Sturmberg and Martin 1 call
for PHC and UHC to become a “system as a whole framework” where UHC
operates as financing PHC then improving parts of the system will lead
to improving the whole system. However, until PHC is reformed to operate
locally, integrated with local welfare, housing and other services, it
can be argued that uniting two damaged systems will lead to further
damage and inadequacy for people’s health and wellbeing. UHC is rarely
universal; this is demonstrated in Australia by the growth of
out-of-pocket costs (OOPs) which are currently estimated as 20% of
health costs. 32, 33 OOPs are comprised of co-payments
on prescription medicines, gap fees for GP, specialists, allied health
care, plus costs associated with tertiary care. The support of the
private health insurance (PHI) industry via tax credits for those able
to afford PHI has further undermined UHC in Australia. Another aspect of
its lack of universality is the funding of the system, with 39% of
funding in Australia going to tertiary care and 1.34% in 2013-14 to
preventive health services.34, 35