sac 3, chapter 7 (medicare)

Question 1

According to the WHO, a health system is

Answer 1

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

Question 2

Australia’s health system is made up to two main components:

Answer 2

public and private health care

Question 3

Public component includes

Answer 3

public-sector health services and schemes that are provided by the Australian state/territory and local governments, including, public hospitals, Medicare, Pharmaceutical Benefits Scheme (PBS) and the National Disability Insurance Scheme (NDIS)

Question 4

Private sector includes

Answer 4

private health insurance, private hospitals and medical practitioners in private practices

Question 5

Medicare

Answer 5

Australia’s universal health insurance scheme

gives all Australians, permanent residents and people from countries with a reciprocal agreement access to essential healthcare at a subsidised price

The government contributes to a specific amount to health service, so that the patient pays a smaller, more affordable price

Question 6

‘Universal healthcare’ means

Answer 6

all people in a particular place (usually a country) have access to healthcare without facing any barriers

Question 7

Schedule fee:

Answer 7

The amount of money that the government deems appropriate for a particular medical service or procedure

Question 8

Patient co-payments:

Answer 8

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

Question 9

Bulk-billing:

Answer 9

When the doctor charges only the schedule fee. The payment is claimed directly from Medicare so there are no out-of-pocket expenses for the patient

Question 10

Medicare covers:

Answer 10

GP consultations
Eye tests
X-rays
Pathology test
Specialist consultations
Public patient in a public hospital

Question 11

Medicare does not cover:

Answer 11

Cosmetic surgery
Glasses and contact lenses
Chiropractors
Hearing aids
Most physiotherapy
Medication and aids
Many dental services
Ambulance services
Home nursing
Ambulance services
Treatment and accommodation in a private hospital

Question 12

Medicare has three main objectives:

Answer 12

To make healthcare affordable for all Australians

To give Australians access to health services according to need

3. To provide a high quality of care

Question 13

Medicare is funded through three sources of income:

Answer 13

1. The Medicare levy – a 2% tax placed on the income of most taxpayers
2. The Medicare levy surcharge – an extra 1-1.5% tax placed on the income of high-income earners who do not have private health insurance
3. General taxation

Question 14

medicare Advantages

Answer 14

Makes healthcare affordable and accessible to all

Available to all Australian residents

Involves contributions from the whole country (via the Medicare levy and taxation)

Essential healthcare is covered (tests, examinations, doctors’ and specialists’ fees (schedule fee only) and some procedures such as X-rays and eye tests
Available to all Australian residents

Question 15

Disadvantages of Medicare

Answer 15

Does not cover all health services
No choice of doctor for in-hospital treatment
No private rooms available if you are in a public hospital
Long waiting times for health services
Often does not cover the full amount of a doctor’s visit

Question 16

The Pharmaceutical Benefits Scheme

Answer 16

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

Generally, people pay no more than a capped amount ($31.60) for prescription medicine

Certain concession card holders pay a reduced amount ($7.70)

Question 17

PBS Safety Net

Answer 17

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

Drugs that are not on the PBS, must be paid for in the full amount by patients

Question 18

Advantages of the PBS

Answer 18

Cheaper prescription medicines
Protects families from large expenses
Equitable access to essential medication regardless of SES

Question 19

disadvantages of PBS

Answer 19

Requires large amount of government subsidies
Not all prescription drugs are included

Question 20

National Disability Insurance Scheme

Answer 20

provides support and services for people with permanent, significant disabilities and their families and carers

Supports individuals with disability to gain independence, involvement in their community, education, employment and health and wellbeing

Question 21

The aim of the NDIS is to

Answer 21

create individualised support plans that help people to have greater independence, community engagement, employment and functional daily support in their homes

Question 22

The NDIS helps individuals to:

Answer 22

Access mainstream services and support: e.g. healthcare, education, public housing, legal help or aged care

Access community services and support: e.g. sporting clubs, libraries or community groups

Maintain informal support arrangements: e.g. support you don’t pay for, such as that from family and friends

Receive reasonable and necessary funded supports: e.g. ramps that make home wheelchair accessible

Question 23

what is Private Health Insurance

Answer 23

Type of insurance where members pay a premium (fee) in return for payment towards health-related costs not covered by Medicare

Question 24

We need PHI to:

Answer 24

Support the public health system (take the strain off the Australia public health system)

Support all Australians – currently 13 million people are covered by PHI

Support an ageing Australian population

Contribute to funding the healthcare system (e.g. private hospitals are funded by private health insurance)

Question 25

PHI offers 3 different types of cover:

Answer 25

1. 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 (see next slide) 2. General treatment cover: ‘extras’ including physio, dental, podiatry, etc 3. Combined cover: combination of both hospital and general treatment cover

Question 26

Private health insurance rebate

Answer 26

receive a rebate from the government to help cover the cost of their premiums can opt to pay a reduced premium and the government will pay the balance or they can pay the total and then claim the rebate through their tax return Those who earn more will receive a smaller rebate, or no rebate

Question 27

Medicare Levy Surcharge

Answer 27

People earning over a certain amount pay an extra tax as a Medicare levy surcharge if they do not purchase private health insurance This encourages high income earners to take out private health insurance

Question 28

Lifetime Health Cover

Answer 28

People who take up private health insurance after the age of 31 pay an extra 2 per cent on their premiums for every year they are over the age of 30 This encourages younger people to take up PHI and keep it for life

Question 29

Age-based discount

Answer 29

Insurers have the option of offering young people aged 18-29 a discount of up to 10 per cent for hospital cover

Question 30

private health insurance Advantages

Answer 30

Enables access to private hospital care Choice of doctor while in public or private hospital Shorter waiting times for some medical procedures such as elective surgery Depending on the level of cover purchased, services such as dental, chiropractic, physiotherapy, optometry and dietetics could be paid for Helps to keep the costs of operating Medicare under control High income earners with private health insurance do not have to pay the additional tax, called the Medicare Levy Surcharge Government rebate for eligible policy holders Lifetime Health Cover incentive The age-based discount may provide cheaper private cover for those aged 18-29

Question 31

private health insureance disadvantages

Answer 31

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 Qualifying periods apply for some conditions, such as pregnancy Policies can be complex to understand and so create confusion for the average person

Question 32

Funding

Answer 32

Relates to the financial resources that are provided to keep the health system adequately staffed and resourced, so a high level of care is available for those who need it. Relates to the money used to pay for services and resources provided by the health system to patients,

Question 33

Funding the health system means

Answer 33

more people can receive treatment by reducing costs the individual must contribute more people can access healthcare and receive treatment

Question 34

funding the PBS

Answer 34

Essential medicines are subsidised through the PBS, providing treatment for many conditions Australians are taxed a small proportion of their taxable income to help the government subsidise the cost of common medications listed on the PBS list

Question 35

Funding ndis

Answer 35

provide funding for a range of resources that promote health status, including carers who can provide support with daily living and staying socially connected Assistive technology such as wheelchairs and bed rails are provided

Question 36

funding private health insurance

Answer 36

provides much of the funding for private hospitals, which are responsible for around 40% of hospital treatments The federal government funds the private health insurance rebate, which means private health insurance is more affordable for more people

Question 37

Australia’s health system assists in promoting health outcomes by providing:

Answer 37

Healthcare infrastructure – such as hospitals, consulting rooms and medical technology Highly trained health professionals – adequate funding assists in maintaining professional standards through ongoing training and education Personnel – administrative and support staff in public hospitals are largely funded through Medicare and government grants Medical supplies – including those used to administer treatments such as surgical tools, tapes and bandages Public health programs – programs that work to promote health and wellbeing and prevent disease, such as Quit and LiveLighter, are funded through the health system Advances in knowledge and technology through research – such as developments in preventing, diagnosing and treating common conditions

Question 38

Increasing health costs have occurred over time, largely due to:

Answer 38

An ageing population Increasing incomes, a growing economy and rising expectations – More expensive technologies and services – Increased cost of medicines included on the PBS have increased in price

Question 39

Sustainability

Answer 39

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

Question 40

Sustainability medicare

Answer 40

Only covers services that are considered medically necessary, thereby allowing this service to be in place for future generations Determining which services will be subsidised through Medicare can preserve funds for the most necessary services, yielding the greatest gains in health outcomes The Medicare levy increased from 1.5 to 2 per cent in July 2014 to assist in providing the necessary funds to maintain Australia’s health system and introduce the National Disability Insurance Scheme

Question 41

Sustainability PBS

Answer 41

Continually reviewing the medicines available through the PBS means those that will have the greatest benefits are prioritised, which assists in keeping the scheme sustainable The Therapeutic Goods Administration (a federal government body) verifies the effectiveness of all PBS medicines. This contributes to improved treatment and less reliance on the health system Does not cover all medications, thereby allowing this service to be in place for future generations

Question 42

Sustainability ndis

Answer 42

Each participant in the NDIS receives an individualised 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 tested in different places in order to ensure it was worth rolling out for the whole of Australia, making it more sustainable for future generations’ use Not all people with disabilities are eligible, meaning more people with permanent disabilities can get the full care they need, ensuring that people both now and into the future can have access to this service

Question 43

Sustainability private health insurance

Answer 43

Incentives such as the 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 reduces the strain on the public system, improving health outcomes for more people also promotes the sustainability of the public health system, as it alleviates the pressure from the system by giving people access to private hospital services, meaning there are shorter waiting periods for public healthcare services

Question 44

Funding & Sustainability – An efficient health system and workforce

Answer 44

Ensuring that the health workforce is adequately staffed with highly trained healthcare practitioners – responsibility for this rests with the state and territory governments The health workforce must continue to develop in size and skill Ensuring health services are delivered efficiently assists in reducing health-related costs federal and state/territory governments are also working to improve the efficiency of the health system. A key aspect of this work is the development of an electronic health record (eHealth) system in Australia, referred to as My Health Record My Health Record promotes sustainability by streamlining the recordkeeping system and allowing healthcare information to be accessed electronically by an individual’s healthcare provider anywhere in Australia It also works to promote individual’s health literacy

Question 45

Funding & Sustainability – Disease prevention and early intervention

Answer 45

A key intervention for reducing the strain on the health system is to reduce the number of people who need to use it. This is done through disease prevention, early detection and health promotion

Question 46

Funding & Sustainability – Disease prevention and early intervention The health system plays a key role in this process by providing:

Answer 46

Free testing for infectious diseases such as COVID-19 Public cancer screening such as BreastScreen and BowelScreen The Immunise Australia program Health promotion programs

Question 47

Funding & Sustainability – Research and monitoring

Answer 47

Through the National Health and Medical Research Council (NHMRC), the government funds research into a range of health and medical areas The NHMRC supports research to find new ways to cure, treat and prevent illness and disease and to improve the effectiveness of health services in Australia

Question 48

Access

Answer 48

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

Question 49

Access Medicare

Answer 49

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 Allows people to choose their own doctors Heavily subsidised, making it financially accessible People have access to services in public hospitals for medically necessary operations The Medicare Safety Net makes the service more accessible to those who need more treatment

Question 50

Access PBS

Answer 50

All Australian citizens and permanent residents are entitled to access subsidised medicines through the PBS The PBS promotes access to essential medicines for low-income earners by including a concessional co-payment amount Medications are provided at local pharmacies, making them more physically accessible They are also heavily subsidised, making them financially accessible The PBS Safety Net gives people extra financial assistance

Question 51

Access ndis

Answer 51

Improves access to health services for people with significant, life-long disabilities Has been rolled out in every region of Australia, improving access for those living outside major cities Available to all Australian residents with a permanent disability under the age of 65,

Question 52

Access private health insurance

Answer 52

private health insurance rebate increases access to private health insurance for those on lower incomes Private health insurance can increase access to health services that may have otherwise been too expensive for patients to afford The government provides individuals with a partial PHI refund, which assists in making PHI more affordable and therefore increases access People have access to more services through PHI (allied health, dental, etc

Question 53

Access Governments and non-government organisations work to increase access in all geographical areas through a range of interventions:

Answer 53

Royal Flying Doctor Service - a non-government organization that provides health care to thousands of Australians living outside of major cities. The Royal Flying Doctor Service receives funding from the federal and state/territory governments to maintain its fleet of air and road vehicles The Workforce Incentive Program – a federal government strategy that aims to provide financial incentives for doctors who work in rural and remote areas

Question 54

Equity

Answer 54

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

Question 55

medicare Equity

Answer 55

Medicare Safety Net – people who require frequent services covered by Medicare such as doctor’s visits and tests, receive additional financial support. Mental Health Treatment Plans – those with mental health disorders are eligible for 10 individual and 10 group therapy sessions per calendar year with the cost covered by Medicare The system is available to everybody, The different number of services available means that everybody receives the care they need

Question 56

Equity PBS

Answer 56

PBS Safety Net – further protects individuals and families from large overall expenses for PBS-listed medicines. The PBS Safety Net gives people extra financial assistance if they require medication more often, focusing on disadvantaged population groups The concessional co-payment amount provides greater assistance to those who are unemployed or on low incomes Many Aboriginal and Torres Strait Islander peoples can qualify for reduced PBS co-payment amounts under the Closing the Gap initiative Available to all Australians

Question 57

ndis Equity

Answer 57

The individualised plan developed as a 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 all people, especially those who need extra assistance, are able to get the help they need in order to live as normal a life as possible Individualised plans aid each person’s needs

Question 58

Equity private health insurance

Answer 58

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 People who use their private health insurance more often than others do not have to pay a higher premium Those who earn less are entitled to a bigger refund, making PHI more affordable Different company and premium plan options are available for all sorts of different people and incomes, focusing on different people and their personal needs Those on lower incomes receive more financial assistance through the private health insurance rebate