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Neurological Letter from Australia
  1. Graeme J. Hankey
  1. Consultant Neurologist and Head of Stroke Unit, Royal Perth Hospital, Western Australia; Clinical Associate Professor, Department of Medicine, University of Western Australia. E-mail: gjhankey{at}


Australia is a vast country, as large as Europe or the United States, yet populated by only 19 million people. Colonized by Europeans and situated in the Asia-Pacific region, it is a western democracy with multicultural ethnicity, waning European ties (despite ‘endorsement’ of the Queen as head of state in a recent referendum), and increasing integration in the Asia-Pacific economy.

The Australian healthcare system

About 8.5% of the gross domestic product, $Aus 40 billion, is spent on the Australian healthcare system by the public and private sector in a ratio of 2 : 1 (Buckley et al. 1998). The public contribute an ever increasing proportion (now 1.5%) of their taxable income to a 15-year-old-form of public insurance (Medicare), which was designed to provide widely accessible general and specialist care in the community and public hospitals. Individuals who prefer access to the specialist and private hospital of their choice contribute to

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