Australia's Healthcare system

Question 1

Medicare

Answer 1

Australia’s universal health insurance scheme, it gives all Australians, permanent residents and people from countries with a reciprocal agreement (NZ, UK, Sweden…), access to subsidised healthcare administered by the federal government

Question 2

Out-of-hospital expenses

Answer 2

Costs for services such as consultation fees, tests, pathology, eye tests, and x-rays

Question 3

The Medicare benefits schedule

Answer 3

A document that lists the range of services covered and the amount that Medicare will contribute to each known as the schedule fee

Question 4

Schedule fee

Answer 4

The amount that Medicare contributes towards certain consultation and treatments. The government decides what each item is worth and that’s what Medicare pays

Question 5

Patient co-payment

Answer 5

The payment made by the consumer for health products or services in addition to the amount paid by the government

Question 6

Bulk Billed

Answer 6

When the doctor or specialist charges only the schedule fee. The payment is claimed directly from Medicare so there are no out-of-pocket expenses for the patient

Question 7

In hospital expenses

Answer 7

Costs for treatment and accommodation in a public hospital as a public patient, that is covered by Medicare, including initial treatment and aftercare

Question 8

Medicare safety net

Answer 8

Provides extra financial assistance for those that incur significant out of pocket costs for Medicare services

Question 9

Private Health Insurance

Answer 9

A type of insurance under which members pay a premium in return for payment towards health-related costs not covered by Medicare

Question 10

private health insurance incentives

Answer 10

• private health insurance rebate
• lifetime health cover
• medicare levy surcharge
• age based discount

Question 11

Private health insurance rebate

Answer 11

People who hold a private health insurance get up to a 30% rebate which is income tested on their premiums

Question 12

Lifetime health cover

Answer 12

People who get private health insurance after 31y/o pay an extra 2% on their premium for every year over 30 until they are 40y/o

Question 13

Medicare Levy

Answer 13

2% tax for most Australian taxpayers to fund Medicare

Question 14

Medicare Levy Surcharge

Question 15

Age Based Discount

Answer 15

Offers people aged 18-29 up to 10% off for hospital cover. It is a 2% reduction on premium for every year under 30y/o to a max of under 10%

Question 16

The pharmaceutical benefits scheme

Answer 16

Its aim is to provide essential medicine to people who need them, regardless of their ability to pay. The federal government subsidises essential medicines and consumers only make a co-payment

Question 17

The PBS Safety Net

Answer 17

Ensures that people who spend a large amount of money on PBS medications, receive additional financial support

Question 18

National Disability Insurance Scheme (NDIS)

Answer 18

A national insurance scheme that provides services and support for people with permanent, significant disabilities, and their families and carers. It is funded by the federal and state/territory governments to assist individuals with disabilities to live an ordinary life.

Question 19

Assistive technology

Answer 19

A device, system or design that allows an individual to perform a task that they would otherwise be unable to do, or increase the ease and safety with which a task can be performed

Question 20

What does medicare cover?

Answer 20

• GP consultations
• tests and examinations to treat illnesses
• a limited no. of psych consultations, must be referred by GP & mental health plan
• all in hospital expenses - PUBLIC only
• 75% of schedule fee in private hospital

Question 21

Schedule fee

Answer 21

the amount that Medicare contributes towards certain consultations and treatments. The government decides what each item is worth and that’s what medicare pays.

Question 22

What is not covered by Medicare?

Answer 22

• private hospital costs (other than schedule fee)
• most dental examinations/treatments (unless some 2-17yr olds)
• ambulance services
• home nursing care/treatment

Question 23

Advantages of Medicare

Answer 23

• reduced cost for essential medical services
• choice of doctor for out-of-hospital
• available to all aus citizens
• covers tests & examinations, doctors’ & specialists’ fees & some procedures
• medicare safety net

Question 24

Disadvantages of Medicare

Answer 24

• no choice of doctor for in hospital
• waiting lists for many treatments
• doesn’t cover alternative therapies or allied health
• often doesn’t cover full amount for most doctors

Question 25

Premium

Answer 25

the amount paid for insurance (a fee)

Question 26

Advantages of private health insurance

Answer 26

• access to private hospital care
• choice of doctor in private/public hospital
• shorter waiting times for some procedures
• part/all services (dental, chiro, physio, optometry, dietetics) covered
• high income earners don’t have to pay medicare levy surcharge
• gov rebate
• lifetime health cover

Question 27

Disadvantages of private health insurance

Answer 27

• expensive premiums
• can be gap costs for patient
• qualifying periods for some conditions before can make claim

Question 28

NDIS criteria

Answer 28

Age - under 65
Residency - must live in Australia
Disability:
1. permanent impairment/condition
2. reduces ability to participate in activities without assistance
3. affects capacity for social & economic participation
4. likely to require support for lifetime

Question 29

Funding

Answer 29

relates to the financial resources that are provided to keep the health system adequately staffed and resourced so a high level of care is available for those who need it. More people can receive treatment by reducing the cost.

Question 30

Sustainability

Answer 30

relates to its capacity to provide a workforce and infrastructure such as facilities and equipment into the future, and to be innovative and responsive to emerging needs through interventions such as research and monitoring

Question 31

Access

Answer 31

an accessible health system can provide all people with timely access to quality health services based on their needs, not ability to pay, regardless of where they live in the country.

Question 32

Equity

Answer 32

all Australians should be able to access healthcare when required. The health system must take differences into account if it is to be equitable.

Question 33

Purpose of an Individualised Plan

Answer 33

it’s based on the individual’s goals and aspirations, both now and in the future. It also identifies the functional support needed for daily living and participation, the support needed for daily living and participants, and the support needed to pursue goals.

Question 34

Evaluating effectiveness of initiatives (Indigenous h&w)

Answer 34

• actual/perceived improvements to h+w
• the number of participants taking part
• feedback provided by participants
• action areas of OC are evident
• is education provided?
• is it culturally appropriate?
• taking into account needs of the target group
• funding has been provided
• addresses a significant health issue