New data comparing various health systems from around the world have identified a clear gap between the health of the "haves" and "have-nots" in Australia. It also clearly shows that access and perception of the Australian health system differs markedly depending on income levels. These are just some of the results from an international study being presented at the "Health Services Research Conference" in Sydney this week by leading international health economist Karen Davis, president of The Commonwealth Fund in New York. Davis will present data from a study that used surveys with health consumers (1,000 in each country) to compare perceptions of health systems in the United States, Australia, Canada, the United Kingdom, and New Zealand. The study shows that in Australia, people with below average incomes are twice as likely to report having difficulty getting care than people with higher incomes. In Britain there is almost no difference and in the United States people with low incomes are more than three times as likely to report difficulty getting care than their high-income counterparts. Also, Australians with low incomes were three times more likely to report being in "poor or fair" health than Australians with high incomes. According to Davis: "This study offers a note of caution to health systems that are becoming increasingly reliant on the private sector. It shows that national systems with high private components also have higher levels of inequality with regard to access and consumer experience" The study also identified some clear negatives associated with cost sharing. "Even relatively modest patient co-payments can result in access problems and financial burdens for lower income families," said Davis. In comparing various countries the study showed that people from low-income groups have less access and more negative perceptions of health systems than people from higher income groups and these differences are most pronounced in countries that are overly reliant on private health insurance and private markets.