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Whether Australia should adopt a user-pays approach to healthcare for non-emergency health interventions is a topic of ethical significance. The provision of healthcare is a fundamental concern in any society, and how it is structured can have far-reaching ethical implications (Tulchinsky, 2018). This essay will consider various ethical arguments to determine whether a user-pays system can be ethically justified. The central thesis for this essay is that a user-pays approach may find ethical support under certain circumstances. Australia's current healthcare system offers universal access to essential health services, but the sustainability of this approach is a growing concern, especially in the face of increasing demand (Zurynski et al., 2021). The ethical stance of this essay will not be predetermined; instead, it will emerge from the careful analysis of these considerations. This essay aims to provide readers with a balanced understanding of the ethical complexities surrounding this issue, enabling them to form well-informed opinions.


Bioethical Principles

Autonomy is a fundamental bioethical principle that emphasises individuals' right to make informed healthcare decisions (Varky, 2021). This principle is deeply ingrained in Australian healthcare, as reflected in informed consent procedures and patient-centred care (Gilbert & Kerridge, 2019). A user-pays system in Australia for non-emergency interventions would align with autonomy by allowing individuals to choose and prioritise their healthcare based on their preferences. Moreover, financial resources can significantly limit individuals' autonomy (Steckermeier, 2020). In Australia, access to healthcare is often viewed as a fundamental right, supported by the universal healthcare system Medicare (Australian Government Department of Health and Aged Care, 2019). However, a user-pays system could lead to situations where patients with limited financial means are forced to make healthcare choices based not on their medical needs but on their financial constraints. This can erode the autonomy of those who cannot afford to pay for specific non-emergency interventions, creating a tiered healthcare system where decisions are driven by financial considerations rather than medical necessity (Färdow et al., 2019).

Beneficence, another bioethical principle, underscores the obligation to act in the patient's best interests (Varky, 2021). This means that decisions should be made to promote the patient's well-being and healthcare. A user-pays system may face challenges in upholding this principle in the Australian context. While introducing user payments for non-emergency interventions could incentivise efficiency in healthcare delivery, the profit motive could overshadow the primary objective of providing the best care (Diaconu et al., 2021). The transition to a user-pays model might be met with scepticism in Australia, where the public healthcare system is highly regarded for its patient-centred care (Calder et al., 2019).

Non-maleficence obligates healthcare providers not to harm their patients (Varky, 2021). This principle might be challenged in a user-pays system as decisions could inadvertently harm individuals by delaying or discouraging necessary care if they cannot afford it. In Australia, where healthcare is traditionally considered a public good, and access is primarily determined by medical needs, introducing a user-pays model might disrupt this long-standing equilibrium (Dixit & Sambasivan, 2018).

While there are benefits to ensuring that non-urgent cases do not overburden the healthcare system, introducing user payments could potentially harm individuals who delay or avoid necessary healthcare due to financial constraints. This delay could result in worsened health conditions or complications that would have otherwise been prevented (National Academies of Sciences, Engineering, and Medicine, 2018). A real-world example from Australia is the ongoing debate regarding dental care. Dental health is an integral component of overall well-being, yet dental care often falls outside the scope of Medicare. The cost of dental services is a barrier for many Australians, leading to delayed treatment or avoidance of dental care (Crocombe et al., 2022).

Justice, the fourth bioethical principle, emphasises healthcare resources' fair and equitable distribution (Varky, 2021). Australia's commitment to justice is reflected in the principles of universal access to healthcare services through Medicare. However, introducing user payments raises questions about the just distribution of healthcare services, which may lead to inequities based on financial means. Moreover, justice in healthcare extends to whether patients receive care based on medical needs rather than financial status (Olejarczyk & Young, 2021). Introducing user payments for non-emergency interventions could result in a system where those who can pay receive care promptly while those who cannot face delays (Miller, 2021). This system would violate the principles of justice, as access to healthcare should ideally be based on medical needs and not income.

Apart from the four bioethical principles, several other ethical concepts come into play in Australian healthcare. Human dignity is central to ethical healthcare. It implies that individuals should be treated with respect and that their access to healthcare should not be contingent on their ability to pay (Kadivar et al., 2018). The universal access provided by Medicare in Australia aligns with this concept. Introducing user payments, especially if they lead to delayed or denied care, could undermine human dignity by implying that a person's worth is tied to their financial means. Veracity, or truthfulness, is another critical ethical concept. Maintaining trust between patients and healthcare providers is vital, and this trust can be compromised if patients feel that financial considerations drive healthcare decisions (Amer, 2019). A user-pays system would require open and transparent communication about costs, which, if handled carefully, could maintain trust between patients and healthcare providers (Gauld, 2021).

Ethical Theories

Various ethical theories can be applied to address the ethical complexities surrounding a user-pays healthcare system in Australia. Firstly, utilitarianism seeks the greatest good for the most significant number (Tseng & Wang, 2021). Proponents of user-pays systems argue that they can incentivise efficiency and improve resource allocation, potentially benefitting a more significant portion of the population by reducing wait times for necessary procedures. A user-pays model could contribute to the greatest good by ensuring that resources are used efficiently in a resource-constrained healthcare system like Australia's (The Commonwealth Fund, 2023). However, critics argue that this approach may disproportionately benefit those who can afford to pay while negatively impacting those who cannot, thereby undermining the principle of utility (Verhoeven et al., 2020).

Secondly, deontology emphasises duties and rules. From this perspective, access to healthcare might be viewed as a fundamental right and a societal duty (Tseng & Wang, 2021). Universal access to healthcare services through Medicare aligns with this duty. A shift towards user payments breaches this duty, mainly if it results in delayed or denied care for individuals who cannot afford to pay (Zurinsky et al., 2021). However, proponents of user payments might argue that individuals also must contribute to their well-being and that of society. Balancing these duties is complex and requires careful ethical analysis (Riegler, 2023). Thirdly, virtue ethics evaluates actions based on their alignment with moral virtues. Healthcare professionals must exhibit compassion, fairness, and empathy (Doukas et al., 2022). A user-pays system may challenge these virtues, as healthcare providers find themselves in situations where financial considerations overshadow their ethical obligations. They may need help providing the best patient care and adhering to a profit-oriented healthcare model (Gray et al., 2021).

Furthermore, care ethics prioritise benevolent attitudes and close dialogue with patients to determine what is morally best (Krause & Boldt, 2017). In the context of user payments, this perspective would emphasise the importance of open communication about the financial aspects of care and the need to consider the patient's unique circumstances. Balancing this personalised approach and the healthcare system's financial sustainability (Zurinsky et al., 2022). Lastly, natural law argues for universal and objective moral norms that individuals should adhere to when acting responsibly. These norms often emphasise the inherent value of life and health (Wild, 2022). In the Australian context, universal access to healthcare services reflects a commitment to these norms. The introduction of user payments must be carefully evaluated against these norms to ensure that they uphold the ethical responsibilities of society to protect and promote the health of all its members.


In conclusion, the ethical considerations surrounding the adoption of a user-pays approach to healthcare for non-emergency interventions in Australia are complex and multifaceted. It is clear from the ethical arguments here that upholding fundamental bioethical values like autonomy, beneficence, non-maleficence, and fairness may be extremely difficult for a user-paysing system. These difficulties result from the potential loss of patient autonomy, the danger of putting financial gain before patient welfare, the potential harm brought on by financial limitations, and the potential for generating income-based healthcare disparities. Other crucial ethical ideas like human dignity and veracity and diverse ethical theories like utilitarianism, deontology, virtue ethics, care ethics, and natural law further complicate the topic. A user-pays system may be more effective and efficient in allocating resources. However, it must be carefully weighed against any potential harm it may do to people's access to healthcare, equity, and ethical responsibilities within the healthcare system. The ethical justification for using a user-pays system in Australia for non-emergency interventions cannot be established in light of the ethical considerations made. The risks of compromising fundamental ethical conceptions and ideals and the potential damage to patient autonomy, well-being, and justice outweigh any potential advantages of such a system.


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