3.2.2 - Australia's health system Flashcards
Medicare
Australia’s universal health insurance scheme giving all Australians, permanent residents, + people from countries with a reciprocal agreement, access to subsidised healthcare.
Medicare benefits scheme
Document that lists the range of services covered + the amount that Medicare will contribute to each.
Medicare safety net
Provides extra financial assistance for those that incur significant out-of-pocket costs for Medicare services.
What medicare covers
- All/some of fees relating to many essential HC services (consultation fees for doc + spec, tests + exams that are needed, most surgical procedures, etc).
- Expenses for public patient in private hospital.
- 75% of schedule fee for treatment for public in private.
What Medicare doesn’t cover
- Most costs associated with private hospital care.
- Most dental examinations + treatments
- Home nursing care/treatment
- Cosmetic/unnecessary procedures
- Ambulance services
- Most allied health services (unless referred to by GP or carried out in public hospital).
Advantages of Medicare
- Choice of doctor for out-of-hospital expenses
- Available for all aus citizens
- Reciprocal agreement between aus + other countries
- Medicare safety net provides extra financial support
Disadvantages of medicare
- No choice of doctor for in-hospital treatments
- Waiting lists
- Doesn’t cover alternative therapies
- Often doesn’t cover full amount of doctor’s visits.
PHI
A type of insurance under which members pay a premium/fee in return for health-related costs not covered by Medicare (optional + in-addition to medicare).
Extras cover
Cover for general treatment to pay for services provided by dentists, physiotherapists, + chiropractors, generally aren’t covered by Medicare (premium increases with each addition).
PHI incentives
- PHI rebate
- Lifetime health cover
- Medicare levy surcharge
- Age-based discount
PHI rebate
Policy holders receive a 30% rebate/refund on their premium in tax returns (extra for those over 65) or can choose to pay a reduced premium in which the gov contributes to remaining costs.
Lifetime health cover
People who take up PHI after the age of 31 pay an extra 2% on their premiums for every year they are over the age of 30 (loading removed after 10 consecutive years).
Medicare Levy Surcharge
People without PHI + earning more than a certain amount p/a ($90,000 or $180,000) have to pay this extra tax which increases with income.
Age-based discount
Insurers have the option of offering young people aged 18-29, a discount of up to 10% for hospital cover, allowing for a 2% reduction in premiums each year that the person is aged under 30 (max 10%)
The PBS
A key component of the Fed Gov’s contribution to Aus’s health system in which the government provides subsidised medication to the community (consumers must make a patient co-paymenet).
PBS safety net
Once an individual/family has spent $1497.20 within a calendar year, they only have to pay A$6.60 instead of the regular $41.30.
Pharmaceutical benefits advisory committee (PBAC)
Independant committee made up of health professionals who review + consider new medicines for inclusion in the PBS (3 times a year).
NDIS
A national insurance scheme that provides services + support for people with permanent, significant disabilities, + their families + carers (funded by state/territory govs).
Requirements to be eligible for NDIS
- Under 65
- Residency requirements (live in Aus + be a citizen or hold a permanent visa or protected special category visa).
- Disability requirements - permanent impairment, impairment reduces ability to participate/perform, impairment effects capacity for social + economic participation, likely to require NDIS support for lifetime.
Individualised plan (first step in accessing NDIS once requirements are wet)
Based on individual goals + identifies support needed for ‘ordinary life’.
Medicare - funding
Funds part/all fees associated wth health services through general tax, medicare levy, + medicare levy surcharge.
Medicare - sustainability
Covers only essential services, low cost, is schedule fee appropriate?
Medicare - equity
Safety net accommodates to difference financial needs, available to all citizens.
Medicare - access
Low/no cost, waiting lists = emergency first, my health record (data is accessible wherever you need it).
PHI - funding
User-pay (funded through PHI funds/company + through the fed gov.
*incentives + rebate is fed gov
*user-pay contributes to PHI funds
PHI - sustainability
Meets HC needs of current generation, incentives increase accessibility of HC in future (reduces pressure on medicare + public health system)
PHI - equity
Medicare levy surcharge (doesn’t pressure those who can’t afford PHI).
- Not equitable as not everyone can afford.
PHI - access
PHI rebate makes more accessible as more people can afford, allows access to doctor of choice, improves access for patients who rely on public health system.
PBS - funding
Federal Gov funds through general taxation
PBS - sustainability
Only essential medications (reviewed 3 times a year to keep up to date)
PBS - equity
PBS safety net, no discrimination
PBS - access
Timely access, local/all pharmacies, affordability, reduce time spent in ill-health.
NDIS - funding
Federal gov (provides funding for a range of resources that promote HS).
NDIS - sustainability
3 year roll out, individualised plan meets specific needs of generation.
NDIS - equity
Ensures people with disabilities (+ carers) are able to access more HC, individualised plan can make culturally appropriate.
NDIS - access
Provides necessary financial support to achieve goals + needs, accessible in all regions.
