Chapter 12 - Conclusion

Summary

The conflicts of the 1940s and 1950s left Australia with a particularly rigid set of institutions. Despite claims by the federal government and organized medicine that the Page scheme was a victory for free enterprise, it had required a major expansion of state intervention in the market for medical services. Fee-for-service was enshrined as the central principle of medical remuneration, but only at the expense of handsome subsidization by the taxpayer. Pensioners were now guaranteed free personal health care, but specialist services continued to be excluded. Rigid means testing limited access even further – with a more rigorous income test which removed health benefits from many old age pensioners. At the same time the constitutional and political limits to direct control of price levels and planning of medical and hospital services set extraordinary barriers to the management of public expenditures. Hospitals remained the province of the states, with vast differences in financial arrangements, equity of access and regulation. The ambitious schemes for co-ordination of general practitioner, public health and institutional services had come to nothing.

The goals of the new system were never clear, beyond the preservation of medical autonomy from direct state control. For most of the medical opponents of the Chifley government's schemes this seemed sufficient, a perfect compromise between the rigours of the free market and the regulation of a departmentally-controlled scheme.