 16, 2020.

3. Khadra M. New normal post-COVID-19: Nepean’s experience. Med 
J Aust. August 10, 2020.

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https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/australian-government-partnership-with-private-health-sector-secures-30000-hospital-beds-and-105000-nurses-and-staff-to-help-fight-covid-19-pandemic
https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/australian-government-partnership-with-private-health-sector-secures-30000-hospital-beds-and-105000-nurses-and-staff-to-help-fight-covid-19-pandemic
https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/australian-government-partnership-with-private-health-sector-secures-30000-hospital-beds-and-105000-nurses-and-staff-to-help-fight-covid-19-pandemic
https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/australian-government-partnership-with-private-health-sector-secures-30000-hospital-beds-and-105000-nurses-and-staff-to-help-fight-covid-19-pandemic

