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HHD > U3 O2 ch 6 > Flashcards

U3 O2 ch 6 Flashcards

1
Q

Define health system (WHO definition)

A

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

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2
Q

Common elements of a health system (8)

A
  1. Well trained workforce
  2. Reliable information and research
  3. Up-to-date facilities and medical technologies
  4. Quality medicines
  5. Affordable care
  6. Sustainable
  7. High quality of care
  8. Access for all
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3
Q

Describe Medicare

A

Medicare is Australia’s universal health insurance scheme. It is run by the Federal government and provides all Australian residents access to subsidised healthcare.

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4
Q

What does Medicare cover (3)

A
  1. Fees for essential health care.
  2. What the government considers to be clinically necessary hospital and doctor fees.
  3. In Hospital and Out-of-hospital expenses.
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5
Q

What Out-of-hospital expenses does Medicare cover (5)

A
  1. Consultation fees for GPs and Specialist Doctors
  2. X-rays
  3. pathology tests
  4. Eye tests by optometrists
  5. Child Dental Benefits Scheme for children whose families receive Family Tax Benefit A or Youth Allowance
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6
Q

What is The Medicare Benefits Schedule

A

A document that lists the range of services covered and the amount that Medicare will contribute to each, known as the schedule fee.

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7
Q

Define Schedule fee

A

The the amount that
Medicare contributes towards
certain consultations and
treatments. The government
decides what each item is worth
and that’s what Medicare pays.

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8
Q

Define Patient co-payments

A

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

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9
Q

Define Bulk billing

A

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

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10
Q

What In hospital expenses does Medicare cover (

A
  1. Public hospital - Doctor treatment, theatre and accomodation is paid for
  2. Private hospital or private patient in a public hospital - Medicare will pay 75% if the schedule fee for treatment by doctors and specialists, but nothing else.
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11
Q

Services not covered by Medicare (4)

A
  1. Cosmetic procedures
  2. Allied health services (unless referred by a GP or carried out in a public hospital
  3. Ambulance services
  4. Glasses, contact lenses, hearing aids
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12
Q

Describe the Medicare Safety Net

A
  1. Provides extra financial assistance for those that incur significant out-of-pocket costs for Medicare services
  2. Once an individual or family has contributed a certain amount in out-of-pocket expenses for out of hospital services, Medicare services will have a smaller co-payment for the rest of that calendar year
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13
Q

Advantages of Medicare (6)

A
  1. Choice of doctor for out-of-hospital services
  2. Essential health care is accessible to all Australians through basic hospital and medical treatment
  3. Reciprocal agreement between Australian and other countries allows Australian citizens to access free healthcare in selected countries
  4. Diagnostic procedures are covered
  5. The Medicare Safety net provides extra financial contributions for medical services once an individual’s or family’s co-payments reach a certain level
  6. Breaks the cycle of ill health
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14
Q

Disadvantages of Medicare (4)

A
  1. No choice of doctor for in-hospital treatments
  2. Long waiting periods
  3. Does not cover alternative therapies
  4. Often does not cover the full amount of a doctor’s
    visit
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15
Q

How is Medicare funded (3)

A
  1. Medicare Levy
  2. Medicare Levy Surcharge
  3. General Taxation
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16
Q

What is Medicare Levy

A

Additional 2% tax on most taxpayers (low incomes can be exempt)

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17
Q

What is Medicare Levy Surcharge

A

High income earners who do not have Private Health Insurance have to pay an extra tax called the Medicare Levy Surcharge which is an extra 1-1.5% tax

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18
Q

What is general taxes

A

The money collected from the Medicare levy and the Medicare Levy Surcharge is not enough to cover operating costs of Medicare so many is taken from general taxes

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19
Q

Describe Pharmaceutical Benefits Scheme (PBS)

A

The Federal government scheme provides Australians with necessary prescribed medicines at a subsidised price.

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20
Q

How is PBS funded

A

General taxes

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21
Q

What is the PBS Safety Net (2)

A
  1. The cost of your medicines is reduced to the concession price once you reach the Safety Net threshold, for the rest of the calender year
  2. Concessions that reach the PBS Safety Net get PBS prescriptions at no cost for the rest of the calendar year
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22
Q

Who is responsible for what drugs are on the PBS (2)

A
  1. The Pharmaceutical Benefits Advisory Committee (PBAC) reviews current drugs on the list and assesses other drugs for effectiveness and cost effectiveness.
  2. The government must agree to fund it
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23
Q

What is the National Disability Insurance Scheme (NDIS) (3)

A
  1. The NDIS is a national insurance scheme that provides services and support for people with permanent, significant disabilities, and their families and carers.
  2. Funded by the federal and state/territory governments
  3. The NDIS works to assist individuals with disabilities to live an ordinary life.
  4. Curates an individualised plan based on the individual’s goals and aspirations.
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24
Q

How is the NDIS funded

A

0.5% of the Medicare Levy

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25
Q

What are the criteria to get NDIS (5)

A
  1. Permanent disability
  2. Significant disability
    ^ assistance from other people
    ^ assistive technology or equipment
  3. Impairment affects social and economic participation
  4. Need support from the NDIS for your life time.
  5. Under 65
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26
Q

Define assistive technology

A

A device, system or design that allows an indiviual to perform a task that they would otherwise be unalbe to do, or increase the ease and safety with which a task can be performed

27
Q

Describe the individualised plan for NDIS (3)

A
  1. The NDIS develops an individualised plan based on the individual’s goals and aspirations.
  2. Identifies the functional support needed for daily living and participation and the support needed to persue goals
  3. Individual can manage the plan themselves, or nominate someone or the NDIS to do it.
28
Q

What does the NDIS assists participants in

A
  1. Access mainstreme services and supports
  2. Access community services and supports
  3. Maintain informal support arrangements - family and friends help
  4. Receive reasonable and necessary funded supports
29
Q

Describe Private Health Insurance (2)

A
  1. A type of non-government insurance run by private companies, under which members pay a premium in return for payment towards health-related costs not covered by Medicare.
  2. Optional form of health insurance hat can be purchased in addition to Medicare
30
Q

Private health insurance options (3)

A
  1. Private Hospital cover
  2. Extras Cover
  3. Combied
31
Q

Private health insurace options > Private Hospital cover (4)

A
  1. Choice of doctor
  2. Have their own room
  3. Shorter waiting lists for treatments than Public Hospitals
  4. Medicare will still pay 75% of the schedule fee for treatments by doctors and specialists
32
Q

Private health insurace options > Private Hospital does not cover

A

PHI does not pay the full amount Private Hospitals charge as they have their own lists of schedule fees for each service

33
Q

Private health insurace options > Extras Cover (2)

A
  1. Provides benefits on the services not covered by Medicare
  2. For example, dental, gases, physiotherapy
34
Q

Private Health Insurance Incentives purpose (2)

A
  1. To reduce the strain and cost of public health system and Medicare
  2. People are more likely to access dentist or physiotherapist if they have PHI extras coverage
35
Q

Types of Private Health Insurance Incentives

A
  1. Private Health Insurance Rebate
  2. Lifetime Health Cover
  3. Medicare Levy Surcharge
  4. Age-based discount
36
Q

Types of Private Health Insurance Incentives > Private Health Insurance Rebate

A

Income tested rebate on PHI premiums

37
Q

Define Income Test

A

A determination of whether an individual or family is eligible for government assistance based on their level of income

38
Q

Types of Private Health Insurance Incentives > Lifetime Health Cover

A

People who take up PHI after the age of 31 pay an extra 2% for every year they are over the age f 30

39
Q

Purpose of Types of Private Health Insurance Incentives > Lifetime Health Cover

A

Encourages more younger people to take up PHI.
As a result helps offset the cost of providing healthcare for older Australians, who are more likely to need it

40
Q

Types of Private Health Insurance Incentives > Medicare Levy Surcharge

A

High income earners that don’t have PHI have to pay an extra tax known as the Medicare Levy Surcharge. Have to pay a total of 3-3.5% tax which is more expensive than taking out PHI

41
Q

Types of Private Health Insurance Incentives >Age-based discount (2)

A
  1. Allows individuals to receive a discount on their premiums based on their age
  2. Typically, younger receive a discount while old may pay higher premium, thus encouraging more younger people to take out PHI
42
Q

Advantages of PHI (5)

A
  1. Access to private hospital care
  2. Choice of doctor in public/private hospital
  3. Immediate treatment/shorter waiting times
  4. May cover range of services not covered by Medicare
  5. Keeps Medicare costs and strain on public health system down
43
Q

Disadvantages of PHI (4)

A
  1. Premiums are costly
  2. Still have to pay patient co-payments
  3. Widens the gap between what the rich and poor can get
  4. May not feel worth it when preferred surgeon/doctor and own room is not available
44
Q

Reasons for increasing health costs (3)

A
  1. Ageing population = higher proportion of chronic conditions requiring care
  2. Increasing incomes, a growing economy and rising expectations for h+w
  3. Expensive technologies and services
45
Q

Define a sustainable health system

A

Relates to its capacity to provide a workforce and infrastructure into the future, and to be innovative and responsive to emerging needs through interventions such as research and monitoring

46
Q

What are the features of Australia’s sustainable health system

A
  1. Funding and Regulation
  2. Efficeint health system and workforce
  3. Disease prevention and early intervention
  4. Research and monitoring
47
Q

Sustainability within Medicare

A

Determining which services should be subsidised through Medicare can preserve funds for the most necessary services yielding the greatest health gain and not wasting money.

48
Q

Sustainability within PHI

A
  1. PHI provides much needed funding for the health system, keeping the public hospital system operating, thus promoting systainbility over the long term
  2. The government contributes 75% if the schedule fee for treatment in private hospitals and doesn’t have to pay for accomodation or other costs. Saves the government funding and therefore sustainbility
49
Q

Sustainability within the PBS

A

Money is not wasted on ineffective drugs and instead preserving money to necessary services yielding the greated health gain and not wasting money

50
Q

Sustainability within the NDIS

A

Each participant in the NDIS receives an individualised plan, which means that only necessary funds are spent on each person. Thus more people can access the NDIS and experienced improved health outcomes

51
Q

Define an Accessible health system

A

All people receive timely quality health care, based on need, not about pay, or geographic location, or socioeconomic group

52
Q

Accessibility within Medicare

A

All Australians of all SES backgrounds can use Medicare and services they cover

53
Q

Accessibility within PHI

A

The Federal government’s private health insurance rebate increases access to PHI for those on lower incomes

54
Q

Accessibility within the PBS

A
  1. All Australian citizens and permanent residents are entitled to access subsidised medicines through the PBS
  2. subsidised medication through the PBS, include further concession for low income earners
55
Q

Accessibility within the NDIS

A

Improves access to health services for people with significant, life-long disabilities

56
Q

Examples of geographic access

A
  1. Royal Flying Doctor Service
  2. Rural Retention Program
57
Q

Explain the Royal Flying Doctor Service and how it increases access in all geographical areas (2)

A
  1. It is a NGO that provides healthcare to many Australians living outside of major services.
  2. Funded by governments
58
Q

Explain the Rural Retention Program and how it increases access in all geographical areas (2)

A
  1. Federal gov strategy that aims to provide financial incentives for doctors who work in rural/remote areas.
  2. Increases access to healthcare for those living outside Australia’s major cities.
59
Q

Examples of cultural access (1)^(1) (1)

A
  1. Indigenous Health Incentive
    ^ Provides financial incentives to medical practices to provide culturally appropriate healthcare for Indigenous people.
  2. Close the Gap
60
Q

Equity within Medicare

A

MEDICARE SAFETY NET

61
Q

Equity within PHI

A

PHI rebate provides financial assistance to those on low incomes

62
Q

Equity within the PBS

A
  1. Equity means ensuring fair access to resources, in PBS case means providing access to Medicare to disadvantaged groups. Equity is promoted by the PBS as low-income earners have access to a concessional co-pyment fee, which allows those who can’t afford medicine greater financial support than the standard co-payment offered by the PBS for the greater Australian population.
  2. Many Indigenous Australians can qualify for a reduced PBS co-payment under the Closing the Gap initiative
63
Q

Equality within the NDIS

A

The individualised plan ensures that those with more significant needs receive more assistaince

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