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May 20, 1988

Medicare Down Under: Bureaucracy Triumphant

Author Affiliations

Sydney, Australia

Sydney, Australia

JAMA. 1988;259(19):2903. doi:10.1001/jama.1988.03720190071037

Sunshine, beaches, the Harbour Bridge, the Opera House, theatre, art, music, oysters, beer, football, horse racing, and a favourable exchange rate—Sydney seems a tourist's paradise. We local physicians aren't sure that it's a paradise for us.

Had this letter been written in the mid-1960s, it would have described a variety of health services that met the needs of all Australians and that remunerated physicians adequately. A letter in the mid-1970s would have described a new scheme that made little difference to health services, but considerably decreased general practitioners' incomes. This letter records the latest scheme, which has seriously damaged the delivery of health services and eroded the incomes of all physicians.

Medicare, financed by a compulsory levy on income, started in 1983. It covers all charges at state hospitals and medical services at physicians' offices. Additional insurance for private hospital accommodation charges is permitted. But private insurance for physicians' fees