Health and human development unit 3 outcome 2 part B

Medicare

Provides access to healthcare at little or no cost to all Australians, permanent residents and people from countries with a reciprocal agreement.

PBS

An Australian government program that provides subsidised prescription medication to Australian residents, as well as foreign visitors covered by a reciprocal healthcare agreement. The PBS aims to provide essential medicines to people who need them, regardless of their ability to pay.

NDIS

National insurance scheme that provides services and support for people with permanent, significant disabilities and their families and carer. Individualised plan, the plan is based on the individuals’ goals and aspirations, both now and in the future.

Private health insurance

A type of insurance under which members pay a premium (or fee) in return for payment towards health -related costs not covered by Medicare. It is an optional form of health insurance that can be purchased in addition to Medicare. Private health insurance is an important part of Australia’s health system. As well as contributing much of the necessary healthcare funding, it gives Australians more choice in the sort of care they wish to access.

Public sector

• Government funded

• Medicare, hospitals, PBS, NDIS

Private sector

• Individual funded

• Private health insurance, private hospitals, private practitioners

What does medicare cover?

• GP/specialists

• public hospital care

• optometrists

• some dental

• cheaper prescriptions

Schedule fee

Governments set fee for services/GPS’s

Patient co-payment

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

Bulk-billing

No out-of-pocket cost (medicare schedule fee accepted as full payment)

Medicare safety net

Ensures that people who get frequent services covered by Medicare will receive treatment at a reduced rate once they hit a certain level.

Medicare levy

2% tax funding medicare

Medicare levy surcharge

Extra tax (1–1.5%) for high earners without private insurance

General taxation

Not enough is generated through the two other sources of funding, so extra is contributed through general tax.

Services not covered by Medicare

• Ambulance services

• Dental examinations/treatments

• Most allied services (speech pathology, psychology)

• Medicines (not covered by PBS)

Advantages of Medicare

• Low cost

• Australian wide

• Public hospital care

• Recipricol agreement

Disadvantages of Medicare

• Waiting times

• Limited choice of doctor

• Gap payments

• Limited allied health coverage

PBS safety net

Once spending threshold is reached, medicines become much cheaper (concessional rate).

Who can access the NDIS

Those ages 7-65. Those living in Australia

What is an individualised plan

 

Tailored to personal goals, needs, and future aspirations

Private health insurance options

• Private hospital cover

• General treatment cover (dental, physiology, chiropractic)

• Combined cover - both

Private health insurance rebate

A government payment that helps reduce the cost of private health insurance premiums (fees) (based on income/age).

Lifetime health cover

A government initiative that encourages people to take out private hospital insurance earlier in life (higher fees if join after 31)

Age-based discount

A discount available for young adults (18-29)

Advantages of private health insurance

• Faster treatment

• Choice of doctor

• Shorter waiting times

• Extra allied services

• Rebates

Disadvantages of private health insurance

• Costly

• Complex policies

• Gaps in coverage

• Waiting periods (pregnancies)

Medicare funding

Medicare represents funding because it provides subsidised access to healthcare services such as GP visits and hospital treatment. This promotes health status by improving access to early diagnosis and treatment, helping to reduce mortality rates and increases life expectancy.

PBS funding

PBS represents funding because it subsidises the cost of prescription medicines. This promotes health status by helping Australians manage illnesses more effectively, reducing morbidity and YLD.

Private health insurance funding

Private health insurance represents funding because it helps cover the cost of private healthcare services. This promotes health status by reducing waiting times for treatment, which can lower morbidity and improve quality of life.

NDIS funding

NDIS represents funding because it provides financial support and services for people with disabilities. This promotes health status by reducing YLD and improving wellbeing and independence.

Medicare sustainability

Medicare contributes to sustainability by providing ongoing access to healthcare. This supports ongoing access to essential services and improves health status over time, including increased life expectancy and reduced mortality rates.

PBS sustainability

PBS contributes to sustainability by making medicines affordable for Australians. This supports long-term health by improving chronic disease management and reducing morbidity and YLD.

Private health insurance sustainability

Private health insurance contributes to sustainability by reducing pressure on the public healthcare system. This helps maintain access to care and supports improved life expectancy and lower mortality rates through timely treatment.

NDIS sustainability

NDIS contributes to sustainability by providing long-term support for people with disabilities. This improves quality of life, supports participation in society, and reduces years lived with disability (YLD).

Medicare access

Medicare promotes access by reducing the cost of healthcare services such as GP visits and hospital treatment. This improves early treatment and prevention, which can reduce mortality rates and increase life expectancy.

PBS access

PBS promotes access by making prescription medicines more affordable. This improves treatment of illness, reducing morbidity and years lived with disability (YLD).

Private health insurance access

Private health insurance promotes access by providing coverage for private health services and reducing waiting times for some treatments. This can reduce morbidity and mortality rates through timely care.

NDIS access

NDIS promotes access by funding services, equipment and support for people with disabilities. This improves functioning and quality of life, reducing years lived with disability (YLD).

Medicare equity

Medicare promotes equity through the Medicare safety net, which reduces out-of-pocket costs once a threshold is reached. This improves access for higher-need individuals and helps reduce health inequalities, supporting increased life expectancy and lower mortality rates.

PBS equity

PBS promotes equity through the PBS safety net, which lowers the cost of medicines once families reach a spending threshold. This ensures people with high medication needs can continue treatment, reducing morbidity and YLD.

Private health insurance equity

Private health insurance promotes equity by reducing pressure on the public health system, helping improve access for those who cannot afford private care. This can reduce inequalities in waiting times and improve health outcomes, including lower mortality rates.

NDIS equity

NDIS promotes equity through individualised funding plans based on each person’s needs and goals. This ensures tailored support, improving independence and quality of life, and reducing YLD.