hhd U2 AOS 2 (healthcare system)

Health literacy

relates to how people access, understand and use health information and services in ways that promote and maintain health and wellbeing

Health system

is the organisation of people, institutions and resources that deliver health care services to meet the needs of the population

General practitioners

a doctor who has a wide range of skills and looks after the health of most people in the community.

They help diagnose and treat many conditions and prescribe medications to treat them, and refer people “specialists” for more specialised care.

Allied health professionals

is a term used to describe health professionals outside the medical, dental and nursing professions

private health insurance often covers part of the costs

e.g. dietitians, psychologists, audiologists

Medicare

• Medicare is Australia's universal health insurance scheme

• Every Australian citizen is entitled to receive Medicare benefits. Dependent children under the age of 18 are listed on their parent's or guardian's Medicare card

What does Medicare cover?

OUT OF HOSPITAL EXPENSES:

Medicare will pay all or some of the fees relating to many essential services.

• Consultations with GPs and specialists (e.g. dermatologist, paediatrician)

• Tests and examinations needed to treat illness, such as x-rays, eye tests performed by optometrists

• Most surgical procedures performed by GP’s are covered

• Although most basic dental services are not covered by Medicare, some dental procedures can be covered e.g. some surgical procedures and services for some children aged 2-17

IN HOSPITAL EXPENSES:

• As a public patient in a public hospital, treatments by doctors and specialists are completely covered, including initial treatment and aftercare. The cost of staying in a public hospital is also completely covered.

What is not covered by Medicare?

Costs associated with treatment in a private hospital. Medicare will pay 75% of the Schedule Fee for treatment in private hospitals but will not contribute to accommodation and other costs.

• Most dental examinations and treatment

• Home nursing care and treatment

• Ambulance services

• Allied health specialists such as; physiotherapy, podiatry.

• Health related aids such as; glasses and contact lenses, hearing aids

Advantages of Medicare

• 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

• Reciprocal agreement between Australia and other countries allows Australian citizens to access free healthcare in selected countries

• 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 co-payments reach a certain level.

Disadvantages of Medicare

• No choice of doctor for in-hospital treatments

• Waiting list for many treatments e.g. surgery

• Does not cover alternative therapies or allied health services

• Often does not cover the full amount of a doctor's visit

⭐Schedule fee

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

⭐Bulk billing

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?

• general taxation (income collected through general tax from all Australians)

• the Medicare Levy

• the Medicare Levy surcharge

⭐Medicare Levy

an additional 2 percent tax placed on the taxable income of most tax payers. Those with low incomes (below $20 000) or those with special circumstances e.g. pension card holders may be exempt from paying the levy.

⭐Medicare Levy surcharge

an additional 1 to 1.5 percent tax on income of people without private health insurance earning more than a certain amount ($90 000 for individuals and $180 000 for families in 2014-18)

Pharaceutical Benefits Scheme (PBS)

an Australian Government program with the aim to provide medicines to all people, regardless of income. It makes essential prescription medicines more affordable by subsidising the cost. All Australians with a Medicare card can access PBS-listed medicines, paying only a co-payment.

e.g. fenfluramine for Dravet’s syndrome

Patient co-payments

the amount a patient pays towards the cost of their PBS subsidised medicine.

From 1 January 2023, you may pay up to $30.00 for most PBS medicines, or $7.30 if you have a concession card. The PBS pays the rest.

PBS Safety Net

ensures that people who spend a large amount of money on PBS medications receive additional financial support. From 1 January 2023, the PBS Safety Net threshold for patients with a concession card will be $262.80 and for other eligible patients it will be $1563.50.

⭐Premium

the regular payment made to a PHI company to keep the insurance policy active

⭐Gap

the out-of-pocket cost the patient pays when the medical provider’s fee is more than what Medicare and the private health insurer cover.

Community services

Community services offer support (information, advice, practical help, financial help) to the public.

1. Doctors, dentists, hospitals

2. Sports or recreational clubs 

3. Headspace 

4. Places of worship

5. Volunteer organisations

6. Secondary School Immunisation Program

Check document for descriptions and how they each impact H+W

Australian Charter of Healthcare Rights

outlines the rights of patients, consumers and other people using the Australian Healthcare system. These rights are essential to ensure that no matter where healthcare is provided within Australia, it is of high quality and it is safe.

Right

a moral or legal entitlement to have to do something

Seven rights of the healthcare system

1. Access

2. Safety

3. Respect

4. Communication

5. Participation

6. Privacy

7. Comment

Access

a right to access healthcare

e.g. everyone being able to access subsidised health care through Medicare

Safety

a right to receive safe and high-quality health care

e.g. have sterile surgical requirements

Respect

a right to be shown respect, and to be treated with dignity and consideration.

e.g. all people regardless of their age, race, religion, SES are treated with respect when dealing with the health care system

Communication

a right to be informed about services, treatment, options and costs in a clear and open way

e.g. health practitioners having clear and open discussion about treatment

Participation

a right to be included in decisions and to make choices about your health care

e.g. a medical practitioner will discuss possible/alternative treatments which require the consent of the individual

Privacy

a right to privacy and confidentiality of your personal information

e.g. patient confidentiality- a set of rules that means that anything discussed (information stored by doctor, medications prescribed, any other personal information) between a doctor and patient must be kept private

Comment

a right to comment on your health care, and to have your concerns addressed

e.g. the ability to give feedback and to have a formal complaints mechanism in place (health system complaints)

What are 6 patient responsibilities?

1. provide information about their past and present illnesses, hospitalisations, medications and other matters relating to their health history

 

2. ask questions when they do not understand explanations given about the risks and benefits of the proposed healthcare, treatments or procedures

 

3. follow the instructions and medical orders of their doctors, nurses and medical support staff to bring about the best outcomes from treatment

 

4. report any safety concerns immediately to their doctor, nurse or healthcare support staff

 

5. treat medical staff with respect

 

6. ask questions about costs before treatment.

Medical confidentiality

a set of rules that means that anything discussed between a doctor and patient must be kept private (doctor-patient confidentiality)

2 exemptions to privacy laws

1. If the patient or someone else’s health and wellbeing or safety are seriously threatened (e.g. if a patient is unconscious and a paramedic, doctor or nurse needs to know whether the patient is allergic to any drugs)

2. When the information will reduce or prevent a serious threat to public health or safety (e.g. warning the public if there is an outbreak of a serious contagious illness).

What are the 6 factors affecting access to health services?

1. Cost/SES

2. Confidentiality

3. Schedule/time constraints

4. Geographic location

5. Complicated system and health literacy

6. Cultural factors 

Cost/SES (factor affecting access)

SES refers to a person’s position in society relative to other people based on the factors of income, education and occupation. Limited financial resources=reduced options for transport.

e.g. PHI may be out of reach for those on low incomes, and there are still some out of pocket expenses for items covered by Medicare.

Confidentiality (factor affecting access)

can relate to worry that the healthcare practitioner will disclose private information to their parents or someone else, or that someone they know will see them at the clinic or waiting room

Schedule/time constraints (factor affecting access)

Many youth who attend school or work find it difficult to attend appointments during the day.

Long waiting times in waiting rooms are also a barrier to youth attending appointments.

Geographic location (factor affecting access)

People living in rural or remote areas have trouble accessing health services compared to those living in cities, often because of the large distances they need to travel to access doctors and hospitals.

There are lower numbers of doctors and hospitals and also reduced availability of current technology for diagnosis and treatment of patients with both emergencies and chronic health needs.

Complicated health system and health literacy (factor affecting access)

Many youth report that the process of booking appointments, using their Medicare card, referral processes and other complicated systems is too difficult to navigate.

Many young Australians may find it challenging to apply for their own card, and so remain linked to a family card (which then links to confidentiality)

Cultural factors (factor affecting access)

• Language barriers

• Religious beliefs

• Values and expectations of the services provided

e.g. Indigenous Australians sometimes find it difficult to communicate with medical practitioners who may lack understanding of their culture

e.g. members of the Jehovah’s Witness religion are not allowed to receive blood donations from others

Digital media

Digital media refers to audio (sound), video and photographic content that has been converted into a digital media file e.g. websites, mobile apps

Opportunities presented by digital media

• Language barriers

• Geographial location (save money + time)

• Low SES (besides internet cost, most info is free)

Challenges presented by digital media

• Knowing whether the information is reliable (misinformation)

• Low SES = lower health literacy and low SES is more likely to use digital media

• Self-diagnosing/cyberchondria