Chapter 7 - Australia's healthcare system Flashcards
1
Q
What are Australia’s two main components to the health care system
A
- Public health care
- Private health care
2
Q
What are the public components
A
- Public hospitals
- Medicare
- Pharmaceutical benefits scheme (PBS)
- National disability insurance scheme (NDIS)
3
Q
What are the private components
A
- Private health insurance
- Private hospitals
- Medical practitioners in private practices
4
Q
What is Medicare
A
Medicare is Australia’s universal health insurance scheme. It gives all Australians reciprocal agreement access to subsidised healthcare
5
Q
What services are covered by Medicare
A
- X-rays
- Doctor and specialist consultations
- Eye test performed by optometrist
- Fee-free treatment and accommodation in public hospitals
- Pathology such as blood and urine tests
- 75% of the schedule fee for treatment in a private hospital
6
Q
How does Medicare work
A
- Schedule fee
- Patient co-payments
- Bulk-billing
7
Q
What is a schedule fee
A
The amount of money that the government deems appropriate for a particular medical service or procedure
8
Q
What is patient co-payment
A
The payment made by the consumer for health products or services in addition to the amount paid by the government
9
Q
What is bulk-billings
A
When the doctors charges only the schedule fee. The payment is claimed directly from Medicare so there are no out of pocket expenses for the patient
10
Q
What does Medicare cover
A
- GP consultations
- Eye test
- X-rays
- Pathology test
- Specialist consultations
- Public patient in a public hospital
11
Q
What doesn’t Medicare cover
A
- Cosmetic surgery
- Glasses and contact lenses
- Chiropractors
- Hearing aids
- Most physiotherapy
- Medication and aids
- Ambulance services
- Home nursing
- Treatment and accommodation in a private hospital
12
Q
What are Medicare three main objectives
A
- To make healthcare affordable for all Australians
- To give Australians access to health services according to need
- To provide a high quality of care
13
Q
How is Medicare funded
A
- Medicare levy
- Medicare levy surcharge
- General taxation
14
Q
What is Medicare levy
A
Australian taxpayers are charged 2% of their taxable income to help the federal government fund Medicare
15
Q
What is Medicare levy surcharge
A
An extra 1-1.5% tax placed on the income of high-income earners who do not have private health insurance
16
Q
What is general taxation
A
The revenue collected from Medicare levy and the Medicare levy surcharge are not enough to cover its full cost so the government can also use general taxation to fund this system
17
Q
What are advantages of Medicare
A
- Makes healthcare affordable and accessible to all
- Choice of doctor for out of hospital services
- The Medicare safety net provides extra financial contributions for medical services once an individuals or family co-payment reach a certain level
- Reciprocal agreement between Australia and other countries allows Australian citizens to access free health care in selected countries
18
Q
What are disadvantages of Medicare
A
- Does not cover all health services
- No choice of doctor for in hospital treatment
- No private room available if you are in a public hospital
- Long waiting times for health services
- Often does not cover the full amount of a doctors visit
19
Q
What is the Pharmaceutical benefits scheme (PBS)
A
- Aims to provide essential medicines to people who need them, regardless of their ability to pay
- Medicines are subsidised and consumers must make a patient co-payment
20
Q
What is the PBS safety net
A
- Once individuals (or their immediate family) have spent $1,647.90 within a calendar year on the PBS listed medicine, the patient pays only a concessional co-payment rate of $7.70 rather than the normal $31.60
21
Q
What are advantages of the PBS
A
- Cheaper prescription medicines
- Protects families from large expenses
- Equitable access to essential medication regardless of SES
22
Q
What are disadvantages of the PBS
A
- Requires large amount of government subsidies
- Not all prescription drugs are included
23
Q
What is the National disability insurance scheme (NDIS)
A
Most recent federal government strategy that provides support and services for people with permanent, significant disabilities and their families and careers who are aged under 65 years
24
Q
What is private health insurance
A
Type of insurance where members pay a premium fee in return for payment towards health-related costs not covered by Medicare
25
What different covers does private health insurance cover
1. Hospital cover
2. General treatment cover
3. Combined cover
26
What is hospital cover
Includes the cost of in hospital treatment by a doctor and hospital costs including accommodation and theatre fees. You can have different degrees of hospital cover
27
What is general treatment cover
‘Extras’ including physio, dental, podiatry
28
What is combined cover
Combination of both hospital and general treatment cover
29
Why do we need private health insurance
- Support the public health system (take the strain off the Australia public health system)
- Support all Australians
- Support an ageing Australian population
- Contribute to funding the healthcare system
30
What are the private health insurance incentives
- Private health insurance rebate
- Lifetime health cover
- Medicare levy surcharge
- Age based discount
31
What is private health insurance rebate
- Most Australians with private health insurance receive a rebate from the government to help cover the cost of their premiums
- Those who earn more will receive a smaller rebate or no rebate
32
What is Medicare levy surcharge
- People earning over a certain amount pay an extra as a Medicare levy surcharge if they do not purchase private health insurance
- Calculated according to income and ranges from 1-1.5%
33
What is lifetime health cover
- People who take up private health insurance after the age of 31 pay an extra 2% on their premiums for every year they are over the age of 30
- This encourages younger people to take up private health insurance and keep it for life
34
What is age based discount
- Insures have the option of offering young people ages 18-29 a discount of up to 10% for hospital cover
35
What are advantages of private health insurance
- Choice of doctor while in public or private hospital
- High income earners with private health insurance do not have to pay the additional tax called Medicare levy surcharge
- The age based discount may provide cheaper private cover for those aged 18-29
36
What are disadvantages of private health insurance
- Costly in terms of the premiums that have to be paid
- Sometimes have a gap which means the insurance doesn't cover the whole fee and the individual must pay the difference
- Policies can be complex to understand and so create confusion for the average person
37
What is the definition for funding relating to its role of Australia's health system
Relates to the financial resources that are provided to keep the health system adequately staffed and resources, so high level of care is available for those who need it
38
What is does funding relate to and its role of Australia's health system
- Relates to the money used to pay for services and resources provided by the health system to patients
- Funding the health system means more people can receive treatment by reducing costs the individual must contribute
- As a result, more people can access healthcare and receive treatment for a range of conditions, reducing morbidity and mortality rates
39
Funding for Medicare
- Medicare funds part or all the fees associated with health services
Funded by the federal government, Medicare levy, Medicare levy surcharge and general taxation
40
Funding for the PBS
- Essential medicines are subsidised through the PBS, proving treatment for many conditions, promoting health outcomes
- Australians are taxed a small proportion of their taxable income to help the government subsidies the cost of common medications listed on the PBS list
41
Funding for NDIS
- Provide funding for a range of resources that promote health status, including careers who can provide support with daily living and staying socially connected
- Also through assistive technology (wheelchairs)
42
Funding for private health insurance
- The federal government funds private health insurance rebate which means private health insurance is more affordable for more people
- Provides much of the funding for private hospitals
43
What is the definition for sustainability relating to its role of Australia's health system
Relates to its capacity to provide a workforce and infrastructure such as facilities and equipment into the future and to be innovative and responsive to emerging needs through interventions such as research and monitoring
44
What is does sustainability relate to and its role of Australia's health system
- As the population grows and ages, different needs emerge within the Australian population, the health system is experiencing increasing pressure
45
Sustainability for Medicare
- By removing the cost of healthcare, individuals are able to access healthcare sooner, which will lead to improved health outcomes and reduce the cost of treatment in the long term.
- Only covers essential, medically necessary services so that we are able to financially support the health of people in the future.
46
Sustainability for the PBS
- Continually reviewing medicines available through the PBS and contributes to improved treatment less reliance on health system
- Does not cover all medications thereby allowing this service to be in place for future generations
47
Sustainability for NDIS
- Each participant in the NDIS receives an individual plan which means that only necessary funds are spent on each person as a result and therefore more people can access the NDIS and experience improved health outcomes
48
Sustainability for private health insurance
- Incentives such as private health insurance rebate, lifetime health cover and the age-based discount assist in maximising the funding gained through the private system. This means more people are treated through the private system, which reduced the strain on the public system, improving health outcomes
49
What is the definition for access relating to its role of Australia's health system
An accessible healthcare system is one that can provide all people with timely access to quality health services based on their needs, not their ability to pay, regardless of where they live in the country
50
What does access relate to and its role of Australia's health system
- Access must be available to people from all socioeconomic groups and those living within and outside Australia’s major cities
51
Access for Medicare
- Medicare provides access to people of all socioeconomic backgrounds to services such as doctors consultations and treatment in public hospitals
- Medicare provides funding for telephone and video consultations which can assist those living outside major cities in accessing health services
52
Access for the PBS
- All Australian citizens and permanent residents are entitled to access subsidised medicines through the PBS
53
Access for NDIS
- Improves access to health services for people with significant lifelong disabilities under the age of 65
54
Access for private health insurance
- High income earners who are willing to pay
- Private health insurance rebate increases access to private health insurance for those on lower incomes
- Increases access to health services that may be otherwise been to expensive for patients to afford
55
What is the definition for equity relating to its role of Australia's health system
An equitable health system is one that takes the different circumstances of individuals and groups into account so that those who need more support are able to receive it. As a result, disadvantaged individuals and groups are targeted in an attempt to create a level playing field
56
What does equity relate to and its role of Australia's health system
- Australians have different health care needs; the health system must take these differences into account if it is to be equitable and fair for all people
57
Equity for Medicare
- Through Medicare safety net which people who require frequent services covered by Medicare such as doctor visits and tests receive additional financial support.
58
Equity for the PBS
- PBS safety net: further protects individuals and families from large overall expenses for PBS listed medicines.
- Available to all Australians
59
Equity for NDIS
- The individualised plan developed as part of the NDIS ensures that those with more significant needs receive more assistance
- Those who require NDIS do not have to pay more towards funding it than those who don’t
60
Equity for private health insurance
- Those on lower incomes receive more financial assistance through the private health insurance rebate
- Those aged 65 and over who often have lower incomes receive a greater rebate from the government if they have private health insurance
