Policy Forum: Medicare at 40

The 40th anniversary of universal healthcare in Australia marks a significant milestone in the country's healthcare system, and this policy issue brings together nine articles that explore various aspects of Medicare. These articles reflect on its origins, celebrate its achievements and provide an analysis of its impact. Most importantly, these evidence-based articles provide advocacy and possible solutions to pressing issues. A recurrent theme in most of them is the need for financial reform to focus on early intervention, promote collaboration and teamwork, and support the adoption and diffusion of new technologies. The authors also emphasise the importance of research support, data collection and availability, and collaboration between academia and policymakers. The first article reflects on the work of John Deeble and Richard Scotton, who delivered the blueprint for Medicare in the 1960s. Ross Williams offers a history of their work and a reflection on how a supportive research environment, policy design informed by data and collaboration between academia and government paved the way for the establishment of Medicare. A fundamental objective of Medicare is to guarantee that every Australian has fair access to healthcare at the time of necessity, irrespective of their geographical location or financial capacity. Is Medicare providing universal access to all Australians? Karinna Saxby and Mike Stephens explore how Medicare policies have shaped healthcare access for priority populations, focusing on Aboriginal and Torres Strait Islander peoples and LGBTIQ+ populations. The authors call for structural reform, including robust and integrated data collection, to improve equitable access for these populations. They also emphasise the crucial role of diversity and inclusion in the process of researching, designing and implementing health policy to guarantee improved continuity of care and health outcomes in these populations. In the third article, Jongsay Yong and Ou Yang investigate the fragmented funding and provision of aged care. With an ageing population and increasing longevity, the current system will struggle to finance the increasing demand for healthcare services. The authors highlight the need for urgent financial reform and alternative care approaches to ensure quality and efficient care for older patients. The article by Philip Clarke and Henry Cutler addresses the ongoing debate over universal dental insurance. It explores the historical exclusion of dental care from Medicare and proposes alternative funding approaches, such as income-contingent loans, to expand the comprehensiveness of universal insurance coverage. With the current government's commitment to investing in primary care, Yuting Zhang examines the monetary feasibility of free general practitioner (GP) visits. The article then questions the effectiveness of government investment in private insurance and argues for better targeting and optimal redistribution of funds. By examining the impact of Medicare on priority populations and addressing challenges related to access and comprehensiveness, these articles contribute to the ongoing efforts to ensure equitable healthcare for all Australians. Our healthcare needs are changing, with more people living with chronic conditions and needing care from multiple specialists. The following articles explore the need for evolving models of care that support person-centred team healthcare and the adoption of new technologies. Jean Spinks, Susan Nancarrow, Sue McAvoy and Lisa Nissen contribute important thoughts on the complex interactions that require a systems-thinking approach. Policies aiming to support multidisciplinary team care need to collectively consider the crucial need for financing reform that rewards teams, the scope of practice, the governance of primary care and health workforce planning. Clair Sullivan explores the role of new technology, including artificial intelligence (AI), in transitioning from a reactive break–fix model of healthcare, where the focus is on treatment, to a proactive predict–prevent model, where the goal is to prevent disease. It highlights the potential of predictive analytics, preventive interventions and proactive management strategies in improving patient outcomes and resource utilisation. This will depend heavily on financial support for new technologies and data availability and access. Tina Brock, Sandra Davidson and Elizabeth Molloy ask how to prepare the health workforce to work under these new models of care. The authors suggest focusing on training teamwork skills and investing in an interdisciplinary workforce, including educating them in informatics and data analytics. This issue concludes with a reflection by Jane Hall, Kees Van Gool, Philip Haywood and Denzil Fiebig, who have been playing a vital role in developing the profession and mentoring a new generation of health economists in Australia. Their article celebrates what has been achieved, but also encourages us to think about what needs urgent consideration from a whole-of-system perspective, focusing on the financing of the system to improve access, affordability, fairness and make the system efficient and comprehensive. The authors conclude that 'for Medicare to continue to deliver on its objectives over the next 40 years, there is a need for more agility, the political will to embrace change, and an investment in the research to guide it'. I hope you enjoy these insightful pieces. Open access publishing facilitated by The University of Melbourne, as part of the Wiley - The University of Melbourne agreement via the Council of Australian University Librarians.