Chapter 11 - Healthcare system Flashcards
Medicare
Australia’s universal healthcare system.
Aims to improve access to healthcare of all Australians in need of treatment - no matter your age race and income, and is little to no cost
3 Objectives of medicare
3 main objectives:
- To make healthcare more affordable for all Australians
- To give all Australians access to healthcare services with priority according
- To provide a high quality of care
How Medicare works
- Covers in hospital & out of hospital services
Provides free or subsidized treatment by general practitioners and optometrists & certain diagnostic tests - Out of hospital services → patients can choose to be treated by their own general practitioner & are refunded for all or some of the doctor’s fee by Medicare (depends on billing options chosen by doctor)
- Coverage of healthcare services by Medicare is based on Medicare Benefits Scheme (MBS) which lists fees set by federal government for a range of services
Practitioners may elect to change more than the schedule fee → patient will have to pay difference as an out of pocket amount
Bulk billing
The doctor bills Medicare directly - Doctor accepts the Medicare payment as full payment for the service, so there’s no cost to the patient. Indicator of affordability of healthcare, as they remove cost as an obstacle to seeking care.
Scheduled fee
A fee set for a service by the Australian Government.
Medicare safety net:
Additional rebate scheme introduced by federal gov. for the benefit of patients, covering a range of doctors’ visits and tests received out of hospital. It provides for reimbursement of 100% of MBS fee for out of hospital services once the relevant threshold has been met.
Services covered by Mrdicare
Out of hospital services:
- Free or subsidized treatment by health professionals - - doctors’ consultation fee as often as needed
- Tests and examinations needed to treat illness - x rays and pathology tests
- Optometrists’ eye tests
- Most procedures performed by general practitioners
In hospital services:
- Treatment and accommodation as public patient is provided in public hospital by doctor appointed by hospital as result of an emergency or after referral from a doctor
= Private patients in private and public hospitals receive 75% of Medicare schedule fee for services and procedures - excludes accommodation in hospital, theater fees and medicines
Services not covered by Medicare
- Ambulance services
- Home nursing
- Hearing aids, contact lenses & glasses
- Dental examinations and treatment
Funding of Medicare
Funded by federal government, which raises revenue from taxpayers → 2% Medicare levy paid by taxpayers and based on taxable income.
The Pharmaceutical Benefits Scheme
Limited scheme that provided free medication for pensioners, as well as making 139 essential medicines free to other members of the community.
Provides timely, reliable and affordable access to necessary medicines for Australians.
Aim:
subsidize cost of wide range of prescription medications, providing Australians with vital medications at affordable prices to ensure optimal health outcomes and economic objectives achieved.
Funding of the Pharmaceutical Benefits Scheme
Funded through taxes by Australian Government’s National Medicine Policy.
Advantages and disadvantages of PBS
Advantages :
- Access to essential medication at subsidized rate/are free
- Access to medications from local pharmacies - doesn’t require medications to be purchased from specialized services
- Available to all Australians citizens Provides additional support to those with concession cards by having lower co payments
Disadvantages :
- Financial burden on Australian Government
- Doesn’t cover ALL medications
- Co payments of $38.80 that still needs to be paid by most Australians
Private health insurance:
Covers some of the costs associated with private hospital treatment and a range of extras or ancillary health services like dental care or physiotherapy.
Reasons for choosing private health insurance
- To give people a choice of being treated in a private hospital
- Choice of hospital
- Choice of doctor who treats them in a hospital
- Entitled to have own room whilst in hospital
Advantages and disadvantages of private health insurance
Advantages :
- Able to access private hospital care
- Access a wider range of services not covered by Medicare
- Shorter waiting times for some public procedures
- Choice of doctor in a public/private hospital
Disadvantages
- Can be costly
- Out of pocket costs for some services in policies
- Qualifying or waiting periods for some procedures
- Often people feel they are paying for services that they don’t use
