PBS and NDIS

What is it?

Been evolving since 1948, when the government provided lifesaving and disease-preventing medication to the community free of charge. The aim was to provide essential medicines to people who needed them, regardless of their ability to pay. The purpose of the PBS remains the same today, but instead of being free, medicines are now subsidised and consumers must make a patient co-payment.

Patient-co payment for PBS subsidised medicataion

$31.60

or $7.70 for concession card holders

(Government pays remainder)

PBS safety net

Once someone or their immediate family has spent $1647.90 within a calendar year on PBS-listed medicine patients only pay the concessional payment of $7.70 rather than the normal $31.60

Key term

Reduces the BURDEN on…

Benefits Advisory Committee (PBAC)

Meds that are part of the PBS are reviewed twice a year by the PBAC, which is an independent committee made up of health professionals who review and consider medication

PBS Medication selection criteria

-Clinical effectiveness

-Safety

-Cost effectiveness compared to other treatments

Data points

-2022-23 more than $17 billion was paid through the PBS

-On average there were around eight and a half prescriptions subsidised for every person in Australia

NDIS

National Disability Insurance Scheme

Provides services and support for people with permanent, significant disabilities, and their families and carers

NDIS and PBS funding

Funded by federal and state/territory governments

NDIS Aim

Works to assist individuals to like an ordinary life

NDIS Eligibility

-Must meet age, residency and disability requirements

-Must be under 65 when applying

-Must live in Australia or hold a permanent visa or a protected special category visa

DISAILITY REQUIREMENTS

-Must have an impairment or condition that is likely to be permanent (lifelong)

-Impairment substantially reduces ability to participate effectively in activities, or perform tasks or actions unless you have:

assistance from other people

have assistive tech or equipment

cant participate effectively even with assistance, or aids and equipment

Impairment affects your capacity for social and economic participation

Likely to require support under the NDIS in your lifetime

NDIS Individualised plan

First step once someone is eligable

-You create an individualised plan based on goals and aspirations of the individual.

-Identify functional support needed for daily living and participation, the support needed to pursue goals, and how the individuals want to manage their plan over time

NDIS assists participants to..

-Access mainstream services

-Access community services

-Maintain informal support arrangements

-Receive reasonable and necessary funded support

Access mainstream services

-Services available for ALL Australians from people like doctors or teachers through health and education systems

-Covers areas like public housing and the justice and age care systems

-NDIS provides information about appropriate support options and assists participants in accessing such services by providing resources such as transportation

Access community services and support

-Activities and services available to everyone in a community such as sports clubs, community groups, libraries, or charities.

-Many individuals wish to be socially connected by accessing services and supports within communities

Maintain informal support arrangements

-Help people get from family and friends.

-SUPPORT PEOPLE DONT PAY FOR and is generally part of most peoples lives.

Receive reasonable and necessary funded supports

-NDIS can pay for supports that are reasonable and necessary, meaning they are related to a persons disability and are required for them to live an ordinary life

-Funding is provided for assistive technology like a mobility cane, nonslip bathmat, etc

-Funding also provided to pay for carers if individual requires assistance with daily tasks