Australia’s Universal Health Care System Outperforms Canada’s on Key Measures: Fraser Institute

Dr. Del Dorscheid (C) takes part in board rounds in the COVID-19 intensive care unit at St. Paul's hospital in downtown Vancouver, on April 21, 2020. Jonathan Hayward/The Canadian Press

Australia’s universal health care system outperforms Canada’s on key measures, including wait times and cost, and includes a larger role for private hospitals, says a comprehensive Fraser Institute report.

“The Australian system outranks Canada’s on a range of performance indicators, while spending less as a percentage of GDP,” states the Jan. 16 report, The Role of Private Hospitals in Australia’s Universal Health Care System.

According to the report, Australia consistently outperforms Canada in terms of timely access to health care resources. The comparison, based on several key indicators of health care performance, indicates that Australia has better outcomes in terms of ease of access to after-hours care, same-day primary care appointments, and notably, timely access to elective surgical care and specialist appointments.

“This close integration with private hospitals is maintained while ensuring universal access to more timely care than is provided to Canadians,” the report says.

On the topic of health care cost differences between Canada and Australia, the report focuses on national spending as a percentage of GDP and per capita expenses, noting that both countries rank high in health care spending among high-income countries with universal care systems, but with notable differences.

Australia was reported to spend 11.5 percent of its GDP on health care, ranking it seventh highest among 30 high-income countries with universal health care. In contrast, Canada’s health care expenditure was higher at 13.3 percent of its GDP, making it the highest spender among these countries.

In terms of per capita spending, Australia spent US$6,089 (adjusted for purchasing power parity) and ranked sixth out of the 30 countries. Canada was just behind Australia, ranking eighth with a per capita expenditure of US$5,988.

In the context of the COVID-19 pandemic, the report highlights how private health care clinics in Canada were utilized to address the surgical backlog, reflecting a broader trend in high-income countries with universal health care systems. In Australia, private hospitals are integral to the health care framework, contributing significantly to elective surgeries and other medical services.

The report emphasizes the deep integration of public and private sectors in both the financing and delivery of health care in Australia. Around 55.2 percent of the Australian population had private health insurance in 2021/22, funded by 33 registered private insurance companies. The Canadian Medical Association says 27 million Canadians—about 70 percent of the population—have private insurance, though governments paid for 72 percent of all health care as of 2022.

Private hospitals in Australia, including for-profit and not-for-profit institutions, account for nearly half of all hospitals and a third of all care beds.

Private hospitals in Australia deliver care to fully funded public patients in two main ways: contracted care through inter-hospital contracts or formal programs, and care funded by the Department of Veterans’ Affairs. In addition, private health insurance is partially subsidized by the government.

The report underscores that a significant portion of private hospital expenditures, about 32.8 percent in 2019/20, originated from government sources. This public-private partnership in health care underlines the Australian system’s ability to provide universal access while involving private entities in care delivery.

“The Australian system is a demonstrative case of an arrangement in which the noble goals of universal coverage are balanced with a pragmatic approach towards involving the private sector as a partner,” the report states.