1. Medicare
1.1. Known as the Universal Healthcare System
1.2. Introduced by Federal Govt in 1984 to provide access to healthcare for all Australians.
1.3. Medicare Aim: To provide access to adequate healthcare at little or no cost to all Australians in need of treatment, regardless of age or income.
1.4. Medicare has 3 main objectives: - To make healthcare more affordable for all Australians - To give all Australians access to healthcare services with priority according to clinical need - To provide high quality care
1.5. Medicare Benefits Scheme includes - a schedule of fees for a range of services and - is set by Federal Government
1.6. Medicare Bulk Billing
1.6.1. The medical practitioner bills Medicare directly and accepts the scheduled fee. The patient has no ‘out of pocket’ expenses. Bulk billing removes cost as an obstacle to seeking care.
1.6.2. If bulk billing is not done the client has two options: ............................ 1. They can pay the account in full, then claim the benefit from Medicare. 2. The other option is to submit the unpaid account to Medicare and receive a cheque made out to the medical practitioner, which is then passed on to the doctor along with any balance still owing..
1.7. Medicare Safety Net
1.7.1. An additional rebate scheme introduced by the federal government for the benefit of patients, covering a range of doctors’ visits and tests received out of hospital. It provides for reimbursement of 100 per cent of the Medicare Benefits Schedule (MBS) fee for out-of-hospital services once the relevant threshold has been reached.
1.7.1.1. Medicare Funding: Funded by the Federal Government - raises revenue from taxpayers
1.7.1.1.1. General Income tax
1.7.1.1.2. Medicare Levy: in addition to general income tax, most taxpayers pay a levy of 2.0% of their taxable income - amount paid depends on income
1.7.1.1.3. Medicare Levy Surcharge - High income earners (Individuals earning more than $90,000 and families with a combined income of $180,000) pay an extra tax if they do not have a certain level of private health insurance.
1.7.2. Knowns as a protective measure designed to avoid patients have to pay high medical costs
1.8. Medicare Cover
1.8.1. What is covered: Out-of-hospital: Free or subsidised treatment by doctors tests/examinations needed to treat illness, including X–rays and pathology tests Optometrists eye tests Most surgical and therapeutic procedures performed by GPs In and out of hospital services
1.8.2. What is not covered: - Dental examinations - Home nursing treatment - Ambulance services - ‘Alternative medicines’ or ‘extras’ - chiropractic, physiotherapy, acupuncture, massage, naturopathy, aromatherapy, podiatry, osteopathy etc. - Any cosmetic or unnecessary procedures are not covered in a private hospital (will pay 75% of the schedule fee) - Health related aids - glasses, contact lenses, hearing aids, prostheses - Medical cost for which someone else is responsible - E.g.: compensation insurer, an employer, governments or government authority (TAC)
2. The Pharmaceutical Benefits Scheme (PBS)
2.1. PBS was established in 1948
2.2. It is considered timely, reliable and affordable to access medicines in Australia
2.3. Aim of PBS is to subsidise the cost of a wide range of medications
2.3.1. Ability to provide medications at affordable prices - reduce the impact of a range of health conditions - reducing illness - improving health status decreasing morbidity and mortality - increasing life expectancy
2.4. Funded by the Federal Government
2.5. A medicine is considered cost effective if, for significant medical conditions, the improvements in health outcomes justify the additional costs to the Scheme (and any harms) compared with its main alternate therapy. + 2600+ brands of medicines available – changing all of the time
2.6. PBS provides medicines that are nessesary to maintian the health of the community in a way that is cost effective
2.7. The PBS Safety Net
2.7.1. The 2021 PBS Safety Net threshold is: $316.80 for concession card holders $1,497.20 for general patients. Once you reach the threshold, you’ll need to apply for a PBS Safety Net card to get cheaper medicines. Your medicine will then either: - Be free for concession card holders OR - Cost up to $6.60 for general patients.
3. Australia’s health system is complex and incorporates a wide variety of public and private service providers. (Medicare, PBS & Private Health Insurance
3.1. Including doctors, nurses, specialists, other health professionals, hospitals, clinics, preventative health programs, research centers, pharmaceutical companies and private health insurance companies.
4. Private Health Insurance
4.1. Private Health Insurance covers full or partial costs for healthcare
4.1.1. Singles or families generally have a choice of: - hospital cover or - ancillary cover or - hospital & ancillary cover Able to choose level of cover - top, intermediate or basic
4.1.1.1. Main reasons for people having private health insurance: - Shorter waiting lists in private hospitals - Choice of hospital & doctor - Improved accommodation – private room
4.2. Including hospital cover and ancillary (extras) cover
4.3. Contributions to the private health insurance fund is known as a premium.
4.4. - Hospital cover *Total or partial costs of treatment in hospital ~ public or private hospital. *Allows patient to have wider choice of doctors or hospitals. *Can also choose timing – not on waiting list. - Ancillary (or extras) cover *Dental, optical, podiatry and physiotherapy treatments
4.5. More people relying on Medicare => greater demand on public hospital services => greater cost to govt. (and taxpayers)
4.5.1. Federal Government introduced incentives to encourage Australians to have private health insurance
4.5.1.1. - Private Health Insurance (PHI) Rebate
4.5.1.1.1. Provides most Australians with a rebate from the Federal Government to help cover the cost of their premiums
4.5.1.2. - Medicare Levy Surcharge
4.5.1.2.1. - Introduced to encourage higher income earners to take out private health insurance - Depending on income the surcharge might be more than the cost of private health insurance so it is worthwhile having private health insurance
4.5.1.3. - Lifetime coverage scheme
4.5.1.3.1. This incentive encourages people to stay in private health insurance throughout their lives. People who take out private health insurance later in life pay more than those who have had it since they were young To avoid extra costs to premium people encouraged to take out private health insurance by July 1 following their 31st birthday.