As our leaders sometimes say, when challenged about the state of health care in Australia, what other country would you like to get sick in? Not many, as it turns out. Australia’s health system is nearly world-beating, the latest report from the Commonwealth Fund of New York finds.

But with two important exceptions. The Commonwealth Fund compares the performance of the health systems of 11 Western nations on five outcomes. Australia scores third best overall, rating in the top three of the five outcomes:& top in Equity and in Health Care Outcomes and second in Administrative Efficiency.

It is a tribute to the high care standards of our health professionals and hospitals and to the success of Medicare in supporting equity of access and administrative efficiency of our universal health system.

Australia ranked highest on the equity domain, meaning it had the smallest income-related disparities in performance based on selected measures. The domain compares performance for higher and lower income individuals on 11 measures. A larger difference represents lower equity between income groups. A smaller difference indicates better performance among those with below-average income.

In another marker, Australia’s record in reducing avoidable death is the second best and this has improved by 18 per cent in the past decade.

And when comparing spending with health system outcomes, Australia’s score tops all other countries.

So, what’s not to admire about Australia’s health performance?

Well, there are two measures on which Australia scores below most other countries — Access to Care and Care Process. These point to weaknesses which have the potential to gradually erode our healthy system.

On the Access to Care domain, Australia came in at eighth out of 11. This domain encompasses two aspects: affordability and timeliness, including patient reports of avoiding medical care or dental care because of cost, having high out-of-pocket expenses, facing insurance shortfalls, or having problems paying medical bills. The report includes a new measure of the percentage of respondents who received counselling or treatment for mental health issues if they wanted or needed it. Three other measures of wait times were excluded because they were asked early in the 2020 COVID-19 pandemic and results were thought to be unreliable.

The poor performance on this measure bears out an issue that CHF has been highlighting for many years: out of pocket costs. The gap costs, sometimes resulting in what has been called “bill shock” when a patient receives an unexpected bill for hundreds of dollars after surgery, has become a significant downside for those with private health insurance. It has also meant that many people, insured or not, must think twice about seeing a specialist as recommended by the GP because a large part of the specialist’s fee is not covered by Medicare.

The growing gap between what Medicare covers and the actual fee charged contrasts with Australia’s modest government spending on health compared to other countries. The rise in Australia in recent years of American-style for-profit health funds, should give pause for thought when we consider the performance of the US health system. The Commonwealth Fund report shows once again, that the American health system, the most expensive in the world, delivers the worst outcomes overall.

The other domain in which Australia fares relatively poorly is Care Process which includes measures of; preventive care, safe care, coordinated care, and engagement and patient preferences. Again, this is a sphere where CHF has been active in seeking reform, greater government engagement and expenditure.

We have strongly supported the Federal Government’s ten-year reform plans for both primary health care and preventive health. Both areas, properly resourced and supported, have the potential to foster a healthier Australia through more effective care and better-informed communities.