U3 AOS2 The Australian healthcare system (5)

Question 1

Health system

Answer 1

All the activities and service providers, such as doctors, nurses, specialists, and other health professionals whose primary purpose is to promote, restore and or maintain health.

Question 2

Primary healthcare

Answer 2

Refers to an individual’s first contact or gateway to the healthcare system. As primary healthcare is not often related to hospital care it can include services at local clinics, community health centres, health promotion program, general practitioner (GP) visits, preventative initiatives, and dentist visit.

Question 3

Secondary healthcare

Answer 3

Includes health services and medical care provided by specialists after a referral from a primary healthcare professional. These can include occupational therapy, physiotherapy, or a speech pathologist.

Question 4

Medicare coverage

Answer 4

The coverage of healthcare services by Medicare is based on the Medicare Benefits Schedule (MBS).

Question 5

List 3 examples of the treatment publicly insured patients will receive

Answer 5

Patients who are referred to treatment by a medical practitioner are admitted into a public hospital as a public patient and pay nothing for their treatment, food and accommodation while in hospital;

The hospital will appoint a suitably qualified doctor, and public patients do not have a choice about which doctor treats them;

They may also not have a choice about when they are admitted to hospital;

Question 6

List 3 examples of the treatment privately insured patients will receive

Answer 6

Individuals can choose to be treated as a public patient even if they are privately insured;

Those who choose to be treated in a private hospital or as a private patient in a public hospital can select the doctor or specialist of their choice;

Medicare will pay 75 per cent of the Medicare Benefits Schedule (MBS) or schedule fee for the services performed by the doctor and some or all of the balance will be covered by private health insurance;

Question 7

List the three main objectives of Medicare

Answer 7

To make healthcare more affordable for all Australians, to give all Australians access to healthcare services with priority according to clinical need, and to provide a high quality of care.

Question 8

Medicare

Answer 8

A universal healthcare system funded by the Commonwealth Government that aims to improve access to healthcare for all Australians in need of treatment at little or no cost regardless of age, or income.

Question 9

Medicare Benefits Scheme (MBS)

Answer 9

A schedule of fees for a range of services that is set by the federal government, and the percentage contribution from Medicare.

Question 10

Schedule fee

Answer 10

A fee set for a service by the Commonwealth Government.

Question 11

Bulk billing

Answer 11

When the doctor bills Medicare directly therefore accepting the Medicare payment as full payment for the service so there is no cost to the patient.

Question 12

Medicare safety net

Answer 12

A protective measure designed by the federal government to avoid patients having to pay high medical costs, which covers a range of out-of-hospital costs (e.g., ultrasounds, blood tests, and x-rays) and provides reimbursement of 100% of the MBS fee for out-of-hospital services once the relevant threshold of $477.90. has been reached.

Question 13

Medicare extended safety net

Answer 13

Under the extended safety net, Medicare pays 80% of out-of-pocket costs once a threshold of $2169.20 is reached for families or individuals or $692.20 for concession card holders or families who receive Family Tax Benefit Part A.

Question 14

Gap amount

Answer 14

The difference between the Medicare benefit and the schedule fee.

Question 15

Out-of-pocket costs

Answer 15

The difference between the Medicare benefit and what a doctor charges.

Question 16

Give 4 examples of out-of-hospital services covered by Medicare

Answer 16

Free or subsidised treatment by health professionals, such as doctors’ consultation fees as often as needed (including some specialists), optometrists’ eye tests, most procedures performed by general practitioners, and tests and examinations needed to treat illness, including x-rays and pathology tests.

Question 17

Give 4 examples of out-of-hospital services not covered by Medicare

Answer 17

General/ most dental examinations and treatments (i.e., except under specific circumstances), ambulance services, most allied health services, such as physiotherapy, speech pathology, occupational therapy, chiropractic services, podiatry, or psychology services, and hearing aids, contact lenses and glasses.

Question 18

Give 2 examples of in-hospital services covered by Medicare

Answer 18

Treatment and accommodation as a public patient in a public hospital by a doctor appointed by the hospital as a result of an emergency or after referral from a doctor;

75% of the Medicare schedule fee for services and procedures for a private patient in a public or private hospital (which does not include accommodation in hospital or items such as theatre fees or medication);

Question 19

Chronic medical condition

Answer 19

A condition that has been present for at least six months is likely to be present for six months or is terminal.

Question 20

Reciprocal healthcare agreements

Answer 20

Agreements made between several countries and Australia (e.g., New Zealand, the United Kingdom, Sweden, the Netherlands, Finland, Italy etc) that means that some of the costs of essential treatment may be covered for Australian visiting these countries, and vice versa when residents of these countries visit Australia.

Question 21

List the exceptions to the services covered and not covered by Medicare

Answer 21

Child dental benefit service, general practitioner (GP) management plan, team care arrangement plan, allied health, and overseas.

Question 22

Child dental benefits service or schedule

Answer 22

For those aged 2-17 years old who are covered by Medicare and have a parent receiving an eligible payment receive certain government benefits such as Family Tax Benefit Part A and receive basic dental services through the Child dental benefits schedule.

Question 23

General practitioner (GP) management plan

Answer 23

Enables individuals to access health services needed to treat their chronic condition.

Question 24

Team care arrangement plan

Answer 24

Set up when an individual needs to see more than two healthcare professional for treatment. It can provide Medicare rebates for services not typically covered by Medicare.

Question 25

Allied health

Answer 25

Allied health services are typically not covered by Medicare, however people with a chronic medical condition may be entitled to receive a Medicare benefit to help manage their condition under specific circumstances.

Question 26

Overseas

Answer 26

Reciprocal healthcare arrangements mean that some overseas treatments are covered by Medicare.

Question 27

Equity

Answer 27

It is about ensuring that we are all on an even playing field by providing an extra support for people in need so they can have the same opportunities in life as everyone else. It means the needs of people should guide the distribution of support.

Question 28

List 3 advantages of Medicare

Answer 28

It is available to all Australian citizens, regardless of their age or income, due to the reciprocal arrangements, Australians may be able to access free or subsidised healthcare in a range of other countries, and being able to access essential healthcare as a public patient in a public hospital at little or no cost.

Question 29

List 3 disadvantages of Medicare

Answer 29

Places a significant financial burden on the Commonwealth Government, there may be long waiting lists – especially for less essential treatments, and there are often gap amounts or out-of-pocket costs to the individual.

Question 30

Who is Medicare funded by?

Answer 30

The federal government, the 2% Medicare Levy, and the Medicare Levy Surcharge

Question 31

The federal government, as a funder of Medicare

Answer 31

The federal government raises taxpayer revenue which may be used to pay for a range of government services such as healthcare.

Question 32

The 2% Medicare Levy, as a funder of Medicare

Answer 32

This levy is paid by most taxpayers, is based on taxable income, and is paid in addition to general income tax to fund Medicare.

Question 33

The Medicare Levy Surcharge, as a funder of Medicare

Answer 33

An additional amount is paid by individuals and families who do not have private health insurance. The surcharge was set between 1 and 1.5 per cent of total income for a single taxpayer who earns above $90 000 and for families who earn over $180 000 a year.

Question 34

Explain the purpose of the Pharmaceutical benefits scheme (PBS)

Answer 34

To subsidise the cost of a wide range of prescription medications, providing Australians with vital medications at affordable prices to ensure that optimal health outcomes.

Question 35

Pharmaceutical Benefits Scheme (PBS)

Answer 35

A limited Australian government scheme that aims to provide timely, reliable, affordable, and subsidised cost to a wide range of prescription medications, as well as making 139 essential medicines free to Australian residents, as well as foreign visitors covered by a Reciprocal Health Care Agreement.