Australias Health System

What are the 2 main components of Australias health system?

Public sector and private sector

What is the public sector made up of?

• Public hospitals

• Medicare

• PBS

• NDIS

What is the private sector made up of?

• Private health insurance

• Private hospitals

• Medical practitioners in private practice

What is Medicare?

Medicare is Australias universal health insurance scheme which aims to ensure all Australian are able to access basic healthcare that is subsidised by the government, when and where they need it

Who can access Medicare?

• All Australian permanent residents

• Those people from countries with a reciprocal agreement

Services covered by Medicare

General practitioner consultation fees, treatment and accomodation as a public patient in a public hospital, eye tests, x-rays, blood tests

Services not covered by Medicare

Most dental examinations and treatments, accommodation costs in a private hospitals, alternative therapies, health aids, ambulance services

Bulk billing

When a services provider chooses to charge the patient no more than the scheduled fee for their services. The service provide is paid directly by the government for their services, therefore bulk billing services are considered ‘free’ for the patient.

Scheduled fee

The amount the government, via Medicare, contributes towards the costs of treatments and services.

Patient co-payments or out of pocket expenses

When the service provider chooses to charge more than the schedule fee for their service the patient will have to make up the difference.

Medicare safety net

Once an individual, or family’s out-of-pocket expenses have reached the threshold amount, the Medicare services for that individual or family are charged at a cheaper rate for the remained of the year.

Advantages of Medicare

• Available to all Australian citizens

• Safety net provides extra financial contributions for medical services once an individuals or familys co-payments reach a certain level

• Choice of doctor for out of hospital services

Disadvantages of Medicare

• Does not cover alternative therapies

• Waiting lists for many treatments

• No choice of doctor for in hospital treatments

How is Medicare funded?

General taxation, Medicare levy, Medicare levy surcharge

General taxation

The costs of Medicare are significant and these costs are not met by the Medicare levy and levy surcharge. These additional costs are covered through general tax revenue.

Medicare levy

Most tax payers in Australia pay an additional 2% of their taxable income towards the costs of Medicare.

Medicare Levy Surcharge

High income earners without private health insurance pay an additional 1-1.5% tax on top of the Medicare Levy

The Pharmaceuticals Benefits Scheme

Provide essential medicines that are subsidized to reduce illness

National Disability Insurance Scheme

The NDIS is a national insurance scheme that provides services and support for people with permanent, significant disabilities, and their families and carers. Funded by the federal and state/territory governments, the NDIS works to assist individuals with disabilities to live an ordinary life.

Who can access the NDIS?

• Australian citizens or people who hold a permanent visa or a Protected Special Category Visa

• People who live in Australia where the NDIS is available

What are the disability requirements for the NDIS?

• You have an impairment or condition that is likely to be permanent

• Your impairment substantially reduces your ability to participate effectively in activities, or perform tasks or actions

• Your impairment affects your capacity for social and economic participation

• You are likely to require support under the NDIS for your lifetime

Individualised plans - NDIS

If the residency and disability requirements are met, the first step in accessing the NDIS is developing an individualised plan. The plan is based on the individuals

In the individual plans participants are able to..

• Access mainstream services and supports

• Access community services and supports

• Maintain informal support arrangements

• Receive reasonable and necessary funded supports

What is the 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. 

How is private health insurance funded?

Private hospitals (which are largely funded by private health insurance companies) provide about one-third of all hospital beds and 40% of hospital separations. 

What does private health insurance cover out of hospital?

People can receive cover for general treatment to pay for services which are generally not covered by Medicare provided by

• dentists

• physiotherapists

• chiropractors

How does private health insurance work?

private health insurance works by participants paying a premium, which can vary depending on how many people are covered by the policy and the options included in the policy. 

What does private health insurance cover in hospital?

In private hospitals, patients get their choice of doctor, can have their own room and generally dont have to wait for extended periods for elective surgery. Private hospitals usually charge more than the scheduled fee for service, but private health insurance companies pay the additional costs.