unit 2 AOS 2

Question 1

Australia’s health system

Answer 1

PUBLIC SECTOR:
-public hosptials
-medicare
-the pharmaceutical benefit scheme

PRIVATE SECTOR:
-private health insurance
-private hospitals
-private practises

Question 2

what is medicare?

Answer 2

-australias universal health insurance scheme
-established in 1984
- provides all australians and permanent residents access to health care that is subsided by the government

Question 3

what does medicare cover?

Answer 3

-consultation fees for doctors (general practitioners or GPs)
-specialists (e.g. dermatologist, paediatrician),
-tests and examinations needed to treat illnesses
-x-rays and pathology tests
-eye tests.
-Most surgical and other therapeutic procedures performed by general
practitioners are also covered.
-Medicare will cover a limited number of consultations with a psychologist
-Medicare Safety Net ensures that people who require frequent services covered by Medicare, such as doctor’s visits and tests,
receive additional financial support.
-cost of staying in a public hospital

Question 4

what doesn’t medicare cover?

Answer 4

-general/most dental examinations and treatments
-ambulance services
-home nursing
-most allied health services, such as physiotherapy, speech pathology,
occupational therapy, chiropractic services, podiatry or psychology services
-hearing aids, contact lenses and glasses
-medicines (except those covered by the PBS)
-medical costs incurred overseas
-medical examinations for employment purposes, life insurance or
superannuation
-medical services that are not clinically necessary
-private hospital costs other than treatment, such as accommodation inmhospital or items such as theatre fees and medicines
-acupuncture (unless part of a doctor’s consultation).

Question 5

what is the schedule fee

Answer 5

-The Schedule fee is an amount set by the federal government for each medical service.
-For most general practice consultations, Medicare now rebates 100 per cent of the Schedule fee.
-patient will have to pay the difference as an out of pocket fee
-the Schedule fee for a standard GP’s visit in 2016 was $37.05.

Question 6

what is the bulk bill?

Answer 6

-If the doctor bills Medicare directly, this is known as ‘bulk-billing’, and means that the doctor accepts the Medicare payment as full payment for the service.
-This means there is no cost to the patient.

Question 7

how is medicare funded?
-how are general taxes used?

Answer 7

-revenue collected from the medicare levy and the medicare levy surcharge does not meet the full operating cost of medicare.
-therefore income collected through general taxation is also used to help fund the cost of medicare.

Question 8

how is medicare funded?
-what is the medicare levy ?

Answer 8

-medicare is funded by the commonwealth government partly through contributions made to the health care system through a 2 percent medicare levy, which is payed by most taxpayers who earn over a certain amount and based on taxable income.

Question 9

how is medicare funded?
-what is the medicare levy surcharge?

Answer 9

-people without private health insurance earning more than a certain amount (90 000 a year for individuals and 180 000 for families) have to pay an extra tax called the medicare levy surcharge.
-the medicare levy surcharge increases as income increases.

-Targeted at high income earners without private health insurance.

Question 10

advantages of medicare?

Answer 10

-Reduced cost for essential medical services including free treatment and
accommodation in a public hospital
-Choice of doctor for out-of-hospital services
-Available to all Australian citizens
-Covers tests and examinations, doctors’ and specialists’ fees (Schedule fee only), and some procedures such as x-rays and eye tests
-The Medicare Safety Net provides extra financial contributions for medical
services once an individual’s or family’s co-payments reach a certain level.

Question 11

disadvantages of medicare?

Answer 11

-No choice of doctor for in-hospital treatments
-Waiting lists for many treatments
-Does not cover alternative therapies or allied health services
-Often does not cover the full amount of a doctor’s visit

Question 12

what is the pharmaceutical benefit scheme?

Answer 12

-An Australian Government program that provides subsidised prescription medication to Australian residents, as well as foreign visitors covered by a Reciprocal Health Care Agreement.
-the PBS provides timely, reliable and affordable access to necessary medicines for Australians.
-The aim of the PBS is to subsidise the cost of a wide range of prescription medications, providing Australians with vital medications at affordable prices

Question 13

Pharmaceutical Benefits Scheme (PBS)
How does it work?

Answer 13

Currently, around 5000 brands of prescription medicine are covered by the PBS. This includes different brands of the same medicine.

Question 14

Pharmaceutical Benefits Scheme (PBS)
Advantages

Answer 14

-It provides access to essential medication at a subsidised rate or in some cases no cost.
It enables access to medications from local pharmacies and does not require medications to be purchased from specialised services.
-It includes the PBS safety net ($1,497.20) and the RPBS to further protect people from the high cost of medication.
-It is available to all Australian citizens, regardless of their age or income.
-It provides additional support to those with concession cards by having lower co-payments.

Question 15

Pharmaceutical Benefits Scheme (PBS)
Disadvantages

Answer 15

-It places a significant financial burden on the
Commonwealth Government.
-It does not generally cover all medications.
-For most Australians, there is still a co-payment of $41.30.

Question 16

Pharmaceutical Benefits Scheme (PBS)
How is it funded?

Answer 16

-The PBS is funded by the Commonwealth Government through taxes.
-When a doctor prescribes a PBS-approved medication, patients pay the subsidised amount and the government pays for the remaining cost of the drug.

Question 17

Private health insurance
What is it?

Answer 17

-Private health insurance is a type of insurance for which members pay a premium (or fee) in return for payment towards health-related costs not covered by Medicare.
-people can choose to purchase PHI

Question 18

Private health insurance
What is it? What does it cover?

Answer 18

-Private health insurance gives Australians choice in the sort of care they wish to access.
-Consumers can purchase cover for private hospital insurance and/ or ‘extras’ cover.
-Private hospitals (which are largely funded by private health insurance companies) provide about one-third of all hospital beds and 40 per cent of hospital separations.
-Extras cover can cover services provided by dentists, physiotherapists and chiropractors and other services not generally covered by Medicare.

Question 19

Private health insurance - Advantages

Answer 19

-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

Question 20

Private health insurance - Disadvantages

Answer 20

-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 (e.g. pregnancy)

Question 21

Private health insurance - Incentives

Answer 21

-In order to encourage people back into private health insurance the government
introduced three main financial incentives to people who purchase hospital cover.

-private health insurance rebate
-lifetime health cover
-medicare levy surcharge

Question 22

Private health insurance - Incentives
Private health insurance rebate

Answer 22

-in 1999, the government introduced to 30 % rebate incentive.
-policy holders receive a 30 % refund on their premiums for private health insurance.

Question 23

Private health insurance - Incentives
lifetime health cover

Answer 23

-People who take up private hospital 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 young people to take private health

Question 24

Private health insurance - Incentives
medicare levy surcharge

Answer 24

-People earning more than $90 000 a year ($180 000 for families) pay an extra tax as a Medicare levy surcharge if they do not purchase private health insurance.
-The Medicare levy surcharge is calculated according to income and ranges from 1 per cent to 1.5 per cent.
-This encourages high income earners to take out private health insurance.

Question 25

community services

Answer 25

-doctors, dentists, hospitals
-maternal and child health service
-sports or recreational clubs
-headspace
-places of worship
-volunteer organisations

Question 26

community services
-doctors, dentists, hospitals

Answer 26

(general practice clinics, medical specialists, public and private hospitals, ambulance services and dental services.) These more conventional medical services generally support people in taking care of their physical and mental health and wellbeing.
-Sometimes specialist treatment may be required
-Dental health is a major consideration in maintaining physical health and wellbeing
-accessing psychologists will improve mental h&w

Question 27

community services
–maternal and child health service

Answer 27

-The nurse records children’s growth and developmental progress from birth through scheduled consultations up to 3.5 years old. At each visit, parents receive ‘tip sheets’ on healthcare (physical h&w)
-this service can be extremely beneficial in supporting mental and emotional health and wellbeing as parenting can be stressful
-mothers’ groups, which promote and support the emotional and social health and wellbeing of new mothers.
- As the children of the group get older, their social health and wellbeing is also supported as they learn to interact with others.

Question 28

community services
-headspace

Answer 28

-provides mental health services to 12- to 25-year-olds.
-online counselling services
-reducing stress and anxiety
- Help with discovering who they are and what their purpose is in life can promote the emotional and spiritual health and wellbeing of youth.

Question 29

community services
-sports or recreational clubs

Answer 29

-These clubs often provide outlets for social and mental wellbeing as well as physical health and wellbeing through physical activity and social interaction.
-Being part of a sporting club or other recreational association, such as a music or theatre group, provides many people with a strong sense of belonging and helps to shape their identity, which are both key aspects of emotional and spiritual health and wellbeing
- members also learn resilience and appropriate expression of emotions
- members also learn resilience and appropriate expression of emotions

Question 30

community services
-places of worship

Answer 30

-many people feel a strong sense of belonging and emotional support from a place of worship such as a church, mosque, temple or synagogue.
-promote social health and wellbeing as people with shared opinions, values and beliefs can interact on a regular basis

Question 31

community services
-volunteer organisations

Answer 31

-These volunteers are trained to provide life-saving first aid and CPR and care for all members of the Australian public
-These volunteers learn new skills, make new friends and have the satisfaction of helping their community.

Question 32

the Australian charter of healthcare rights

The charter of Healthcare Rights has three guiding principles that describe how it applies in the Australian health system:

Answer 32

1. Everyone has the right to be able to access healthcare and this right is essential for the Charter to be meaningful.
2. The Australian government commits to international agreements about human rights, which recognise everyone’s right to have the highest possible standard of physical and mental health and wellbeing.
3. Australia is a society made up of people with different cultures and ways of life, and the Charter acknowledges and respects these differences.

Question 33

What can I expect from the Australian health system?
RIGHTS

Answer 33

ACCESS - I can access services to address my healthcare needs.

SAFETY - I receive safe and high quality health services, provided with professional care, skill and competence.

RESPECT - The care provided shows respect to me and my culture, beliefs, values and personal characteristics.

COMMUNICATION - I receive open, timely and appropriate communication about my healthcare in a way I can understand.

PARTICIPATION - I may join in making decisions and choices about my care and about health service planning.

PRIVACY - My personal privacy is maintained and proper handling of my personal health and other information is assured.

COMMENT - I can comment on or complain about my care and have my concerns dealt with properly and promptly.

Question 34

Patient rights

Answer 34

• information about their diagnosis
• information from the doctor or health service on the costs of the proposed treatment, including any likely out-of-pocket expenses
• seek other medical opinions about their condition
• information on visiting arrangements for family and friends while they are in hospital
• privacy of and access to their own medical records
• treatment with respect and dignity
• care and support from nurses and allied health professionals
  -participate in decisions about their care
  -make a comment or complaint about any aspect of their hospital or medical treatment.

Question 35

Patient Responsibilities

Answer 35

-provide information about their past and present illnesses, hospitalisations, medications and other matters relating to their health history
-ask questions when they do not understand explanations given about the risks and benefits of the proposed healthcare, treatments or procedures
-follow the instructions and medical orders of their doctors, nurses and medical support staff to bring about the best outcomes from treatment
-report any safety concerns immediately to their doctor, nurse or healthcare support staff
-treat medical staff with respect
-ask questions about costs before treatment.

Question 36

medical confidentiality

Answer 36

-Medical confidentiality is a set of rules that means that anything discussed between a doctor and patient must be kept private.
-This is known as doctor–patient confidentiality. When a patient consults a new doctor, they can choose whether to share their previous medical records with them.

Question 37

privacy in health care

Answer 37

means that what a patient tells their doctor, any information the doctor stores, medications prescribed and any other personal information is kept private.

Question 38

Exemptions to privacy laws

Answer 38

-if the patient or someone else’s health and wellbeing or safety are seriously threatened (for example if a patient is unconscious and a paramedic, doctor or nurse needs to know whether the patient is allergic to any drugs)

-when the information will reduce or prevent a serious threat to public health or safety (for example, warning the public if there is an outbreak of a serious contagious illness).

Question 39

factors affecting access to health care

Answer 39

-geographical location
-gender
-socioeconomic status
-health literacy
-cultural factors

Question 40

geographical location

Answer 40

-People living in rural and remote regions of Australia have difficulty accessing the level of health services available to those living in major cities, often simply because of the large distances that need to be covered to access doctors and hospitals.
-Access to healthcare for rural and remote Australians is not only limited by lower numbers of doctors, specialists and hospitals, but also by the reduced availability of current technology for diagnosis and treatment of patients with both emergency and chronic health needs
-Access for some people might be improved by services such as the Royal Flying Doctor Service, but treatment for emergency health needs is still considerably slower than for those living in major cities, where access to emergency medicine is facilitated by ambulances and close proximity to hospitals.

Question 41

socieoeconomic status

Answer 41

-Socioeconomic status refers to a person’s position in society relative to other people based on the factors of income, occupation and education.
-Many health services are unavailable to families and individuals on low incomes because they are simply too expensive.
-Despite Medicare offering bulk billing GP services and free treatment and accommodation in a public hospital (see topic 10), there can still be large out-of-pocket expenses for prescription medication, specialists, surgery and dental care.
-Limited financial resources can also reduce options for transport. Without easy access to transport, such as a car or affordable public transport, it can be very difficult for some people to access health services.
-people who work long hours, do shift work or travel for their occupation can probably afford the medical services if they earn a high income, but do not have the time to seek medical treatment outside their work hours.

Question 42

health literacy

Answer 42

• Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions
  -Health consumers are required to participate in more complicated preventative healthcare and self-care regimes, understand more complex health information and navigate more complex health systems.
  -Health literacy is not just about reading and interpreting information about health problems and issues, but using the information to make good decisions based on a thorough understanding of the health services available and how best to access and use these services.
  -good health literacy help us to make better health related decisions

Question 42

cultural factors

Answer 42

cultural factors that affect access to healthcare: language barriers, religious beliefs, values and expectations of the services provided.
-For Aboriginal and Torres Strait Islander peoples, the predominantly western-oriented health system is staffed by non-Indigenous practitioners who may lack understanding of Indigenous culture and concepts of health and wellbeing. This can leave patients feeling disempowered and less likely to access health services.
-some religions, beliefs prevent patients from receiving some available treatments.

Question 42

gender

Answer 42

-Compared with females, males made a smaller proportion of GP consultations and hospitalisations.

barriers to males accessing health services:
-limited opening hours outside of work hours
-lack of male health professionals and embarrassment at discussing sensitive, emotional issues or reproductive health services with female health professionals
-discomfort in the waiting room and having to state the reason for the visit
-social norms and values associated with a traditional view of masculinity including self-reliance and perseverance in the face of pain.