Australia's Healthcare System - Unit 3 AOS 2 Flashcards
1
Q
Medicare
A
- Australia’s universal health insurance scheme which provides Australians and some overseas residents (with reciprocal agreement) access to subsidised healthcare
2
Q
what Medicare covers
A
- Out of hospital expenses – consultation fees for doctors, tests and examinations (eye tests, blood tests), and most surgical procedures performed by general practitioners
- In hospital expenses – accommodation and treatment by doctors
3
Q
what does Medicare not cover
A
- Most costs associated with private hospital care
- Most dental examinations
- Home nursing care or treatment
- Ambulance services
- most allied health services
- Health aids such as glasses, hearing aids and contact lenses
4
Q
components of medicare
A
- Schedule fee – The amount that Medicare contributes towards certain consultations and treatment. It’s based on the amount thought to be reasonable on average for that particular service. If a doctor charges only the schedule fee, the patient has no out-of-pocket expenses and has been bulk-billed. If not, the patient must pay the difference, known as the patient co-payment.
- Bulk billing – when doctors charge only the schedule fee and so the patient has no out of pocket expenses. It is only for services listed in the Medicare Benefits Schedule
- Patient copayment – the payment made by the consumer in addition to the amount paid by the government
- Medicare safety net – Provides extra financial support to those that incur significant out-of-pocket costs for Medicare services in a single year, making Medicare services cheaper for the remainder of that year.
5
Q
how is Medicare funded
A
- Medicare Levy – an additional 2 percent tax placed on most individuals which goes towards Medicare
- Medicare Levy Surcharge – people who do not have private health insurance and earn over a certain amount will be taxed extra
- General taxation - If these do not cover Medicare, the rest will come from general taxation
6
Q
Medicare advantages
A
- Choice of doctor for out of hospital visits
- Available to all Australians
- It provides basic healthcare at little to no cost
- The reciprocal agreement allows Australians to access free healthcare in selected countries.
- Medicare safety net
7
Q
Medicare disadvantages
A
- No choice of doctor for in hospital visits
- There are often waiting lists for non-emergency treatments
- It often doesn’t cover the full healthcare cost meaning the patient may experience out of pocket expenses.
- Does not cover alternative therapies
8
Q
Medicare’s role in promoting health
A
- Funding – Medicare is funded by Medicare Levy, Medicare Levy Surcharge and general tax. Medicare funds a lot of the fees associated with health services, such as GP consultations and pathology tests. This can allow people to access healthcare and thus experience a lower level of morbidity as they can have their conditions diagnosed and treated.
- Sustainability – Medicare only covers costs that are deemed medically necessary. Limiting the services they cover allows costs to be kept under control, regulating its ability to provide in the future. It also means that by providing subsided treatment, people are more likely to access healthcare before serious conditions develop, reducing the need for expensive treatments in the future. The Medicare levy increases, providing more funds
- Access – Medicare seeks to address financial barriers promoting access to healthcare at little or no costs. All Australians regardless of personal attributes are able to access healthcare. Medicare allows for the choice of doctor for out of hospital visits which can be more culturally appropriate for some. It funds services that are provided over telephone for those living regionally.
- Equity - The Medicare safely net means that individuals can be provided with additional financial support if they quire more healthcare. This demonstrates the promoting equal access to for all families. Mental Health Treatment Plans mean people with mental health disorders are eligible for 10 individual and 10 group therapy sessions covered by Medicare per calendar year.
9
Q
Private health insurance
A
- A type of insurance where members pay a fee in exchange for payment towards health related costs not covered by Medicare. It’s an optional form of health insurance purchased in addition to Medicare.
10
Q
private health insurance incentives
A
- Private health insurance rebate – depending on an individuals income, they can be eligible for a refund for part of their costs for their insurance premium.
- Medicare levy surcharge – people who earn a certain amount pay extra on their Medicare if they do not purchase PHI. Encourages those who can afford to take out private health insurance to do so.
- Aged based discount – people between 18 and 29 have a discount of up to 10 percent for health cover
- Lifetime health cover - Those who take out insurance after the age of 30 take out an extra 2 percent each year that they don’t have PHI. Encourages people to take insurance out young and keep it for life.
11
Q
private health insurance advantages
A
- Gives individuals a choice of doctor for private or public hospitals
- Reduced waiting times
- There is financial coverage for a wider range of services such as physiotherapy
- Reduces pressure on the public health system which alleviates waiting times for non-emergency treatments.
12
Q
private health insurance disadvantages
A
- The premiums that have to be paid can be expensive and there may still be out of pocket expenses
- There are often waiting lists for non-emergency treatments
- People pay for services they do not use
- There may still be waiting periods
13
Q
role of PIH in promoting health
A
- Funding – PHI is funded by premiums paid by consumers. Private health insurance provides much of the funding for private hospitals, which can allow people to efficiently access healthcare
- Sustainability – Incentives such as the private health insurance rebate maximise the funding gained through the private system. This means more people can be treated in private health, reducing strain on the public system so more people can access effective healthcare. This allows for more people to be treated sooner, allowing future generations better access to healthcare.
- Access – PHI allows greater access to services not covered by Medicare and waiting times are shorter. The private health insurance rebate increases access to private health insurance for those on lower incomes. Private health insurance can increase access to health services that may have otherwise been too expensive for patients to afford.
- Equity - Those on lower incomes receive more financial assistance through the private health insurance rebate. Those aged over 65 (who often have a lower income) receive a greater rebate.
14
Q
PBS
A
- is a program run by the Australian government that subsidises various essential prescription medicines for Australian citizens, permanent residents, and visitors from selected countries
- It aims to provide essential medications to all regardless of their ability to pay
- Consumers must still make a patient copayment
15
Q
PBS safety net
A
- Designed to financially protect individuals and families who require a large amount of medicines.
- Once they reach a certain threshold in a calendar year, they will receive medications at an even more subsides cost for the rest of the year.
