Tax Expenditures on Health in Australia: 1960–61 to 1988–89

Commonwealth government tax expenditures arise because departures from the tax structure produce favourable tax treatment of particular types of activities or taxpayers. Such tax concessions can be used in the same way as direct expenditures to give effect to government policies, and in fact are often used as substitutes for direct expenditures. Although estimates of tax expenditures on health in more recent times are readily available, this form of subsidisation of the health sector has not been used heavily since the introduction of Medicare in 1984. It is for the period spanning the 1960s and the 1970s, when tax expenditures were a much more important source of health care finance, that consistent estimates are lacking. This article presents estimates of the revenue cost of income tax concessions for health in Australia over the period 1960–61 to 1988–89 and integrates these estimates into the currently available health expenditure statistics. It is concluded that failure to allow for tax expenditures on health when analysing public expenditures on health in Australia can lead to misleading conclusions about the net fiscal impact of changes in the Commonwealth's health expenditure policy. In particular, the fiscal effect of introducing Medihank in 1975 is significantly lower if account is taken of changes to tax concessions on health occurring at the same time. Likewise, the net cost of the introduction of Medicare in 1984 is overstated by measures based on direct outlays alone.