Second-best in the world no guarantee of an equitable healthcare system

The study, conducted by US think tank The Commonwealth Fund, compared the healthcare systems of 11 high-income countries to measure performance in five key domains: care process, access, administrative efficiency, equity and health care outcomes.

US President Donald Trump says his administration has come up with an alternative to Obamacare, but contends, "it's an unbelievably complex subject, nobody knew that healthcare could be so complicated".

But experts warn a self-congratulatory pat on the back risks overlooking the reality faced by some of Australia's most vulnerable patients.

"All self-congratulations and praise should be tempered by the realisation that Australia ranks very poorly on equity," Dr Lesley Russell from the University of Sydney's Menzies Centre for Health Policy says.

While Australia's health service was praised for its safety, efficiency, and healthcare outcomes for patients, and was among the top-ranked countries on issues such as preventative measures and patient engagement, it fared worse when it came to equity.

In the past year, one in 10 Australians struggled to access medical care because of cost, a factor that saw Australia slide down the rankings to seventh in the category measuring equity.

Here, Dr Russell raises a red flag: "This indicates that the universality of Medicare is being undermined by difficulties in affordable access for many Australians", she says.

While the report attributes Australia's good performance to universal healthcare coverage, Dr Russell is ambivalent. "In theory Australia has this," she says, but "in practice, not so much for some segments of the population."

Dr Ranjana Srivastava, a veteran oncologist and best-selling author, does not shy away from the question of equal access to care, sharing some of Dr Russell's reservations.

"Australia did not fare as well when it comes to equity," she says. "This does ring true to me."

"I am always surprised and humbled to see how treatment outcomes for patients who have the same disease but belong to different postcodes can be so vastly different."

"The factors that I regularly see in play here are socioeconomic disadvantage, health illiteracy, and the lack of advocacy."

Since the last study was conducted in 2014, Australia has jumped two spots from fourth position, leapfrogging past Sweden and Switzerland into second position.

But the data used to assess Australia's performance spans from 2014 to 2016, meaning it may not reflect the impact of the Medicare rebate freeze – a policy which the AMA maintains will widen the chasm between the type of medical care available to the rich and the poor.

"Granted our healthcare system has problems", Dr Srivastava says, "they are well documented by the media – and we should not rest on our laurels."

Overall however, Dr Srivastava points out that the results of the study reflect a culture within Australia's health institutions where care is the primary concern.

"Time and again, I have seen the care, compassion and efficiency with which patients are treated, no matter their ability to pay," Dr Srivastava says.

"A universal health care system like ours treats healthcare as a right rather than a privilege. The countries that are doing well, I think, believe in a moral responsibility to care for their sick, vulnerable and elderly."

The overall health system performance scores:

The Sydney Morning Herald