2.2 Explain how government and non-government organisations share responsibility for the health system

1. What “shared responsibility” means

Shared responsibility means that healthcare in Australia is not funded, delivered, or regulated by one organisation alone. Instead, responsibility is divided across different parts of the system, including government and non-government organisations, which each play a role in making healthcare available, affordable, safe, and effective.

This shared model exists because healthcare is complex. A health system needs money to operate, services to deliver care, and rules to protect patients and maintain standards. In Australia, these responsibilities are spread across multiple organisations rather than controlled by a single provider. As a result, the system depends on coordination between those organisations so that healthcare works as a connected whole.

1.1 Shared funding

Responsibility is shared first through funding. Australia uses both public funding raised through taxation and private spending to support healthcare.

Public funding supports major parts of the system, including Medicare, the Pharmaceutical Benefits Scheme (PBS), public hospitals, and many community health services. At the same time, private spending also plays a major role through private health insurance, direct fees, and out-of-pocket costs paid by individuals.

This means the healthcare system is not funded by government alone. Instead, it relies on a combination of government spending and non-government contributions. This affects how much capacity the system has, how quickly some services can be accessed, and how affordable care is for different groups.

1.2 Shared service delivery

Responsibility is also shared through service delivery. Healthcare is provided through both public services and non-government providers.

Governments directly operate many important parts of the system, especially public hospitals and community health services. However, many everyday healthcare services are delivered in private settings. For example, most GP clinics are private businesses, even when consultations are subsidised through Medicare. Many specialist services, allied health services, pharmacies, pathology services, and diagnostic imaging providers also sit outside government ownership.

Not-for-profit organisations contribute as well, especially in prevention, support, outreach, advocacy, and community-based care. This shows that governments do not deliver all healthcare directly. They often make care possible through funding, planning, and regulation, while services themselves may be delivered by other organisations.

1.3 Shared regulation and quality

The system also involves shared responsibility for regulation and quality. Healthcare must not only be available, it must also be safe, lawful, and consistent.

Governments set the legal and policy framework that health services must operate within. National and state systems help regulate medicines, medical devices, health facilities, and professional practice. Public, private, and not-for-profit services are all expected to meet quality and safety standards.

This means responsibility is shared not only in paying for and delivering care, but also in protecting patients and maintaining confidence in the health system.

2. Federal, state and territory and local government

Within the government sector, responsibility is shared across federal, state and territory, and local government. These three levels do not all do the same thing. Instead, each level has its own main areas of responsibility, while still working as part of the broader healthcare system.

In general, the Commonwealth provides national leadership, major funding, and national regulation. State and territory governments run most public health services and manage much of day-to-day service delivery. Local government has a smaller role, but still contributes through environmental health, prevention, and local community health support.

2.1 Commonwealth government (federal)

The Commonwealth government plays a major role in national health policy, funding, and regulation. It helps shape the overall direction of the healthcare system by deciding national priorities, funding mechanisms, and broad regulatory arrangements.

Its main responsibilities include:

• funding Medicare, which helps Australians access medical services
• funding the Pharmaceutical Benefits Scheme (PBS), which reduces the cost of many prescription medicines
• contributing funding to public hospitals through agreements with state and territory governments
• supporting national planning in primary care, including through Primary Health Networks, which help identify local needs and support services such as mental health care, after-hours care, and chronic disease programmes
• contributing to health research and broader public health activities, which help improve prevention, policy, and system quality over time
• regulating medicines and medical devices through the Therapeutic Goods Administration (TGA)
• supporting national safety and quality systems across the health system
• funding or supporting some services for particular groups, including parts of Aboriginal and Torres Strait Islander health, aspects of aged care, and some services linked to veterans’ health

Overall, the Commonwealth does not run most hospitals or community clinics directly, but it plays a major role in shaping how the entire system functions.

2.2 State and territory governments

State and territory governments have the main responsibility for operating much of the public health system and turning policy into actual services.

Their main responsibilities include:

• owning and running most public hospitals, including emergency departments, inpatient care, surgery, and outpatient clinics
• delivering a wide range of community health services
• providing public mental health services and public health clinics
• providing public dental services for eligible groups
• delivering family and child health services
• delivering some women’s health services
• providing home and community care
• running rehabilitation programmes
• managing important public health and prevention functions, including disease monitoring, outbreak management, health protection, and local public health programmes
• regulating many services and facilities within their jurisdictions through licensing, inspection, and compliance processes

This means state and territory governments are the part of government most directly involved in the day-to-day delivery of healthcare. They are responsible for making sure many essential public services are actually available for people to use.

2.3 Local government

Local government has a more limited role than the Commonwealth or the states and territories, but it still shares responsibility for the health system in practical ways.

Local councils mainly contribute through:

• environmental health
• prevention
• support for healthier local communities

Their responsibilities vary across jurisdictions, but commonly include food safety inspections, waste management, sanitation, and monitoring local environmental health issues. Councils also influence health through decisions about the built environment, such as parks, walking spaces, recreation facilities, and community amenity.

In some areas, local government also supports health promotion or prevention activities, including community health education and, in some cases, immunisation clinics in partnership with state health services.

Although local councils do not run the healthcare system in the same way as higher levels of government, they still contribute by helping create safer, healthier, and more supportive local environments.

3. Non-government sector – private and not-for-profit

The non-government sector plays a major role in the Australian healthcare system. It contributes by delivering services, adding capacity, improving choice, supporting prevention and advocacy, and helping meet needs that may not be fully met through government services alone.

This sector includes both private organisations and not-for-profit organisations. While these groups operate differently, both are important in explaining how responsibility for healthcare is shared across the system.

3.1 Private sector

The private sector includes businesses and practitioners who provide healthcare services as paid services. Many parts of day-to-day healthcare in Australia are delivered through this sector.

The private sector includes:

• many GP practices, even when their services are partly subsidised through Medicare
• most specialist consultations
• private hospitals, which provide a large proportion of elective procedures
• extensive allied health services
• most dental care
• many pathology services
• many diagnostic imaging services
• pharmacies

Funding in the private sector comes from a mixture of private health insurance, direct fees paid by patients, and public subsidies such as Medicare rebates and PBS arrangements. This means the private sector is not completely separate from government funding. Instead, it often operates alongside public support.

The private sector strengthens the healthcare system by adding capacity and increasing choice. However, it also means that access to some services may depend partly on a person’s ability to pay.

3.2 Not-for-profit sector

Not-for-profit organisations operate to achieve a health, community, or advocacy purpose rather than to generate profit. They often make an important contribution in areas such as:

• prevention
• patient support
• outreach
• health promotion
• counselling
• advocacy

Some not-for-profit organisations provide direct services, while others focus more on education, support, navigation, or representing the needs of specific groups. This part of the system includes both large organisations working across a state or the nation and smaller local groups responding to community needs.

A particularly important part of this sector is community-controlled care. For example, Aboriginal Community Controlled Health Organisations show how not-for-profit organisations can provide community-led, culturally safe healthcare that is shaped by the needs and priorities of the community itself.

Not-for-profit organisations may rely on a mix of government contracts, grants, donations, and fundraising. This allows them to complement the work of governments and private providers, especially in areas where trust, local knowledge, advocacy, or specialised support are important.

4. How they work together

Shared responsibility becomes easier to understand when you look at how the healthcare system works in real situations. In practice, one organisation may help fund a service, another may deliver it, and another may help regulate it or maintain quality and safety. This means healthcare in Australia works through connected responsibilities rather than one single provider doing everything. The next dot point explores more directly how this becomes person-centred collaboration in individual care.

This table shows that shared responsibility is built into the way the healthcare system operates. Different organisations do different parts of the work, but the system functions best when these roles are connected clearly and consistently.