CHAPTER 4

MEDICARE

Medicare is Australia’s universal health insurance scheme that provides
access to health care that is subsidised by the government.
NOT FREE it is subsidised
Schedule fee: the amount medicare covers towards certain treatments and consultations
patient co-payment: payment made by the patient for the service, that is in addition to the cost covered by Medicare
Bulk billing: when a doctor only charges the schedule fee for an appointment

consultation fees for doctors and specialists
tests and examinations needed to treat illnesses, including x-rays and pathology tests, and eye tests performed by optometrists.
Most surgical and other therapeutic procedures performed by general practitioners
some surgical procedures performed by approved dentists.
Some dental services for children aged 2 – 17 (Child Benefits Dental Scheme)
In hospital expenses

Medicare levy
- 2% tax placed on all taxable income
Medicare levy surcharge
- People without private health insurance earning more than ($ 90,000 a year for individuals and $ 180,000 for families in 2017–18) have to pay an extra tax.
- aims to encourage individuals to take out private hospital cover and, where possible, to use the private system to reduce the demand on the Medicare-funded public system.
general taxation

Advantages

Disadvantages

Provides essential medications at subsidised costs
The federal government funds the PBS and decides which medications will be included under the scheme.
There are a number of drugs not on the PBS- patient then needs to pay full amount.

national disability insurance scheme
national insurance scheme that provides services and support for people with permanent, significant disabilities, and their families and carers.

Age and residency requirements:
- be aged under 65 years
- Australian citizen/permanent resident or on a protected special category visa
Disability requirements:
- 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 unless you have:
  - assistance from other people or you have assistive technology
  - equipment (other than common items such as glasses)
  - you can't participate effectively even with assistance or aides and equipment an
- your impairment affects your capacity for social and economic part
- you are likely to require support under the NDIS for your lifetime

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 additional insurance purchased on top of Medicare.
forms an important part of Australia’s health system.

Private health insurance rebate

based on income
some people with private health insurance are eligible for a rebate (or refund) from the federal government ranging from 9 to 27 per cent

Lifetime Health Cover

those who take out insurance after the age of 31 pay an extra 2 per cent on their premium for every year they are over the age of 30

The Medicare levy surcharge

high income earners who do not have private health insurance pay a higher premium.
This is income tested so those with higher incomes pay a higher surcharge (the surcharge can be 1, 1.25 or 1.5 per cent)

Advantages

Disadvantages

expensive in terms of premiums
sometimes insurance doesn’t cover everything and individuals have to cover the difference
qualifying periods apply for some conditions (e.g. pregnancy)
policies can be complex to understand

Relates to:
- its capacity to provide a workforce and infrastructure such as facilities and equipment
- to be innovative and responsive to emerging needs through interventions such as research and monitoring

Providing all people with timely access to quality health services based on their
needs, not ability to pay, regardless of where they live in the country.