chapter 6- Australias health care system

Question 1

medicare

Answer 1

Australias universal health insurance scheme, established in 1984. access to subsidised healthcare.

Question 2

Schedule fee

Answer 2

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 3

Bulk billing

Answer 3

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

Question 4

Patient co-payments

Answer 4

the payment made by the consumer for health products or services in addition to the amount paid by the government

Question 5

Pharmaceutical Benefits Scheme (PBS)

Answer 5

The Pharmaceutical Benefits Scheme (PBS) is a Federal Government initiative that was introduced to subsidise the cost of a wide range of prescription medicines

Question 6

services covered by medicare

Answer 6

• doctor and specialist consultations
• x rays
• pathology, blood and urine tests

Question 7

safety net

Answer 7

extra financial assistance for those that incur significant out of pocket costs for Medicare services.
further financial support is provided by the government, making Medicare services cheaper for the remainder of that year.

Question 8

not covered by medicare

Answer 8

• home nursing care or treatment
• ambulance services
• most allied health services (unless referred by a GP
or carried out in a public hospital).

Question 9

advantages of medicare

Answer 9

• Choice of doctor for out-of-hospital services
• Available to all Australian citizens
• Covers tests and examinations, doctors’ and
specialists’ fees (schedule fee only), and some
procedures such as x-rays and eye tests

Question 10

how is medicare funded

Answer 10

• the Medicare levy 2%
• the Medicare levy surcharge 1-1.5%
• general taxation.

Question 11

disadvantages of medicare

Answer 11

• No choice of doctor for in-hospital treatments
• Waiting lists for many treatments
• Does not cover alternative therapies
• Often does not cover the full amount of a doctor’s
visit

Question 12

lifetime health cover

Answer 12

those who take out private health insurance over the age of 31 pay an extra 2% on their premiums for every year they are over 30

Question 13

medicare levy surcharge

Answer 13

high income earners without private health insurance pay an extra tax (based on they earn ranging from 1-1.5)

Question 14

private health insurance rebate

Answer 14

the federal government will pay a percentage of the premiums paid for the eligible private health insurance members. The amount paid depends on the income. Higher income receives a lower or no rebate.

Question 15

age based discount

Answer 15

insurers have the option to offering young people ages 18-29 a discount of up to 10% for hospital cover

Question 16

advantages of PHI

Answer 16

• choice of doctor in hospital treatements
• shorter waiting times for some medical procedures such as elective surgery
• helps keep the costs of operating medicare under control
• government rebate for eligible policy holders makes private health insurance cheaper for those on lower incomes

Question 17

disadvantages of PHI

Answer 17

• costly in terns of the premiums that have to be paid
• qualifying periods apply for some conditions (pregnancy)
• policies can be complex to understand can create confusion for the average person

Question 18

NDIS

Answer 18

The NDIS is a national insurance scheme that provides services and support for people with permanent, significant disabilities, and their families and carers.

Question 19

NDIS disability requirements

Answer 19

• you have an impairment or condition that is likely to be permanent
(i.e. it is likely to be lifelong)
• reduces your ability to participate effectively in activities, or perform tasks or actions unless you have
• affects capacity for social and economic participation
• you are likely to require support under the NDIS for your lifetime.

Question 20

NDIS plan assists participants to:

Answer 20

• Access mainstream services and supports.
• Access community services and supports.
• Maintain informal support arrangements.
• Receive reasonable and necessary funded supports.

Question 21

PHI incentives

Answer 21

• private health insurance rebate
• lifetime health cover
• medicare levy surcharge

Question 22

funding of Australia’s health system

Answer 22

Medicare funds part or all of the fees associated with health services — including doctor and specialist consultations, pathology tests and fee-free treatment in public hospitals
• Essential medicines are subsidised through the PBS, providing treatment for many conditions, promoting health outcomes

Question 23

sustainability of Australia’s health system

Answer 23

• The Medicare levy increased from 1.5 to 2 per cent in July 2014 to assist in providing the necessary funds to maintain Australia’s health system.
• Each participant in the NDIS receives an individualised plan which means that only necessary funds are spent on each person. As a result, more people can access the NDIS and experience improved health outcomes.

Question 24

access to Australia’s health systems

Answer 24

• Medicare provides funding for telephone and video consultations which can assist those living outside major cities in accessing health services

Question 25

equity to australias health systems

Answer 25

• People who use their private health insurance more often than others, do not have to pay a higher premium