Australia's Health system Flashcards
3 Areas that make up Australia’s health system
- Medicare
- Pharmaceutical benefit scheme (PBS)
- Private health insurance
What is Medicare?
Australia’s universal health insurance scheme that gives all Australians, permanent residents, and people from countries with reciprocal agreements access to affordable healthcare’s.
What does Medicare cover (in-hospital)?
- Public patient in a public hospital - hospital treatment is covered.
- Public patient in a private hospital or private patient in a public hospital- 75% of scheduled fee is covered.
What services are NOT covered by Medicare?
-Most dental examinations & treatment (although some children aged 2-17 can qualify for Medicare funded dental care).
-Home nursing care or treatment.
-Ambulance services.
-Alternative therapies- Chiropractic, acupuncture, remedial massage, physiotherapy, pediatric health related aids.
How is Medicare funded?
- General income tax- income collected through general income tax of all Australians.
- Medicare Levy: 2% tax on taxable income of most tax payers (low income may be exempt).
- Medicare Levy Surcharge: Those earning over $90,000 (individually) & $180,000 (families) without PHI pay extra tax of 1% - 1.5%. As income increases, so does surcharge. Aimed at encouraging people with higher income to take out PHI to take some of the financial pressure off Medicare.
Positives of Medicare?
-Reduced costs of essential medical services including fee treatment & accommodation in a public hospital.
-Some choice of doctor for out-of-hospital services.
-Available to all Australian citizens.
-Reciprocal agreement between Australia & other countries allows Australians citizens to access free healthcare in selected countries.
-Covers tests & examinations, doctors & specialists fees (scheduled only) & some procedures such as x-rays & eye tests.
-The Medicare safety net provides extra financial contributions for medical services once an individual or families co-payments reach a certain level.
Negatives of Medicare?
-No choice of doctor for in-hospital treatments.
-Waiting lists for many treatments.
-Does not cover alternative therapies or allied health services.
-Often does not cover the full amount of a doctors visit if they are probate practice or independent.
What does Medicare Cover? (Out-of-hospital)
-Consultation fee for doctors (general practitioner) & specialists (dermatologists, pediatricians).
-Tests & examinations needed to treat, diagnose illness/conditions (x-rays, pathology tests, eye tests).
-Most surgical procedures performed by G.P.
-Some dental procedures and services for children aged 2-17.
Why is Private health Insurance important part of the Health Care system if not everyone can afford it?
Additional insurance on top of Medicare. Gives more choice to the sort of care they want to access. Forms an important part of the health care system that helps to reduce the burden on the burden on the public health care system.
What services might private health insurance cover that Medicare does not?
Complementary therapies- physiotherapy, chiropractic, osteopathy, nutritionist, massage therapy, dentist, optometry & costs of glasses etc..
Disadvantages of PHI?
-Maybe be expensive in terms of the premium that have to be paid.
-Sometimes will have to the ‘gap’ for treatments where insurance doesn’t cover the whole fee.
-Qualifying periods apply for some conditions or access to treatments (time periods that you won’t be able to claim for that service).
-Policies can be hard to understand.
What is PBS?
The PBS is a key component of the health system that is responsible for administering essential medicines. Provides essential medicines to people who need them, regardless of their ability to pay where costs of prescription medication is subsided (by the government) with co-payments being made by the individual
What is Private Health insurance?
Type of insurance where members pay a premium (fee) in return for payment towards health related costs not covered by Medicare.
What are parts of PBS that can help those that may be disadvantaged in some way?
Healthcare: card holders (those on a pensions or those who receive government allowances or meet age requirements) will only pay maximum costs of $38.80 or the minimum $6.30 for medicines.
PBS Safety Net-Protection: From large expenses from medications. $149.90 spent in a calendar year on PBS medications, then only pay concessional rate.
Difference between Medicare and PBS?
Medicare is Australia’s universal scheme that allows all Australians access to a wide range of health services such as G.P consults and x-rays as a public patient in a public hospital where as the PBS is a more specific giving Australians access to essential medicines only.
