Australian Healthcare System Notes

Overview of the Australian Health System

  • Jointly run by federal, state/territory, and local governments.

  • Aims to provide quality, safe, and affordable healthcare.

  • Key providers: GPs, medical specialists, allied health workers, nurses.

  • Medicare & public hospitals offer free/low-cost access; private insurance provides choice outside the public system.

Medicare

  • Universal healthcare scheme since 1984.

  • Three major parts: medical services, public hospitals, medicines.

  • Covers costs for public hospital services and some other health services (GPs, specialists, etc.).

  • Pharmaceutical Benefits Scheme (PBS) makes prescription medicines cheaper.

  • Available to citizens, permanent residents, and those from countries with reciprocal agreements.

Medicare Benefits Schedule (MBS)

  • List of government-subsidized health services.

  • Features a safety net to reduce out-of-pocket costs after a certain threshold.

Pharmaceutical Benefits Scheme (PBS)

  • Makes medicines more affordable by listing brand name, generic, biologic, and biosimilar medicines.

  • Requires products to be proven safe and effective before sale.

  • Government pays the majority cost; individuals pay less, especially with a concession card.

  • PBS Safety Net further reduces prescription costs after a threshold is met.

Private Health Insurance

  • Two types of cover:

    • Hospital cover: For costs of hospital treatment as a private patient.

    • General treatment (extras) cover: For non-medical services like dental and physio.

  • Government provides a means-tested rebate to help with costs.

Primary Health Networks (PHNs)

  • Coordinate health services in local areas.

  • Support healthcare providers, coordinate different parts of the health system, assess local health needs, and provide extra services (after-hours, mental health, etc.).

Government Responsibilities

  • Australian Government:

    • Medicare Benefits Schedule (MBS).

    • Pharmaceutical Benefits Schedule (PBS).

    • Private health insurance regulation.

    • Primary healthcare quality.

    • Aged care services subsidization.

    • Health data collection.

    • Medical research funding.

    • Veterans' healthcare funding.

    • Aboriginal and Torres Strait Islander healthcare.

    • Doctor numbers and distribution.

    • Vaccine procurement.

    • Medicine and device regulation (TGA).

    • Hearing services subsidization.

    • Organ and tissue transplant coordination.

    • Blood product supply.

    • Health emergency coordination.

    • Food supply safety.

    • Radiation protection.

  • State/Territory and Local Governments:

    • Public hospital management.

    • Preventive services.

    • Community and mental health services.

    • Public dental clinics.

    • Ambulance services.

    • Patient transport schemes.

    • Food safety regulation.

    • Health premises regulation.

  • Shared Responsibilities:

    • Public hospital funding.

    • Preventive services (cancer screening).

    • Health professional registration.

    • Palliative care funding.

    • Mental health reform.

    • National health emergency response.

Health System Challenges

  • Ageing population.

  • Increasing chronic disease rates.

  • Rising costs of medical research and innovations.

  • Utilizing emerging health technologies.

  • Improving use of health data.

Cost of Healthcare

  • Funded by government, non-government organizations, private health insurers, and individuals.

  • In 2016-17, nearly 181181 billion was spent on health.

    • 41%41\% by the Australian Government.

    • 27%27\% by state and territory governments.

    • 17%17\% by individuals.

    • 9%9\% by private health insurers.

    • 6%6\% by non-government organizations.