medicare Flashcards
bulk billing
when the doctor or specialist charges only the schedule fee. the payment is claimed directly from medicare and there is no out of pocket expenses
schedule fee
the amount that medicare contributes towards certain consultations and treatments
- the government decides what each item is worth and that’s how much medicare pays
- doctors and private hospitals can choose to charge more than this fee
income test
a determination of whether an individual or family is eligible for government assistance based on their level of income
out-of-pocket expenses
costs that patients must pay themselves
incentive
something that motivates or encourages someone to do something
patient co-payment
the payment made by the consumer for the health products or services in addition to the amount payed by the government
medicare safety net
provides extra financial assistance for those that incur significant out of pocket costs for medical services
WHO definition of a health system
all the activities whose primary purpose is to promote, restore and/or maintain health.
the public sector
- provided by the federal, state, and local governments
- includes:
- public hospitals
- medicare
- the pharmaceutical benefits scheme (PBS)
the private sector
- private health insurance
- private hospitals
- medical practitioners in private practices
medicare
Australia’s universal health insurance scheme. Established in 1984, Medicare gives all Australians, permanent residents and people from countries with a reciprocal agreement (New Zealand, the United Kingdom, the Republic of Ireland, Belgium, Sweden, the Netherlands, Finland, Italy, Malta, Slovenia and Norway) access to healthcare that is subsidised by the government.
out of hospital expenses (medicare)
- consultation fees for doctors and specialists
- tests and examinations needed to treat illnesses such as x- rays
- pathology such as blood tests
- eye tests performed by optometrists
- most surgical and other therapeutic procedures performed by GPs are covered
public hospital expenses covered by medicare
- as a public patient in a public hospital, accommodation and treatment by doctors and specialists is covered by medicare, including initial treatment and aftercare
private hospital expenses covered by medicare
medicare will pay 75% of the schedule fee for treatment by doctors or specialists
- will not contribute to accommodation or other costs such as theatre fees and medication
what does medicare cover?
- doctor and specialist consultations
- most surgical and therapeutic procedures performed by GPs
- x-rays
- eye tests
- pathology eg blood and urine tests
- fee-free treatments and accommodation in public hospitals
- dental services for some children under the Child Dental Benefits Scheme have to use this full answer otherwise it is wrong
- 75% of the schedule fee for treatment in a private hospital
what is not covered by medicare?
- any cosmetic or unnecessary procedures
- most costs associated with private hospital care (only 75% of treatment)
- most dental examinations and treatment
- ambulance services
- home nursing care or treatment
- most allied health services (unless referred by a GP or in a public hospital)
alternative medicinces
- not covered by medicare
- chiropractic services
- acupuncture
- remedial massage
- naturopathy
- aromatherapy
may contribute to these services is they are carried out or referred by a GP
health-related aids
- not covered by medicare rebate
eg - glasses and contacts
- hearing aids
- cost of artificial limbs (prostheses)
advantages of medicare
- choice of doctor for out-of-hospital services
- available to all Australian citizens
- reciprocal agreement between Australia and other countries that allows Australian citizens to access free healthcare in selected countries
- covers tests and examinations, doctors and specialists fees (schedule fee) and some procedures such as xrays and eye tests
- the medicare safety net provides extra financial contributions for medical services once an individuals or families co-payments reach a certain level
disadvantages of medicare
- 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 doctors visit`
how is medicare funded?
three sources:
- the medicare levy
- the medicare levy surcharge
- general taxation
the medicare levy
- an additional 2% tax placed on the taxable income for taxpayers
- some people with low incomes may be exempt
the medicare levy surcharge
- peole without private health insurance who earn over a certain amount of money are required to pay an additional tax of 1-1.5% towards medicare (income tested)
- this is an incentive for those on higher incomes to take out private health insurance, which takes some of the financial pressure off medicare.
- aims to encourage people to take out private hospital cover and use the private system
