Australian governments and health service providers play a continual role in ensuring efficient healthcare budget use, which also concerns the meeting of goals within a universal health system, and ensuring compliance with relevant legislation and regulations. As is the case in most developed countries, there is substantial pressure on healthcare budgets, and this in turn places pressure on the capacity of governments to fund universal healthcare. The mixed public-private system in Australia has some imperfections including the fragmentation of care and limitations to fund use oversight, however overall, the system serves Australians relatively well. This article explores the Australian approach to a mixed public-private system and considers some of the complexities which arise as it to support universal healthcare.