Australia's Healthcare system Flashcards
Medicare
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
Out-of-hospital expenses
Costs for services such as consultation fees, tests, pathology, eye tests, and x-rays
The Medicare benefits schedule
A document that lists the range of services covered and the amount that Medicare will contribute to each known as the schedule fee
Schedule fee
The amount that Medicare contributes towards certain consultation and treatments. The government decides what each item is worth and that’s what Medicare pays
Patient co-payment
The payment made by the consumer for health products or services in addition to the amount paid by the government
Bulk Billed
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
In hospital expenses
Costs for treatment and accommodation in a public hospital as a public patient, that is covered by Medicare, including initial treatment and aftercare
Medicare safety net
Provides extra financial assistance for those that incur significant out of pocket costs for Medicare services
Private Health Insurance
A type of insurance under which members pay a premium in return for payment towards health-related costs not covered by Medicare
private health insurance incentives
- private health insurance rebate
- lifetime health cover
- medicare levy surcharge
- age based discount
Private health insurance rebate
People who hold a private health insurance get up to a 30% rebate which is income tested on their premiums
Lifetime health cover
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
Medicare Levy
2% tax for most Australian taxpayers to fund Medicare
Medicare Levy Surcharge
Age Based Discount
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%
The pharmaceutical benefits scheme
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
The PBS Safety Net
Ensures that people who spend a large amount of money on PBS medications, receive additional financial support
National Disability Insurance Scheme (NDIS)
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.
Assistive technology
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
What does medicare cover?
- 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
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.
What is not covered by Medicare?
- private hospital costs (other than schedule fee)
- most dental examinations/treatments (unless some 2-17yr olds)
- ambulance services
- home nursing care/treatment
Advantages of Medicare
- 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
Disadvantages of Medicare
- 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
Premium
the amount paid for insurance (a fee)
Advantages of private health insurance
- 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
Disadvantages of private health insurance
- expensive premiums
- can be gap costs for patient
- qualifying periods for some conditions before can make claim
NDIS criteria
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
Funding
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.
Sustainability
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
Access
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.
Equity
all Australians should be able to access healthcare when required. The health system must take differences into account if it is to be equitable.
Purpose of an Individualised Plan
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.
Evaluating effectiveness of initiatives (Indigenous h&w)
- 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
