CHAPTER FIVE: the australian healthcare system Flashcards
health system
- activities whose primary purpose is to promote, restore and/or maintain health
primary healthcare
- refers to an individual’s first contact with the healthcare system
secondary care
- includes health services and medical care provided by specialists after a referral from a primary healthcare professional.
Medicare
- Australia’s universal healthcare system, which aims to improve the access to healthcare for all Australians and to provide access to adequate healthcare at little or no cost to all Australians in need of treatment, regardless of age or income
Medicare objectives
- to make healthcare more affordable for all
Australians - to give all Australians access to healthcare services with priority according to clinical need
- to provide a high quality of care
Medicare safety net
what is covered by Medicare?
- free or subsidised treatment by health professionals such as doctors’ consultation fees as often as needed (including some specialists)
- tests and examinations that are needed to treat illness, including x-rays and pathology tests
- optometrists’ eye tests
- most procedures performed by GPs
what is not covered by Medicare?
- general/most dental examinations and treatments (except under specific circumstances – see details below)
- ambulance services
- home nursing
- most allied health services, such as physiotherapy, speech pathology, occupational therapy, chiropractic services, podiatry or psychology services
- hearing aids, contact lenses and glasses
- medicines (except those covered by the PBS)
- medical costs incurred overseas
- medical examinations for employment purposes, life insurance or superannuation
- medical services that are not clinically necessary
- private hospital costs other than treatment, such as accommodation in hospital or items such as theatre fees and medicines
- acupuncture (unless part of a doctor’s consultation).
advantages of Medicare
- choice of doctor for out-of-hospital services
- ## available to all Australian citizens
disadvantages of Medicare
- no choice of doctor for in-hospital services
- waiting lists for many treatments
- ## emphasis is on treatment, not prevention
funding Medicare
- general taxation
- Medicare levy of 2% on taxable income, payed by most tax payers- people with low income (<$20,000) or specific circumstances may be exempt from paying levy
- tax payers without private hospital insurance earning more than a certain amount pay a Medicare
levy surcharge — an additional 1—1.5% tax - based on the idea contributions should be made by individuals based on their ability to pay (the more you earn the more you pay)
** Medicare safety net** ensures people who require frequent services covered by Medicare (e.g doctor’s visits and tests) receive additional financial support — when individual’s or family’s patient copayment reaches a certain amount, services covered by Medicare become cheaper for them for the rest of the calendar year
pharmaceutical benefits scheme (PBS)
- Australian Government program that provides subsidised prescription medication to Australian residents, as well as foreign visitors covered by a Reciprocal Health Care Agreement
advantages of PBS
- provides access to essential medication at a subsidised
rate or in some cases, no cost - enables access to medications from local pharmacies
and does not require medications to be purchased from
specialised services - available to all Australian citizens, regardless of their age or income
disadvantages of PBS
- it places a significant financial burden on the Commonwealth Government
- it does not generally cover all medications
- for most Australians, there is still a copayment of $41.00
funding the PBS
private health insurance
private health insurance rebate
private health insurance scheme
medicare levy surcharge
private health insurance scheme
lifetime health cover
private health insurance scheme
age-based discount
private health insurance scheme
funding private health insurance
national disability insurance scheme (NDIS)
- provides services and support for people with permanent, significant disabilities and their families and carers to help them live an ordinary life
- individualised plan
- access mainstream services and supports, including healthcare, education, public housing, aged care and the justice system
- access community services and supports, including sporting clubs, libraries, charities and community groups
- maintain informal support arrangements, including the unpaid help they get from family and friends that is part of most people’s lives
- receive reasonable and necessary funded support, such as the financial support the NDIS will offer that is related to their disability and required for them to improve the quality of their life
eligibility criteria for NDIS
- be under 65 years old
- Australian citizen
- live where NDIS is available
- have disability that is likely to be lifelong
- the disability reduces the ability to participate in activities or perform tasks
funding the NDIS
how medicare promotes health in relation to sustainability
how medicare promotes health in relation to access
how medicare promotes health in relation to equity
how the PBS promotes health in relation to sustainability
how the PBS promotes health in relation to access
how the PBS promotes health in relation to equity
how private health insurance promotes health in relation to sustainability
- private hospitals — reduced demand of public hospitals — people who rely on public
health system can be treated sooner — this applies to current and future generation → aims to achieve absence of illness - physical hwb
how private health insurance promotes health in relation to access
- choose own doctor — meet social and cultural needs — individuals encouraged to access healthcare → have conditions treated while still acting according to values and beliefs - spiritual hwb
how private health insurance promotes health in relation to equity
how the NDIS promotes health in relation to sustainability
how the NDIS promotes health in relation to access
how the NDIS promotes health in relation to equity
