australia's healthcare system : medicare

Question 1

australia’s health system

Answer 1

According to the World Health Organization, a health system is
‘all the activities whose primary purpose is to promote, restore and/or maintain health’.

Question 2

what is the health system made up of?

Answer 2

Australia’s health system is made up of two main components:
1. public healthcare
2. private healthcare

Question 3

1. public healthcare

Answer 3

The public component includes public-sector health services and schemes that are provided by the Australian, state/territory and local governments, and include:
* Public hospitals
* Medicare
* the Pharmaceutical Benefits Scheme

Question 4

2. private healthcare

Answer 4

The private sector includes:
* private health insurance
* private hospitals
* medical practitioners in private practices

Question 5

medicare

Answer 5

Australia’s universal health insurance scheme. Established in 1984, Medicare gives all Australians, permanent residents and people from countries with a reciprocal agreement like New Zealand or the United Kingdom access to healthcare that is subsidised by the government

Question 6

what does medicare cover? - out of hospital expenses

Answer 6

• includes consultation fees for doctors and specialists.
• Covers tests and examinations for illness treatment.
• Covers pathology tests like blood tests.
• Covers eye tests by optometrists.
• Covers most surgical and therapeutic procedures performed by general practitioners.

Question 7

dental services

Answer 7

• Not all basic dental services are covered by Medicare.
• Some procedures, including surgical procedures by approved dentists, are covered.
• Some children aged 2-17 can qualify for Medicare-funded dental procedures under the Child Dental Benefits Scheme.
• To qualify, individuals must be eligible for Medicare and receive certain government benefits.

Question 8

what does medicare cover? - in hospital expenses

Answer 8

• Covers accommodation, treatment, initial treatment, and aftercare in public hospitals.
• Medicare pays 75% of the schedule fee for private hospital treatment.
• Doesn’t cover accommodation, theatre fees, or medication.

Question 9

what does medicare cover? - schedule fee

Answer 9

• Government determines value of each consultation item.
• Medicare pays for this.
• Doctors and private hospitals may charge more than schedule fee.

Question 10

medicare safety net

Answer 10

• Provides financial assistance for significant out-of-pocket costs.
• Government provides additional support after contributing a certain amount ($700 for singles, $1000 for couples/families in 2017).
• Makes Medicare services cheaper for the rest of the year.

Question 11

what is not covered by medicare?

Answer 11

• Medicare covers most ‘clinically necessary’ hospital and doctor’s fees.
• Cosmetic or unnecessary procedures are generally not covered.
• Other services not covered by Medicare include most private hospital care costs, most dental examinations and treatment, home nursing care or treatment, ambulance services, and most allied health services.
• ‘Alternative medicines’ like chiropractic services, acupuncture, remedial massage, Naturopathy, and aromatherapy are not covered by Medicare.
• Health-related aids like glasses, contact lenses, hearing aids, and artificial limbs costs are exempt from the Medicare rebate.
• Pharmaceuticals are not covered under Medicare but may be subsidized under the Pharmaceutical Benefits Scheme.
• Medical costs for which someone else is responsible do not qualify for a Medicare contribution.
• Individuals and families can purchase private health insurance to cover many services not covered by Medicare.

Question 12

advantages of medicare

Answer 12

• Choice of doctor for out-of-hospital services.
• Free healthcare access through reciprocal agreement.
• Covers tests, examinations, and specialist fees.
• Provides extra financial contributions for certain procedures.

Question 13

disadvantages of medicare

Answer 13

• No choice of doctor for in-hospitaltreatments
• Waiting lists for many treatments
• Does not cover alternative therapies
• Often does not cover the full amount of a doctor’s visit

Question 14

how is medicare funded?

Answer 14

Medicare is funded through three sources of income:
* the Medicare levy
* the Medicare levy surcharge
* general taxation

Question 15

medicare levy

Answer 15

• Additional 2% tax on most taxpayers’ taxable income.
• Exemptions for low-income individuals or specific circumstances.

Question 16

medicare levy surcharge

Answer 16

• Individuals and families earning over $90,000 a year and $180,000 for families are subject to a Medicare levy surcharge.
• The surcharge increases with income; 1 - 1.5 % of their tax income
• The surcharge encourages private health insurance, reducing financial pressure on Medicare.
• The aim is to reduce demand on the Medicare-funded public system.

Question 17

general taxation

Answer 17

• Revenue from Medicare levy and surcharge doesn’t cover full operating costs.
• General taxation income also used to fund Medicare costs.