Chapter 6 - Australia’s Health System

Question 1

Describe Medicare

Answer 1

Australia’s universal health insurance scheme. It gives all Australians, permanent residents and people from countries with a reciprocal agreement access to subsidised healthcare.

Question 2

What does Medicare cover? (in and out-of-hospital expenses)

Answer 2

Out-of-hospital expenses
* Medicare will pay all or some fees relating to many essential healthcare services.
* E.g. consultation fees for GPs and specialists

In-hospital expenses
* As a public patient in a public hospital, accommodation and treatment by doctors and specialists is covered by Medicare. If an individual chooses to be admitted to a private hospital or as a private patient in a public hospital, Medicare pays 75% of the schedule fee for treatment by doctors and specialists, but not for accommodation or other costs like theatre fees and medication.

Question 3

What is not covered by Medicare?

Answer 3

• Any cosmetic or unnecessary procedures
• Most costs associated with private hospital care
• Ambulance services
• Pharmaceuticals
• Most dental examinations and treatment
• Home nursing care or treatment

Question 4

Medicare Benefits Schedule

Answer 4

A document that lists the range of services covered and the amount that Medicare will contribute to each, known as the schedule fee.

Question 5

Schedule fee

Answer 5

The amount that Medicare contributes towards certain consultations and treatments. The government decides what each item is worth and that’s what Medicare pays. Doctors and private hospitals may choose to charge more than the schedule fee.

Question 6

Patient co-payments

Answer 6

The payment made by the consumer for health products or services in addition to the amount paid by the government (Medicare).

Question 7

Bulk billing

Answer 7

When the doctor charges only the schedule fee. The payment is claimed directly from Medicare so there are no out-of-pocket expenses for the patient.

Question 8

Medicare Safety Net

Answer 8

Provides extra financial assistance for those that incur significant out-of-pocket costs for Medicare services.

Question 9

Advantages and Disadvantages of Medicare

Answer 9

Advantages:
* Choice of doctor for out-of-hospital services
* Available to all Australian citizens
* Reciprocal agreement between Australia and other countries allows Australian citizens to access free healthcare in selected countries.

Disadvantages:
* No choice of doctor for in-hospital treatments
* Waiting lists for many treatments
* Doesn’t cover alternative therapies (e.g. chiropractic services, remedial massage).

Question 10

How is Medicare funded?

Answer 10

Medicare is funded through three sources of income:
* the Medicare levy
* the Medicare levy surcharge
* general taxation

Question 11

Pharmaceutical Benefits Scheme (PBS)

Answer 11

Austraila’s essential medicine subsidy scheme that allows Australians to have access to many medicines at a subsidised cost.
* More than 5000 brands of prescription

Question 12

Pharmaceutical Benefits Advisory Committee (PBAC)

Answer 12

An independent committee made up of health professionals who review and consider new medications for inclusion in the PBS.

Question 13

National Disability Insurance Scheme (NDIS)

Answer 13

A national insurance scheme that provides services and support for people with permanent, significant disabilities, and their families and carers.

Question 14

Private health insurance

Answer 14

A type of insurance under which members pay a premium (or fee) in return for payment towards health-related costs not covered by Medicare. It is an optional form of health insurance that can be purchased in addition to Medicare.

Question 15

Premium

Answer 15

The amount paid for insurance.

Question 16

Private health insurance options

Answer 16

• Private hospital cover
• General treatment cover (e.g. dental)
• Combined cover - both hospital and general treatment cover

Question 17

Four main incentives to encourage people back into private health insurance

Answer 17

• Private health insurance rebate - increases affordability by refunding a certain % on premiums.
• Lifetime health cover - People who take it up after age 31 pay extra 2% on premiums. Thus, encourages younger people to take it up and keep it for life
• Medicare levy surcharge - People earning more than 90k a year pay extra tax as a Medicare levy surcharge if they don’t purchase private health insurance. Thus, encourages high income earners to take out private health insurance.
• Age-based discount - young people can be offered discount for hospital cover and reduction in premiums each year until age 30.

Question 18

Advantages and Disadvantages of private health insurance

Answer 18

Advantages:
* Enables access to private hospital care
* Choice of doctor in public or private hospital
* Shorter waiting times for some medical procedures

Disadvantages:
* Costly (premiums)
* Sometimes have a ‘gap’ - insurance doesn’t cover whole fee and individual must pay the difference.
* Policies can be complex to understand and so create confusion for the average person

Question 19

Key areas of focus that guide the implementation of Australia’s health system

Answer 19

• Funding - more people can recieve treatment by reducing the costs the individual must contribute.
• Sustainability - relates to the Australian health system’s capacity to provide a workforce and infrastructure, like facilities and equipment, into the future and to be innovative and responsive to emerging needs through interventions like research and monitoring.
• Access - an accessible health system is one that can provides all people with timely access to quality health services based on their needs, not ability to pay, regardless of where they live in the country. Access must be available to all people from all socioeconomic groups and those living within and outside of major cities.
• Equity - as Australians have different healthcare needs, the health system must take these difference into account if it is to be equitable and fair for all people.

Question 20

Considerations for promoting a sustainable health system

Answer 20

• Research and monitoring
• Promoting disease prevention and early intervention
• Ensuring an efficient health workforce and system
• Ensuring adequate funding and regulation of the health system