Medicare Flashcards
What is medicare?
Medicare is Australia’s Universal Health Insurance scheme for Australian Citizens that’s provides medical care to patients via their GP or hospital for little or no cost.
Aim of medicare
To improve access to health care for all Australians and provide access to adequate at little or no cost to all Australians in need of treatment regardless of income or Age.
When was medicare established
1984
Who is responsible for medicare australia?
The Federal Government
The medicare levy
Where people pay 2% tax to Medicare.
Low income earners may be exempt
The medicare levy surcharge
Those earning over a certain amount and don’t have private health insurance pay an additional 1-1.5% income tax to encourage individuals to have private health insurance
General tax
Income from the Medicare levy and Medicare levy surcharge doesn’t meet the full operating costs so general income tax is also used
What is covered by medicare?
o Some of the cost involved in GP visits
o Covers some of the cost of visiting a specialist doctor
o Diagnostic tests needed to treat and diagnose illnesses
Pathology
X-Rays
Eye tests by optometrists (1x every 2 years)
o Cost of all treatment by doctors and specialists if admitted as a public patient to a public hospital
o Subsidises treatment as a patient in a private hospital
What is not covered by medicare
o Cosmetic surgery or unnecessary procedures
o Treatment in a private hospital (75% of schedule fee covered only)
o Private hospital accommodation
o Dental examinations and treatment for adults
o Home nursing care or treatment
o Ambulance transport services
o Allied health services
o Speech Therapy
o Hearing aids, glasses, and contact lenses
o Prostheses
what is a schedule fee?
A particular cost that is set by the government which indicates the amount that medicare will contribute to selected procedures, the fees are based on the amount that thought to be reasonable and average for a particular service.
What is bulk billing?
Bulk Billing is the doctor charges only the schedule fee, the patient does not have to pay any out-of-pocket expenses and he said have been bulk billed.
The medicare safety net
Aims to protect those who have a heavy reliance of medical services from high out-of-pocket expenses. Once an individual, or families out-of-pocket expenses have reached the threshold amount, the Medicare services for the individual family are charged at the cheaper rate for the remainder of the year.
Advantages of medicare
- Choice of doctor for out of hospital services
- Available to all Australian citizens and those countries who have a reciprocal agreement
- Covers tests, examinations, specialist fees and examinations such as MRI’s and X-Rays
- Medicare safety net provides extra financial contributions for medical services once an individual or family’s co-payments reach a certain level
Disadvantages of medicare
- No choice of doctor for in-hospital services
- Waiting lists for many treatments
- Often doesn’t cover the full amount for a doctors visit
Sustainability of medicare
- When individuals are able to access Healthcare earlier, at no or reduced costs, therefore improved health outcomes reduce healthcare costs in the long term
- As medicare only covers essential healthcare services, therefore funding should be available for the future generation of Australians medical needs.
