medicare

Question 1

bulk billing

Answer 1

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

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 how much medicare pays
- doctors and private hospitals can choose to charge more than this fee

Question 3

income test

Answer 3

a determination of whether an individual or family is eligible for government assistance based on their level of income

Question 4

out-of-pocket expenses

Answer 4

costs that patients must pay themselves

Question 5

incentive

Answer 5

something that motivates or encourages someone to do something

Question 6

patient co-payment

Answer 6

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

Question 7

medicare safety net

Answer 7

provides extra financial assistance for those that incur significant out of pocket costs for medical services

Question 8

WHO definition of a health system

Answer 8

all the activities whose primary purpose is to promote, restore and/or maintain health.

Question 9

the public sector

Answer 9

• provided by the federal, state, and local governments
• includes:
  
  • public hospitals
  • medicare
  • the pharmaceutical benefits scheme (PBS)

Question 10

the private sector

Answer 10

• private health insurance
• private hospitals
• medical practitioners in private practices

Question 11

medicare

Answer 11

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.​

Question 12

out of hospital expenses (medicare)

Answer 12

• 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

Question 13

public hospital expenses covered by medicare

Answer 13

• as a public patient in a public hospital, accommodation and treatment by doctors and specialists is covered by medicare, including initial treatment and aftercare

Question 14

private hospital expenses covered by medicare

Answer 14

• if an individual chooses to be admitted to a private hospital or as a private patient in a public hospital, medicare will pay 75% of the schedule fee for treatment by doctors or specialists but will not contribute to accommodation or other costs such as theatre fees and medication

Question 15

what does medicare cover?

Answer 15

• 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

Question 16

what is not covered by medicare?

Answer 16

• 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)

Question 17

alternative medicinces

Answer 17

• 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

Question 18

health-related aids

Answer 18

• not covered by medicare rebate
  eg
• glasses and contacts
• hearing aids
• cost of artificial limbs (prostheses)

Question 19

advantages of medicare

Answer 19

• 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

Question 20

disadvantages of medicare

Answer 20

• 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`

Question 21

how is medicare funded?

Answer 21

three sources:
- the medicare levy
- the medicare levy surcharge
- general taxation

Question 22

the medicare levy

Answer 22

• an additional 2% tax placed on the taxable income for taxpayers
• some people with low incomes may be exempt

Question 23

the medicare levy surcharge

Answer 23

• 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