U2 AOS2 Flashcards
Medicare
Medicare is Australia’s universal health insurance scheme. Medicare gives all Australians, permanent residents and people from countries with reciprocal agreement access to basic healthcare that is subsidised by the federal government.
What does Medicare cover?
-> consultations with health practitioners (GPs and some specialists)
-> mental health services
-> some dental procedures, under the Child Dental Benefits Schedule.
-> tests, imaging + scans needed to treat illnesses (diagnostic imaging, pathology tests, eye tests)
Public hospitals:
-> emergency care
-> most surgeries and procedures (there might be a wait time if it’s not an emergency)
-> medicines provided to you in hospital
-> follow-up care
What doesn’t Medicare cover?
-> ambulance services
-> most dental services
-> glasses and contact lenses
-> hearing devices
-> elective and cosmetic surgery
-> services not on the Medicare Benefits Scheme
-> services provided through the private health system.
-> home nursing care or treatment
Medicare safety net
Ensures that people who require frequent services required by Medicare, such as doctor’s visits and tests, receive additional financial support.
Patient co-payment
The payment made by the consumer for health products or services in addition to the amount paid by the government.
Schedule fee
The amount set by the federal government for each medical service.
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 and specialists.
-> PHI covers the rest depending on type of cover.
Out-of-pocket expenses
Costs that the patients must pay themselves.
Bulk billing
Bulk billing is when the doctor or specialist charges only the Schedule fee. The payment is claimed directly from Medicare so there are no out-of-pocket expenses for the patient.
How is Medicare funded?
Medicare is funded through three sources of income: general taxation (income collected through general income tax of all Australians; the Medicare levy; and the Medicare levy surcharge.
The Medicare levy
An addition 2% tax placed on the taxable income of most tax payers. Those with low incomes (under $20k) or with specific circumstances (e.g. Pensioner Concession Card holders) may be exempt from paying the levy.
The Medicare levy surcharge
An additional 1-1.5% (range bc based on income) tax on high income earners who do not have PHI.
Pharmaceutical Benefits Scheme (PBS)
Federal government subsidises the cost of essential medicines. Consumers must make a patient co-payment.
PBS Safety Net
ensures that people who spend a large amount of money on PBS medications receive additional financial support.
Private Health Insurance
A type of insurance for which members pay a premium in return for payment towards health-related costs not covered by Medicare.
Four tiers of hospital cover:
- Gold
- Silver
3.Bronze - Basic
Advantages of PHI (care)
-> enables access to private hospital care
-> choice of doctor
-> own room if available
-> shorter wait times for elective surgery
-> depending on level of cover - part/all payments for services such as dental, chiropractic, physiotherapy, optometry, dietics
Four PHI incentives:
-> PHI rebate (government rebate for eligible policy holders)
-> ‘Lifetime Health Cover’ incentive (people who take up PHI after age of 31 pay extra 2% on premiums every year they are over age of 30)
-> High income earners with PHI do not need to pay Medicare levy surcharge
-> Age-based discount (insurers have option to offer 18-29s up to 10% discount for hospital cover)
Community services available to support H+W
-> doctors, dentists, hospitals
-> Maternal + Child Health Service
-> sporting + other recreational clubs + associations
-> headspace
-> places of worship
-> volunteer organisations
Australian Charter of Healthcare Rights
-> access
-> safety
-> respect
-> communication
-> participation
-> privacy
-> comment
Exemptions to health privacy laws
-> if patient or someone else’s H+W or safety are seriously threatened (e.g. if patient is unconscious + a paramedic, doctor or nurse needs to know if patient is allergic to any drugs)
-> when the info will reduce or prevent a serious threat to public health or safety (e.g. warning public if there is an outbreak of a serious contagious illness)
Patient responsibilities
-> provide info about medical history
-> ask questions about proposed healthcare
-> follow instructions + orders of doctors + nurses
-> report safety concerns immediately
-> treat medical staff w respect
-> ask questions about costs before treatment commences
Patient rights
-> info about their diagnosis
-> info on the costs associated w treatment
-> seek another opinion
-> treatment w respect + dignity
-> privacy of + access to medical records
-> make comment or complain about treatment or services
Factors that can affect access to health services + info
-> geographic location
-> SES
-> health literacy
-> gender
-> cultural factors
-> digital media
