Chapter 5: Australian Healthcare System Flashcards
1
Q
Components of effective healthcare systems
SEA
A
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Sustainability
- Effectively meeting ongoing health needs, enabling current and future generations to experience good health
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Equity
- Catering to the various requirements of different people
- The needs of people guide the distribution of support
- Closely linked to fairness and social justice
- Providing extra support for people in need so they can have the same opportunities in life as everyone else
-
Access
- Being able to make use of healthcare services without barriers such as location, knowledge, time or cost
2
Q
Health system
A
- Activities that promote, restore and/or maintain health
- Effective healthcare systems are able to deliver quality healthcare services to all people when and where they are required
3
Q
Primary healthcare vs secondary care
A
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Primary – first contact with healthcare system
- Tend to be delivered in local clinics or community health centres (not typically related to hospital care)
- Doesn’t work in isolation (works alongside 2ndary care)
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Secondary – services provided after a referral from a primary healthcare professional
- Offered by specialists or in hospitals
4
Q
Medicare and its 3 mains objectives
A
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Australia’s universal healthcare system that aims to:
- Make healthcare more affordable for all Australians
- Give all Australians access to healthcare services with priority according to clinical need
- Provide high-quality care
- Remove cost as a barrier to seeking health care
5
Q
Services covered and not covered by Medicare
A
-
Covered
- Consultation fees for GPs (100%) and specialists (85%)
- Most procedures performed by GPs
- X-rays and pathology tests
- Optometrists’ eye tests
-
Not covered
- Allied health services e.g. physiotherapy
- Hearing aids, contact lenses and glasses
- Ambulance services
- Home nursing
6
Q
How can Medicare promote HWB?
A
- Physical – healthcare is accessible to all citizens and PRs
- Mental – subsidises costs of health services and, thus, reduces stress and anxiety due to the financial burden of healthcare
7
Q
Medicare safety net
A
- Extra financial support to those that have significant out of pocket costs for health services (e.g. those w chronic illness)
- 100% reimbursement once the threshold has been reached
8
Q
Medicare funding
A
-
Medicare levy
- 2% levy paid by most tax payers
- People who earn below a certain amount are exempt
-
Medicare levy surcharge
- 1-1.5% paid by people earning over a certain amount of money and do not have private health insurance
- Encourages higher income earners to get PHI
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General income taxation
- If the above do not fully cover the costs of medicare
9
Q
Advantages and disadvantages of Medicare
A
-
Advantages
- Accessible for every Australian citizen or PR
- Access to essential healthcare at little or no cost
- Reciprocal agreement allows Australian citizens to access subsidised/free healthcare in selected countries
-
Disadvantages
- Financial burden on the Commonwealth Government
- Long wait times for many treatments (non-emergency)
- Does not cover the cost of allied health services
- No choice of doctor for in-hospital treatments
10
Q
Sustainability, equity and access of medicare
A
-
Sustainability
- Removes the barrier of cost, making people more likely to access healthcare which prevents the development of serious conditions
- Reduces the need for expensive treatment later on (e.g. surgeries), keeping costs under control and sustainable in the future
-
Equity
- Safety net protects people who experience higher costs of healthcare, thus providing extra support to those who need it most
-
Access
- Rebates makes healthcare financially accessible
- Accessible for all Australian citizens and PRs regardless of income, culture, gender, etc.
11
Q
Pharmaceutical Benefits Scheme (PBS)
A
- Australian Government initiative that subsidises the cost of a wide range of prescription medications
- Developed to prevent the development of serious conditions and reduce the burden on the healthcare system
12
Q
How can the PBS promote HWB?
A
- Mental – keeping medication affordable can reduce the stress or anxiety associated with covering high medication costs
- Physical – access to essential medication tends to play an important role in the treatment and control of illness
13
Q
PBS funding
A
- Commonwealth Government through taxes
- Partially by the money collected through co-payments
14
Q
Advantages and disadvantages of the PBS
A
-
Advantages
- Subsidised costs of essential medication
- Available to all Aus citizens, regardless of age/income
- Includes the PBS safety net that further protects people from the high cost of medication
-
Disadvantages
- Financial burden on the Commonwealth Government
- Does not cover all medications
- For most Australians, there is still a co-payment of $41
15
Q
Sustainability, equity and access of the PBS
A
-
Sustainability
- Only the medication that are deemed to have the greatest benefit are listed, keeping costs manageable
-
Equity
- Safety net gives extra support to people who need it most (e.g. those with chronic illness who consistently take expensive medication)
- Cost is significantly reduced or removed once the threshold is reached
-
Access
- Subsidies make medication more financially accessible
16
Q
Private health insurance
A
- An optional subscription or policy that provides individuals with different levels of cover for a fee
- Provides access to services not provided by Medicare
17
Q
How does private health insurance promote HWB?
A
- Emotional – sense of security/peace of mind knowing that you can be readily treated in case of injury or disease
18
Q
PHI funding
A
- By members through the premiums they pay
19
Q
PHI incentive schemes
A
-
Private health insurance rebate
- Rebate (partial refund) from the government to help cover the cost of their premiums
- Dependent on one’s income
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Medicare levy surcharge
- Higher-income earners without PHI are charged an additional 1-1.5% surcharge
- Encourages people to take up PHI
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Lifetime health cover
- Encourages people to get PHI earlier in life
- Once an individual turns 30, PHI will cost an extra 2% each year that they do not join
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Age-based discount
- Discount of up to 10% granted to those aged 18-29
- Makes PHI more appealing to young people who are less likely to use it and may otherwise not see its benefit
20
Q
Why is PHI needed?
A
- Supports the public health system
- ↓ waiting times and demand for beds in public hospitals
- Supports an ageing population
- ↓ pressure on public system due to ↑ demand of medical services provided by an ageing population
21
Q
Advantages and disadvantages of PHI
A
-
Advantages
- Access to private hospital care
- Shorter waiting time for some procedures
- Covers a wider range of services (compared to Medicare)
- Reduces the burden on the public health care system
-
Disadvantages
- High costs for individuals and families
- Out-of-pocket costs for some services
- Feeling as though you are paying for unused services
- Qualifying periods for some conditions e.g. pregnancy
22
Q
Sustainability, equity and access of PHI
A
-
Sustainability
- Reduces the burden on the public system, allowing more people to be treated sooner
- Healthcare needs can be sufficiently & continuously met
-
Equity
- Lower income earners are entitled to a greater rebate on the cost of their premium and are exempt from the medicare levy surcharge
-
Access
- Social access to healthcare as people can choose to be treated by a doctor who best meets their needs
- Greater access to services not covered by medicare
23
Q
National Disability Insurance Scheme (NDIS)
A
- Insurance scheme that provides support for Australians with disability, their families and carers
- Seeks to build independence and increase opportunities and social participation for those living with a disability in Australia
- Helps people with disability to…
- Lead enjoyable and ordinary lives
- Access services e.g. healthcare, education, libraries
- Receive reasonable and necessary funded support
- Maintain support arrangements e.g. from family/friends
24
Q
Reasons why Australians may choose to purchase PHI
A
- Reduce waiting times for (elective) surgery
- Choice of doctor that treats them in hospital
- Access more services than Medicare (e.g.physio)
- Tax benefits to avoid paying the Medicare Levy Surcharge
- To take advantage of the age-based discount
25
Q
NDIS funding
A
- Shared among all levels of government in Australia
26
Q
Sustainability, equity and access of the NDIS
A
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Sustainability
- Introduced in stages, rather than all at once, allowing the program to build up adequate funding over 3 years
- Assists people to gain employment, ↑ taxable income, ↑ the government’s capacity to fund healthcare programs
-
Equity
- Provides individuals and their carers w/ support that is individualised and unique to their specific set of needs
- Support is not dependent on income, but rather, one’s level of disability and the subsequent support required
-
Access
- Supports people to access services e.g. education
27
Q
Implications of increased LE on Australia’s health system
A
- People working and, thus, generating an income for longer, means that more taxation money can be put into Medicare
- There may be increased demand for certain medications, putting strain on the PBS
- Increased burden on the healthcare system can increase the Medicare levy/Medicare levy surcharge
