Australia's health systems Flashcards
Medicare
Australia’s universal health insurance scheme.
services covered by medicare
in-hospital expenses and out-of hospital expenses (x-rays, eye tests, doctor and specialist consultations, blood and urine tests, accommodation in public hospitals, Dental services for some children under the child benefits scheme).
Schedule fee
the amount that
Medicare contributes towards
certain consultations and
treatments. The government
decides what each item is worth
and that’s what Medicare pays.
Doctors and private hospitals may
choose to charge more than the
schedule fee.
patient co-payment
the
payment made by the consumer
for health products or services in
addition to the amount paid by
the government
Bulk- billing
when the doctor
charges only the schedule fee.
The payment is claimed directly
from Medicare so there are no
out-of-pocket expenses for the
patient.
Medicare safety net
The Medicare Safety Net provides extra financial assistance for those that incur significant out-of-pocket
costs for Medicare services. Once an individual or family has contributed a certain amount out of their own
pocket to Medicare services.
Allied health services
health
services provided by trained
health professionals who are
not doctors, dentists or nurses.
Examples include services
provided by physiotherapists,
psychologists and occupational
therapists.
Advantages of medicare
Choice of doctor for out-of-hospital services
* Available to all Australian citizens
* Reciprocal agreement between Australia and other
countries allows Australian citizens to access free
healthcare in selected countries
* Covers tests and examinations, doctors’ and
specialists’ fees (schedule fee only), and some
procedures such as X-rays and eye tests
* The Medicare Safety Net provides extra financial
contributions for medical services once an individual’s
or family’s co-payments reach a certain level
Disadvantages of medicare
-No choice of doctor for in-hospital treatments
* Waiting lists for many treatments
* Does not cover alternative therapies
* Often does not cover the full amount of a doctor’s
visit
How is medicare funded?
-Medicare levy
-general revenue
-medicare levy surcharge
Pharmaceutical Benefits Scheme ((PBS)
The aim was to provide essential medicines to people who needed
them, regardless of their ability to pay. The purpose of the PBS remains the same today, but instead of being
free, medicines are now subsidised and consumers must make a patient co-payment. the government subsidises the cost of medicine for most medical conditions
National Disability Insurance Scheme (NDIS)
The NDIS is a national insurance scheme that provides services and support for people with permanent,
signifi cant disabilities, and their families and carers. The
NDIS works to assist individuals with disabilities to live an ordinary life
How is the NDIS funded
Funded by the federal and state/territory governments.
NDIS individual plan
- Maintain informal support arrangements
- Access community support and services
- Access mainstream services and supports
-receive reasonable and necessary funded supports.
Private health insurance (PHI)
Private health insurance is a type of insurance under which members pay a premium (or fee) in return for
payment towards health-related costs not covered by Medicare. It is an optional form of health insurance that
can be purchased in addition to Medicare.
