Matthew Fisher - Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
Toby Freeman - Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia
Tamara Mackean - College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
Sharon Friel - RegNet School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
Fran Baum - Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia

BackgroundUniversal health coverage (UHC) is central to current international debate on health policy. The primary healthcare (PHC) system is crucial to achieving UHC, in order to address the rising incidence of non-communicable diseases (NCDs) more effectively and equitably. In this paper, we examine the Australian case as a mature system of UHC and identify lessons for UHC policy to support equity of access to PHC and reduce NCDs. MethodsOur qualitative research used policy mapping and monitoring and ۳۰ key informant interviews, and applied policy theory, to investigate the implementation of Australian PHC policy between ۲۰۰۸ and ۲۰۱۸. ResultsAlthough the Australian PHC system does support equity of access to primary medical care, other ideational, actor-centred and structural features of policy detract from the capacities of the system to prevent and manage NCDs effectively, deliver equity of access according to need, and support equity in health outcomes. These features include a dominant focus on episodic primary medical care, which is a poor model of care for NCDs, and an inequitable distribution of these services. Also, a mixed system of public and private insurance coverage in PHC contributes to inequities in access and health outcomes, driving additional NCD demand into the health system. ConclusionCountries aiming to achieve UHC to support health equity and reduce NCDs can learn from strengths and weaknesses in the Australian system. We recommend a range of ideational, actor-centred and structural features of UHC systems in PHC that will support effective action on NCDs, equity of access to care according to need, and equity in health outcomes across geographically and ethnically diverse populations.

Australia, Universal Health Coverage, Primary Healthcare, Health Equity, Non-communicable Disease