C6: health system Flashcards
what is medicare?
Australia’s universal health insurance scheme providing Australian citizens + those w reciprocal agreemnt with access to subsidised care
services covered by medicare (remember min. 3)
- eye tests
- pathology tests
- doctor + specialist consultations
- x rays
- accommodation + treatment in public hospitals
services not covered by medicare (remember min. 3)
- allied health services
- dental services
- ambulance fees
- fees from private hospital
schedule fee
the amount that medicare decides as reasonable and contributes towards the cost of health services
Medicare Safety Net
provides extra financial assistance by making medicare services cheaper for those w significant out-of-pocket costs over a certain amount for Medicare services –> enables them to keep accessing healthcare
Advantages of medicare
- available to all Aus citizens
- reciprocal agreement between Australia and other countries allows healthcare access in other certain countries
- covers cost of treatment in public hospitals
- medicare safety net provides extra financial assistance for health services once out of pocket expenses over a certain amount
Disadvantages of medicare
- long waiting times
- no choice of doctor for in-hospital treatments
- doesn’t cover full amount charged by doctor
How is medicare funded?
- general tax
- medicare levy: 2% tax
- medicare levy surcharge: 1 to 1.5% tax
Medicare levy
1-1.5% tax on high income earners earning over certain amount and don’t have private health insurance –> this is an incentive to to get private health insurance –> reduces strain on Medicare-funded public health system
PBS
provides essential medicines to people who need them, regardless of ability to pay by subsiding medicine but consumers must make a patient co-payment –> enables + increases likelihood people access subsidies medication
PBS Safety Net
- provides financial assistance for people who have significant out of pocket costs from accessing PBS subsidised medication by making them pay lower co-payment –> enable them to have money to get medication
what is NDIS?
insurance scheme helpspeople, once they develop an individualised plan, to: access community services, maintain informal support arrangements (support carers/family etc financially/transport to support disabled person), receive necessary funding (eg. to get assistive technology), access mainstream services
eligibility for NDIS
- Australian citizens
- under 65
- have permanent condition
- condition reduces ability to effectively participate in activities without assistance from others/assistive technology
- affects social and economic participation
- if likely to require NDIS for rest of life
What is private health insurance?
- insurance scheme where people pay a premium in exchange for payment for reduced health costs for services not covered by Medicare
Private health insurance incentives (+explaination)
- private health insurance rebate: low income people receive rebate on premiums for private health insurance –> increases affordability of private health insurance + raises funds for public health system
- Lifetime Health cover: people who get private health insurance after 31 pay extra 2% for premiums every year over 30 –> encourages younger people to get private health insurance
- Medicare levy surcharge: 1-1.5% tax for high income earners w/o private health insurance –> encourages high income earns to get private health insurance
- Age based discounts offers ages 18-29 2% reduced price of premiums for every year until 30 –> increases younger people to get private health insurance
THE INCENTIVES ENCOURAGE PEOPLE TO GET PRIVATE HEALTH INSURANCE –> RELIEVES BURDEN ON MEDICARE-FUNDED PUBLIC HEALTH SYSTEM
Private health insurance advantages
- access to subsidised private hospital care
- choice in doctor in hospital
- shorter waiting times for surgery
- private health insurance incentives
- covers services not covered by medicare
Private health insurance disadvantages
- premiums are costly –> reduced equity as not everyone can afford it
- insurance may not cover whole fee and ndividual has out of pocket cost
- policies can be complex and confusing to understand
Health system funding
Medicare: medicare funds part/all fees of health services
PBS: essential medicines subsidised by PBS –> providing treatment for many conditions, promoting health outcomes
NDIS: provides funding for resources like assistive technology
Private health insurance: premiums fund private hospitals + federal government funds incentives
Health system sustainability
Medicare: determines which services are subsided so funds are preserved for most necessary services + provides necessary funds to maintain Australia’s health system
PBS: PBS-subsidised medication is reviewed so that the most needed are kept
NDIS: only necessary funds are spent according to individualised plan so more people can access ndis
Private health insurance: encourages people, especially younger to get it, reducing public system strain, improving health outcomes
Health system access
Medicare: provides access to all Aus citizens regardless to SES + provides telehealth, increasing healthcare access for rural areas
PBS: provides access to all Aus citizens to subsidised medication + provides access for low SES by them paying a lower co-payments through safety net
NDIS: improves access to health for disabled
Private health insurance: rebate increases access to private health insurance for low SES + increases access to services that would’ve otherwise been to expensive
Health system equity
Medicare: safety net provides extra financial assistance for low SES + provides mental treatment plans
PBS: safety net protects low SES from large out-of-pocket costs from PBS medication, concessional co-payment provides greater assistance for low SES
NDIS: people with more significant needs receive assistance + those requiring it don’t need to pay more funding towards it
Private health insurance: greater rebate offered for low SES and older individuals + people using insurance don’t have to pay higher premium
