C11 The Health System AOS2

Question 1

Health system

Answer 1

All the activities whose primary purpose is to promote, restore and or maintain health.

Question 2

What are Medicare’s 3 objectives?

Answer 2

To make healthcare more affordable for all Australians;
To give all Australians access to healthcare services with priority according to clinical need;
To provide a high quality of care

Question 3

Medicare

Answer 3

A universal healthcare system funded by the federal government that aims to improve access to healthcare for all Australians in need of treatment regardless of age, by providing free or subsidised treatment.

Question 4

Bulk billing

Answer 4

When the doctor bills Medicare directly therefore accepting the Medicare payment as full payment for the service so there is no cost to the patient.

Question 5

Schedule fee

Answer 5

A fee set for a service by the Australian Government.

Question 6

Medicare safety net

Answer 6

A protective measure designed by the federal government to avoid patients having to pay high medical costs which covers a range of out-of-hospital costs (e.g. ultrasounds, blood tests, and x-rays) and provides reimbursement of 100% of the MBS fee for out-of-hospital services once the relevant threshold has been reached.

Question 7

The Extended Safety Net

Answer 7

Medicare pays 80% of out-of-pocket costs once a threshold of $2169.20 is reached for families or individuals, or $692.20 for concession card holders or families who receive Family Tax Benefit Part A.

Question 8

Gap amount

Answer 8

The difference between the Medicare benefit and the schedule fee.

Question 9

Out-of-pocket costs

Answer 9

The difference between the Medicare benefit and what a doctor charges.

Question 10

List 3 services provided by Medicare

Answer 10

Optometrists’ eye tests; Most procedures performed by general practitioners; Tests and examinations that are needed to treat illness, including x-rays and pathology tests

Question 11

List 3 services not provided by Medicare

Answer 11

General and most dental examinations and treatments; Ambulance services; Hearing aids, contact lenses, and glasses

Question 12

Chronic medical condition

Answer 12

A condition that has been present for at least six months is likely to be present for six months or is terminal.

Question 13

Reciprocal healthcare agreements

Answer 13

Agreements made between several countries and Australia (e.g. New Zealand, the United Kingdom, Sweden, the Netherlands, Finland, Italy etc) that means that some of the costs of essential treatment may be covered for Australian visiting these countries, and vice versa when residents of these countries visit Australia.

Question 14

List an advantage of Medicare

Answer 14

Being able to access essential healthcare as a public patient in a public hospital for little or no cost.

Question 15

List a disadvantage of Medicare

Answer 15

A lack of choice of doctors for in-hospital treatment in a public hospital.

Question 16

Explain how the federal government funds Medicare

Answer 16

Through taxes collected from general income that are used to fund government services such as healthcare.

Question 17

Explain how the 2% Medicare Levy funds Medicare

Answer 17

Charged at the end of the financial year on an individual’s income. For example an individual who earns $100,000 will be charged $2,000 Medicare levy.

Question 18

Explain how the 2% Medicare Levy surcharge funds Medicare

Answer 18

Additional 1% -1.5% charge on top of the 2% Medicare levy to high-income earners who do not have private health insurance. Individuals earning over $90 000 and families earning over $180 000.

Question 19

When are patients eligible for the safety net?

Answer 19

When a patients expenses reach $477.90 in a year they are eligible for the safety net.

Question 20

Pharmaceutical Benefits Scheme (PBS)

Answer 20

A limited scheme that aims to provide subsidised cost to a wide range of prescription medications, as well as making 139 essential medicines free to other members of the community.

Question 21

Co-payment

Answer 21

The price an individual pays for a medication covered by the pharmaceutical benefit scheme and it is dependent on their situation. For example general patients pay up to $41 for medication covered by PBS with concession card holders paying $6.60.

Question 22

Pharmaceutical Benefits Scheme (PBS) safety net

Answer 22

Once an individual has spent $1486.80 in any year on medications, they will only need to pay the concession rate of $6.60 per prescription. Any individual who is a concession card holder spending over $3160 on prescription medications is covered by PBS at no cost.

Question 23

The repatriation pharmaceutical benefits scheme (RPBS)

Answer 23

Available to provide subsided medication to war veterans and their dependents. It provides similar coverage to that provided by the PBS but it provides a wider range of pharmaceuticals.

Question 24

Who funds the Pharmaceutical Benefits Scheme?

Answer 24

Federal government (through tax collected e.g., when patients pay the subsidised amount the government pays for the remaining cost of the drug).

Question 25

Explain the difference between the Medicare levy and the surcharge

Answer 25

The 2% Medicare levy is charged at the end of the financial year on an individual’s income whereas the surcharge is an additional 1-1.5% charge on top of the 2% Medicare levy to high-income earners who do not have private health insurance.

Question 26

Private health insurance

Answer 26

Private health insurance is a subscription or policy for which a person pays to provide them with different levels of cover. Private health insurance can provide individuals with additional healthcare services to those provided by Medicare.

Question 27

Purpose of incentive schemes

Answer 27

To reduce the cost of private health insurance to make it more affordable and to lighten the load on public hospitals.

Question 28

Premiums

Answer 28

The amount you pay for your health insurance every month.

Question 29

Private health insurance rebate

Answer 29

Australians with private health insurance receive a rebate from the government to help cover the cost of their premiums. Australians who have private health insurance can pay a reduced premium and the government pays the balance, or they can pay the total and claim the rebate via their tax return.

Question 30

Medicare levy surcharge

Answer 30

An incentive that takes 2% of taxable income to assist in covering the cost of Medicare services. An additional surcharge between 1-1.5% in addition to the 2% has been charged for higher-income earners who do not have private hospital health insurance.

Question 31

Lifetime health cover

Answer 31

An incentive for people to continue with private health insurance coverage throughout their lifetime. Anyone who doesn’t have private health insurance with a registered health fund in Australia before 1 July following their 31st birthday and then decides to take out cover later in life, will pay an additional 2% loading on their premium for each year of age over 30 they join (with the maximum loading being 70%).

Question 32

Age-based discount

Answer 32

Individuals aged 18-29 receive a discount on hospital premiums of two per cent for each year that a person is aged under 30 when they first purchase eligible hospital cover.

Question 33

Who is private health insurance funded by?

Answer 33

Funded by members through the premiums they pay.

Question 34

List the factors affecting access to health services and information

Answer 34

Knowledge, geographic location, cost, language barrier, culture, and religion.

Question 35

Knowledge

Answer 35

Knowledge can positively impact accessing health services and information, as knowing where and how to access services and information is an important step in being able to access the care people need. Knowledge about health services can be important for accessing the right information and care at the right time.

Question 36

Geographic location

Answer 36

The location of the health services can act as a barrier, for example, many large and specialised public health services and hospitals are located in major cities. Therefore this can be a barrier for people who live in the suburbs or in rural areas. Where people live can also impact their access, for example, there may not be the same range of services (e.g. physiotherapy, mental health services etc) in rural areas or services may have shorter opening hours making them harder to access.

Question 37

Cost

Answer 37

As some health services have out-of-pocket costs this can act as a barrier to healthcare. The additional costs associated with healthcare (e.g. medication, time off work for appointments, or transport) can add to the financial burden.

Question 38

Language barriers

Answer 38

As people look up to health professionals this can make people feel intimidated or embarrassed if they have poor literacy skills or a language barrier. This can lead to poor communication from the individual about their symptoms. English-speaking people have an advantage as they are more likely to be able to accurately describe their symptoms which can result in improved healthcare and better health outcomes.

Question 39

Religion

Answer 39

Religion influences a persons world view and can influence their lifestyle and understanding of illness. This can therefore impact issues such as diet and use of medication.

Question 40

Culture

Answer 40

Some cultures attach different meanings to parts of the body or to some types of illness leading to some individuals being less likely to accept forms of treatment. Therefore health service providers need to be culturally sensitive in their assessment.