Chapter 4: Australia’s health system

Question 1

What is sustainability?

Answer 1

Sustainability refers to meeting the needs of the present generation without compromising the ability of future generations to meet their own needs.

Question 2

What is access?

Answer 2

Access in healthcare is about people being able to receive healthcare that they need at an appropriate time and location, without barriers, such as location, cost, and culture interfering.

Question 3

What is equity?

Answer 3

Equity refers to being fair and just, which includes catering for different people’s needs.

Question 4

What is Medicare?

Answer 4

Medicare is Australia’s universal health insurance scheme, which provides all Australian residents (and some overseas visitors) access to necessary healthcare at a subsidised cost, or for no cost at all.

Question 5

Who can access Medicare?

Answer 5

• all permanent Australian residents
• individuals from countries with a reciprocal agreement.

Question 6

What does Medicare cover?

Answer 6

• General practitioner (GP) consultation
• Treatment and accomodation as a public patient in a public hospital
• Eye tests performed by optometrists
• X-rays
• Pathology tests (blood tests)

Question 7

What does Medicare not cover?

Answer 7

• Dental examinations for individuals over 18
• Accomodation costs in a private hospital
• Alternative therapies (chiropractor, physiotherapy, massages)
• Ambulance services
• Hearing aids, glasses and contact lenses

Question 8

How does Medicare promote sustainable?

Answer 8

• Medicare promotes sustainability by only covering ‘clinically necessary’ procedures under the Medicare Benefit Schedule which reduces waste in the health system by prioritising the most pressing needs for current and future generations.
• The Medicare Levy increased from 1.5 to 2 percent to assist in providing the necessary funds to maintain Australia’s health system.

Question 9

How does Medicare promote access?

Answer 9

• Medicare promotes access through bulk billing, which is when a service provider (such as a GP) does not charge the patient more than the schedule fee for their service.
• Medicare provides funding for telephone and video consultations which can assist those living outside major cities in accessing health services.

Question 10

How is Medicare funded?

Answer 10

Medicare is funded by the Medicare Levy Surcharge (high income earners without private health insurance), general taxation (general income tax revenue) and Medicare Levy (most tax payers pay 2% of their tax goes towards Medicare). This allows it to fund for essential medical services for Australians. This includes surgery which can treat disease.

Question 11

How does Medicare promote equity?

Answer 11

• Medicare promotes equity through the Medicare safety net. Once an individual or family’s out of pocket expenses have reached the threshold amount, the Medicare safety net provides cheaper services for the remainder of the year for that individual or family.
• Mental Health Treatment Plans - those with mental health disorders are eligible for ten individual and ten therapy sessions per calendar year with the cost covered by Medicare.

Question 12

What are the advantages of Medicare?

Answer 12

• Every Australian citizen and permanent resident can access Medicare
• Medicare provides access to basic healthcare at little or no cost
• The reciprocal agreement enables Australian citizens to access subsidised/free healthcare in selected countries
• Patients can choose their doctor for out-ofhospital services.

Question 13

What are the disadvantages of Medicare?

Answer 13

• Significant wait times for non-emergency treatments
• Patients are unable to choose doctors for in-hospital treatments
• Individuals will often have to pay more for various healthcare services as Medicare often doesn’t cover the full amount
• Individuals do not have a choice of doctor for in-hospital treatment in the public system
• Does not cover many alternative therapies, such as physiotherapy.

Question 14

What is Private Health Insurance (PHI)?

Answer 14

Private health insurance is an optional type of health insurance which people can have in addition to Medicare, in which members pay a premium in return for payment towards services that are not covered by Medicare.

Question 15

What does PHI cover?

Answer 15

• osteopathy
• physiotherapy
• remedial massages
• ambulance services

Question 16

What are the Private health
insurance incentives
schemes?

Answer 16

1. Medicare levy surcharge: The Medicare levy surcharge is a tax for people who do not have private health insurance, and earn over a certain amount.
2. Private health insurance rebate: The government refunds individuals part of the cost of their insurance premium. This rebate is dependent on how much someone earns: the more someone earns the less money they will get back.
3. Lifetime health cover loading: Once an individual turns 30, the cost of private health insurance will cost an extra two percent each year that the individual does not take up private health insurance.

Question 17

How does PHI promote sustainability?

Answer 17

• Private health insurance reduces the strain on the public system, specifically Medicare.
• The various private health insurance incentive schemes increase the number of people who take up private health insurance such as the Lifetime health cover loading.

Question 18

How does PHI promote access?

Answer 18

• Private health insurance enables people to have greater access to healthcare services not covered by medicare.
• Waiting times for elective surgeries are shorter for all private patients.
• The waiting times for elective surgeries are quicker for everyone, as people in the public health system don’t have to wait as long when there are people using the private health system.

Question 19

How is PHI funded?

Answer 19

Private health insurance is largely funded by the premiums paid by customers.

Question 20

How does PHI promote equity?

Answer 20

• The private health insurance rebate demonstrates equity as lower income earners are entitled to a greater rebate on the cost of their premium.
• Medicare levy surcharge is only applicable to higher-income earners who do not take out private health insurance. This demonstrates equity as it relieves lower-income earners from paying this surcharge.

Question 21

What are the advantages of PHI?

Answer 21

• Patients are able to choose their doctor as a
  private patient in hospital (public or private).
• Reduced waiting times for non-emergency treatments.
• Patients can choose which hospital they want to be treated at.
• Patients are more likely to have a private room.
• It reduces pressure on the public health system.
• There is financial coverage for a wider range of services

Question 22

What are the disadvantages of PHI?

Answer 22

• Cost of premiums can be expensive.
• There may still be out-of-pocket costs, even with extensive coverage.
• Waiting periods may apply for some services.
• You may pay for services that you will not claim.

Question 23

What is the Pharmaceutical Benefits Scheme (PBS)?

Answer 23

The Pharmaceutical Benefits Scheme (PBS) is a program run by the Australian government that subsidises various essential prescription medicines for Australian citizens, permanent residents, and visitors from selected countries.

Question 24

Who can access PBS?

Answer 24

The PBS is available to all Australian citizens and permanent residents who have a valid Medicare card. The PBS is also available to visitors from countries that are part of the Medicare Reciprocal Agreement.

Question 25

What is the PBS safety net?

Answer 25

PBS Safety Net protects individuals and families from high costs of essential prescription medicines by significantly reducing the subsidised costs of medicines once they reach a certain threshold for the remaining calendar year.

Question 26

How does PBS promote sustainability?

Answer 26

• Not every medication is listed on the PBS, only the ones that are classified to have the greatest benefit and impact on the population.
• The amount of patient co-payments are adjusted on 1 January each year in line with the Consumer Price Index (CPI) to match inflation.

Question 27

How does PBS promote access?

Answer 27

• By significantly reducing the cost of various essential prescription medicines, the PBS removes the key barrier of income to accessing essential medicines.
• The PBS is available to all Australians, regardless of characteristics including income, gender, culture.

Question 28

How does PBS promote funding?

Answer 28

• The PBS is partially funded by the money that is collected through patient co-payments.
• The Australian Federal government pays for the PBS through taxes.

Question 29

How does PBS promote equity?

Answer 29

• The PBS Safety Net assists individuals who have high costs for prescription medicines by significantly reducing or removing the cost of them once they reach the threshold.
• Concession cards which gives low-income earners access to reduced price for PBS medicines.

Question 30

What is the National Disabilty Insurance Scheme (NDIS)?

Answer 30

The National Disability Insurance Scheme (NDIS) is an insurance scheme that provides support and services to people with a disability, their families, and their carers.

Question 31

What is NDIS’ aim?

Answer 31

The central aim of the NDIS is to provide people who are born with or acquire a significant disability with
the support they need to lead an enjoyable and ordinary life.

Question 32

What are the age and residency requirements?

Answer 32

Age and residency requirements:
* Fulfil residency requirements: be an Australian citizen, permanent resident, or a Protected Special Category Visa holder.
* Live in a place where the NDIS is geographically available.
* Be aged under 65 when the request to receive support was made

Question 33

What are the disability requirements?

Answer 33

Disability requirements:
* You have a condition or impairment that is likely to be lifelong/permanent; and
* Your condition significantly decreases your ability to properly participate in activities
or complete tasks, unless you have
− Help from other people; or
− Assistive technology such as a wheelchair, walker, or cane (does not include
common assistance such as glasses); or
− You are unable to participate properly with assistive technology or equipment.
* Your impairment negatively affects your ability to participate socially and economically
(such as getting a job and seeing friends); and
* You will likely need support from the NDIS for your entire life

Question 34

How does NDIS promote sustainability?

Answer 34

• The NDIS assists individuals to gain employment. Therefore, there are more Australians who are employed and earning taxable income.
• Providing people with a disability with access to local support and healthcare services decreases the likelihood of individuals with a disability relying on the healthcare system in the future, which reduces the strain placed on the health system.

Question 35

How does NDIS promote access?

Answer 35

• A central aim of the NDIS is to enable participants to enjoy an ordinary life, which involves supporting individuals to access mainstream support and services

Question 36

How does NDIS promote funding?

Answer 36

• The NDIS is jointly funded by the Federal and participating state and territory governments.

Question 37

How does NDIS promote equity?

Answer 37

• The ability to access the NDIS is not based on someone’s level of income.
• The NDIS provides individuals and their carers with the necessary support based on someone’s specific set of needs