Introduction

Health policy debates reflect ‘a strife of interests’ (Sax, 1984). They are usually fraught, dealing as they do with matters of life and death, our hopes for long healthy life and our fears of pain, grief and loss of capacity. The Australian health system delivers essential care and enacts public health policy and programmes designed to keep us healthy. It is also a major industry with ever expanding capacity to diagnose and treat. It is one of Australia's largest employers (ABS, 2013), consistently delivering better than average wage growth for its professional workforce, and supporting strong growth in the pharmaceutical and medical technology sectors. Health policy can also act against powerful commercial interests and through concerted and sustained attention can effectively change the daily habits of the population (Scollo and Winstanley, 2012).

National health systems have many common features, but each is differentiated by what Tuohy describes as the ‘accidental logics’ of history and culture, structural and institutional parameters, and the interactions of the many actors in health policy and the health system. Structurally, power and influence are distributed between the state, capital and the health professions. The institutional dimension is the mix of instruments of control – hierarchy, market and professional collegiality – and the interacting patterns and pathways of their use over time (Tuohy, 1999, pp 6–7). Thus health policy and health systems develop with at least a degree of internal consistency as the various elements, shaped by circumstance, interests and compromise, influence each other to produce something that works in practice. In this chapter we argue that contemporary health policy in Australia is shaped by its response to three fundamental challenges: how to maximise health outcomes; how to ensure equity in access to health care; and how to operate an effective health care delivery system within constrained resources.

Maximising health outcomes: health is ‘produced’ in everyday life

The noise and heat in health policy debates is often driven by the question of who gets what health care at what price and standard. But if the underlying goal is healthy life, a focus on prevention offers a more direct route to health gain.