Australian Health System

Question 1

Provide the definition of a health system

Answer 1

“all actors, institutions and resources that undertake health care actions - where a health action is one where the primary intention is to improve health”.

Question 2

What are the three broad goals of a health system?

Answer 2

-Attainment of the highest quality of health for a country given available resources
-Responsiveness to the expectations of the population
-Fairness of financial contributions-

Question 3

What are the six building blocks of a health system?

Answer 3

• work force
• service delivery
• information
• medicines and technologies
• financing
• governance and leadership

Question 4

List the four health system models

Answer 4

• Beveridge
• Bismark
• NHI model
• Out-of-pocket

Question 5

Describe the Beveridge model

Answer 5

Financier: government via health tax
Provider: Government (majority)
Cost control: strictly enforced by the government
Profit: HFP
Countries: India, UK, Au, Spain, NZ

Question 6

Describe the Bismarck model

Answer 6

Financier: sickness finds (employer and employee)
Provider: Government (majority)
Cost control: negotiated monopsony
Profit: NFP
Countries: Germany, France, Belgium, Japan

Question 7

Describe the NHI model

Answer 7

Financier: Government run insurance into which every citizen pays
Provider: Private
Cost control: negotiated monopsony
Profit: NFP
Singapore

Question 8

Describe the out-of-pocket model

Answer 8

Financier: individual
Provider: private
Cost control: none
Profit: NFP
Countries: USA, India in practice

Question 9

What are the challenges of the Beveridge model?

Answer 9

• frequently beset by long waiting lists for treatment
• thus the provision of a regulated optional private insurance system exists to offset public health system pressures, and to cater to certain income and resident groups
• provides greater choice for people as they have access to both public and private systems

Question 10

Define universal health coverage

Answer 10

• all individuals and communities receive the health services they need
• without suffering financial hardship
• includes the full spectrum of essential, quality health services: health promotion, prevention, treatment, rehabilitation, palliative care

Question 11

Describe federal government health responsibilities

Answer 11

Federal government:
- sets national policies
- responsible for medicare
- joint funding with states and territories of public hospital services
- funds pharmaceuticals via PBS
- funds NACCHos
- supports access to private
- regulates private
- major funder of research via NHMRC
- regulates medicines, devices and blood

Question 12

Describe the health responsibilities of state governments

Answer 12

• manage public hospotals
• license private hospital
• responsible for community based and primary health services (mental health, dental health, alcohol and drug services)
• deliver preventive services e.g. immunisation and cancer screening
• ambulance services
• handling health complaints

Question 13

Describe the health responsibilities of local governments

Answer 13

• provide environmental health-related services e.g. waste disposal, water fluoridation, water supply, food safety monitoring
• deliver some community and home-based health and support services
• deliver some public health and health promotion activities

Question 14

Describe shared responsibilities of governments

Answer 14

• regulation of health workforce
• education and training of professionals
• regulation of pharmaceuticals and pharmacies
• support improvements in safety and quality of health care
• funding of public health programs and services
• funding of Aboriginal and Torres Strait Islander health services

Question 15

Describe the NHRA

Answer 15

All Australian government levels have signed a policy, the National Health Reform Agreement (NHRA), that aims to improve health outcomes for all Australians and ensure the health system is sustainable.

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The NHRA is an agreement between the Australian Government and all state and territory governments.

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It commits to improving health outcomes for Australians, by providing better coordinated and joined-up care in the community, and ensuring the future sustainability of Australia’s health system.

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It is the key mechanism for the transparency, governance and financing of Australia’s public hospital system

Question 16

List the levels of care

Answer 16

• primary
• secondary
• tertiary

Question 17

Describe and distinguish between the medicare levy and medicare levy surcharge

Answer 17

• 2% of taxable income
• do not have to payif single and taxable income is equal or less than 23, 365
• income over, rate differs

Question 18

Describe medicare and MBS

Answer 18

Medicare, implemented in 1984, is Australia’s universal insurance scheme. It guarantees all Australians (and some overseas visitors) access to a wide range of health and hospital services at a low or no cost, including:

-medical services by doctors, specialists and other health professionals

• hospital treatments

-prescription medicines (which is covered by the PBS).

Medicare Benefits Schedule (MBS) lists the medical services covered by Medicare and the fee involved for accessing each service.

As some people may still have to pay out-of-pocket for health care, every year in January, the Australian Government sets safety limits for gap and out-of-pocket expenditure through the Medicare Safety Net.

Current Safety Net Threshold for gap amounts is $495.60 and out-of-pocket expenditure is $2,250. You can learn more about additional thresholds by visiting the Services Australia website.

Question 19

Describe PBS

Answer 19

Under the Pharmaceutical Benefits Scheme (PBS), the Australian Government subsidizes the cost of medicine for most medical conditions. PBS medicine is available to:

-all Australians and concession card holders who have a current Medicare card

-Visitors from 11 overseas countries with which Australia has a Reciprocal Health Care Agreement. If you visit these countries, your health care is covered!

• Veterans, war widows and widowers, and dependents who are eligible under the Repatriation Pharmaceutical Benefits Scheme (RPBS)

Question 20

What does bulk billing cover?

Answer 20

Bulk Billing in Australia covers:

-visits to GPs and some specialists that bulk bill
-basic tests and scans like x-rays and pathology tests
-eye tests performed by optometrists

However, bulk billing is optional for most health care workers. Moreover, health care workers can choose the consultation or procedure fee for a service. This amount may not equal the amount set in the MBS.