The Health System Flashcards
What are the 3 major sections?
Medicare, PBS and Private health
what is medicare?
Medicare is Australia’s universal health insurance scheme that provides subsidised or even free medical services that fall under a certain criteria.
What is medicare’s main objectives?
- to make healthcare affordable for all Australians
- to give all Australians access to healthcare services with priority according to critical needs
- to provide high quality care
What are 3 pros of Medicare?
- Essential Healthcare is available to all citizens and permanent residents (it’s a right not a privilege)
- Low or no cost care (affordable for all)
- Choice of healthcare providers
What are 3 cons of Medicare?
- Limited coverage (some services are not provided under Medicare e.g. dental)
- Waiting time depending on service and location (especially specialist appointments and elective surgeries)
- Higher taxes – tax payers cover the cost
What are 3 ways someone can be eligible for Medicare?
- they hold an Australian Citizenship
- they hold documented New Zealand citizenship and are lawfully living in Australia
- they have been issued with a permanent visa
What is a schedule fee?
It is a cost that the government deems appropriate for the service
what does subsidising the cost do?
You partially pay for the service
What does bulk billing do?
It is when the practice bills medicare directly, bypassing the client all together
How much does Medicare cover with a schedule fee at public GP?
100%
How much does Medicare cover with a Specialist?
85% of schedule fee
What is the Medicare Safety net?
Once an individual or family meets a certain threshold the Medicare safety net provides extra financial support, reducing the cost of medicare services
What is the medicare extended saftey net?
once an individual reaches a certain threshold, medicare pays 80% of out of pocket costs
What do you need in order to get a medicare card?
- be over 15
- be an Australian or New Zealand citizen or a permanent resident
- your current medicare card has other people on it
- you’re on A medicare card
- you WANT your own medicare card
How much does Medicare cover with Private hospital ?
75%
How is medicare funded
Through the
1. medicare levy
2. general income taxation
3. the medicare surcharge
What does the medicare levy do?
for people who pay tax 2% of their taxable income goes to medicare, people who earn below a certain amount is exempt from the Medicare levy
What does the general taxation contribute to Medicare?
If the Medicare levy and levy surcharge doesn’t fully cover the the costs of medicare the remaining amount will come from the general taxation
What is the medicare levy surcharge contribute?
If you are making a certain amount of money and still relying on medicare , you will be charged an additional 1% - 1.5% on tax
Why do we have the medicare levy surcharge?
to encourage high income earners to change onto private health insurance
What is PBS?
The Pharmaceutical Benefits Scheme is a program that subsidies prescription Medication for Australians
What is the PBS Safety Net? (with concession cards)
Individuals/families with concession cards pays over $316.80 the cost for prescriptions is reduced to $0
What is the PBS Safety Net?
once an individual/family pays up to a certain threshold in a year the cost of prescriptions will be reduced
What does PBS do with war veterans? (RPBS)
It covers war veterans with an extended amount of medication this is called the RPBS - repatriation pharmaceutical benefits scheme
What is the PBS safety net threshold for general patients?
$1,497.20
What is the PBS safety net threshold for patients with concession?
$316.80
What is the cost of medication once the threshold is met? (general patients)
$6.60
What is the cost of medication once the threshold is met? (concession)
free
what are 3 cons of PBS?
- financial burden on the government
- failure to cover all medication
- co-payment needs to be paid by most Australians
What are 3 things that is considered before a drug is put onto PBS?
- Effectiveness
- safety
3.cost effectivness
what are 3 pros of PBS?
- provides access to essential medication for a large population for a reduced or free price
- allows medication to be accessed from pharmacies, not just specialists
3.support to those holding concession cards
what is the maximum you are allowed to pay on a PBS covered medicine?
$41.30
What is private health insurance?
Private health insurance is an optional type of health insurance which individual and families can have in addition to Medicare. This insurance requires members to pay a premium in return for payment towards services that are not covered by Medicare.
