摘要: The past forty years of debate about the Australian health care system have been dominated by a debate about private versus universal insurance models to pay for health services, with the Liberal-National Coalition supporting the former, and the Australian Labor Party the latter. Following a long period of stabilisation through the reintroduction of a universal health insurance model by the Hawke government during the 1980s, the election of the Howard government in the mid 1990s saw a shift back to private insurance. International influences from Europe and the USA in the funding, planning, and management of the health system have been the subject of intense scrutiny in the recent past.There is now a general recognition that significant improvements in the performance of the health system are possible, but to achieve them will require change in the relationships between the Commonwealth and state governments and in the way in which health services are planned, organised, and funded. The advocates for change range from the evolutionary to the revolutionary, but there are also significant interests in favour of the status quo. In order to understand the pressures for change and their likely outcomes it is important to have first a reasonable understanding of the current features of the Australian system and how it has evolved. From there the discussion proceeds to current issues and the possible options for their resolution. The Commonwealth derives its main powers for direct involvement in health policy through section 51 (xxiiiA), section 51 (ix), and section 96 of the Constitution. Section 51 (xxiiiA) provides the Commonwealth's broad