2.2.1 (10.2 + 10.3) - Aus healthcare system

Question 1

Medicare

Answer 1

Australia’s universal health insurance scheme which gives all Australian citizens access to healthcare that is subsidised by the government.

Question 2

What does Medicare cover?

Answer 2

• Out-of-hospital expenses (all/some of fees) - consultation fees for doctors + specialists test + examinations needed to treat illness, most surgical procedures.
• In-hospital expenses - public patient in private hospitals (accomodation + treatment by doctors + specialists, 75% of schedule fee).

Question 3

What Medicare doesn’t cover

Answer 3

• Most costs associated with private healthcare
• Most dental examinations + treatments
• Ambulance services
• Home nursing + treatment
• Most allied health services (unless referred to by a GP or carried out in a public hospital).

Question 4

Medicare advantages

Answer 4

• Choice of doctor for out-of-hospital expenses
• Reciprocal agreement with other countries allowing free healthcare.
• Available to all Aus citizens

Question 5

Medicare disadvantages

Answer 5

• Often doesn’t cover full amount of doctor’s visits.
• Does not cover alternative therapies.
• Waiting list for many treatments.

Question 6

Medicare funding

Answer 6

• Medicare levy
• Medicare levy surcharge
• General taxation

Question 7

Medicare levy

Answer 7

An additional 2% is placed on the taxable income of most taxpayers/those who earn more thatn $20,000 p.a (those with low income may be exempt).

Question 8

Medicare levy surcharge

Answer 8

People earning more than a certain amount ($90,000 or $180,000) have to pay an extra tax, which increases as income increases to encourage high-income earners to take out private health care (reduces demand on Medicare).

Question 9

Pharmaceutical Benefits Scheme (PBS)

Answer 9

The government provides free medicines to pensioners + 139 lifesaving and disease-preventing medications to the rest of the community free of charge.

Question 10

PBS safety net

Answer 10

Provides additional support to those who have spent a large amount of money.
- One they/immediate family have spent $1521.80 on PBS-listed medicine, the patient only pays a concessional co-payment rate of $6.60 instead of the normal $41.

Question 11

Pharmaceutical Benefits Advisory Committee (PBAC)

Answer 11

Independent committee made up of health professionals that review + consider new medications for inclusion in the PBS.

Question 12

Private health insurance (PHI)

Answer 12

A type of insurance in which members pay a premium in return for payment towards health-related costs not covered by Medicare.
- Can choose hospital cover and/or extras cover.

Question 13

Extras cover can include

Answer 13

Dental, physio, chiro, psychology, optical, medical aids.

Question 14

PHI advantages

Answer 14

• Shorter waiting times
• High income earners with PHI don’t pay Medicare Levy Surcharge.
• ‘Lifetime health cover’ incentive.

Question 15

PHI disadvantages

Answer 15

• Costly
• GAP costs

Question 16

Private health insurance rebate

Answer 16

Policy holders receive a 30% rebate/refund on the premiums for private health insurance.

Question 17

Lifetime health cover

Answer 17

People who take up PHI after the age of 31 will pay an extra 2% rebate on premiums for every year they are over the age of 30.
- This additional cost lasts until the person has had it for 10 years continuously, then the premium returns to normal cost.

Question 18

Medicare Levy Surcharge

Answer 18

People earning more than $90,000 or $180,000 pay an extra tax if they don’t have PHI.

Question 19

Schedule fee

Answer 19

The amount set by the Federal Government for each medical service.

Question 20

Out-of-pocket expenses

Answer 20

Costs that the patient must pay themselves (when the doctor charges more than the schedule fee).

Question 21

Bulk billing

Answer 21

When the doctor or specialist charges only the schedule fee (payment is claimed directly from Medicare so there are not out-of-pocket expenses).

Question 22

Patient co-payments

Answer 22

The payment made by the patient for health products + services in addition to the amount paid by the government.

Question 23

Allied health services

Answer 23

Health services provided by trained professionals who are not doctors, dentists, or nurses.