ABSTRACT
Medicare, Australia’s system of universal public health insurance, reflects the contradictions and tensions of marketized provision. Medicare supports free care in public hospitals and ‘bulk-billed’ medical services, yet it leaves in place a sizable private health sector comprising private hospitals, private health insurers, and fee-for-service medicine. This chapter examines the mixed political economy of Australian healthcare. It argues the late adoption of public insurance, layered onto an existing private system, and reflects the ‘hybrid’ dynamics of marketization, where liberalization and egalitarian impulses can advance together, or subvert each other, in ways not easily captured by conventional definitions of ‘public’ and ‘private’. Access has been aided by competition, while taxation favors privatization. Public provision advances alongside public subsidy of private provision. Reflecting on recent policy developments in Australian healthcare, the chapter draws on historical institutionalism to draw lessons about the changing nature of welfare state contestation in marketized systems.
