CH5 THE AUSTRALIAN HEALTHCARE SYSTEM Flashcards
(45 cards)
WHO identifies health system as…
all the activities whose primary purpose is to promote, restore and/or maintain health
the WHO identifies that an effective healthcare system is…
one that is able to deliver quality healthcare services to all people when & where they are required
primary healthcare (PH)
-refers to an individual’s first contact with the healthcare system, often seen as a gateway to the health system
-primary healthcare also includes services such as health promotion, prevention initiatives, early detection, early intervention, treatment of illness & management of chronic conditions such as diabetes
-a PH system does not work in isolation, it is part of a bigger system, including secondary care, which includes those offered by specialists or in hospitals
funding the healthcare system
-most funding for medical services is provided by the Commonwealth Government, which in 2016-17 was estimated to be 10.3% of GDP & almost 68% of this expenditure was funded by govs
-most funding for medical services is provided by the Commonwealth Government, with the remaining paid by the non-gov sector, including health insurance & individual out-of-pocket costs
aim of medicare
to improve the access to healthcare for all australians, & to provide access to adequate healthcare at little or no cost to all australians in need of treatment, regardless of age or income
funding of medicare
medicare is funded by the federal gov which raises revenue from taxpayers, & partly funded by commonwealth gov partly through contributions made to the healthcare system through a 2% medicare levy, which is paid by most taxpayers who earn over a certain amount & based on taxable income
medicare 3 main objectives:
1) to make healthcare more affordable for all australians
2) to give all australians access to healthcare services with priority according to clinical need
3) to provide a high quality of care
how medicare works
medicare safety net
-is a protective measure designed to avoid patients having to pay high medical costs
-it covers a range of out-of-hospital costs including doctor & specialists’ consultations, ultrasounds, blood tests & x-rays
-when a patient’s expenses reach $477.90 in any calendar year, they are eligible for the safety net, which will increase their medicare benefit to 100% coverage of the medicare schedule fee for any out-of-hospital services for that year
what is covered by medicare
OUT-OF-HOSPITAL SERVICES:
-free or subsidised treatment by health professionals such as doctor’s consultation fees as often as needed (including some specialists)
-tests & examinations that are needed to treat illness, including x-rays & pathology tests
-optometrists eye tests
-most procedures performed by GPs
IN-HOSPITAL SERVICES:
-treatment & accommodation as a public patient in a public hospital by a doctor appointed by the hospital as a result of an emergency or after referral from a doctor
-75% of the medicare schedule fee for services & procedures for a private patient in a public or private hospital (which does not include accommodation in hospital or items such as theatre fees of medication)
what is not covered by medicare
-general/most dental examinations & treatments (except under specific circumstances)
-ambulance services
-home nursing
-most allied health services such as physiotherapy, speech pathology, occupational therapy, chiropractic services, podiatry or psychology services (except under specific circumstances)
-hearing aids, contact lenses & glasses
-medicines (except those covered by PBS)
-medical costs incurred overseas
-medical examinations for employment purposes, life insurance or superannuation
-medical services that are not clinically necessary
-private hospital costs other than treatment, such as accommodation in hospital or items such as theatre fees & medicines
-acupuncture (unless part of a doctor’s consultation)
advantages & disadvantages of medicare
ADVANTAGES:
-access to essential healthcare as a public patient in a public hospital at little or no cost
-receive treatment by a GP of their own choice at little or no cost
-receiving a range of tests at a subsidised cost
DISADVANTAGES:
-places significant financial burden on commonwealth gov
-may be long waiting lists
-does not cover cost of allied health services; there are often gap amounts or out-of-hospital costs to individual
-individuals do not have their choice of doctor or often their choice of timing for in-hospital treatment
what is the pharmaceutical benefits scheme (PBS)
-PBS is an aus gov program that provides subsidised prescription medication to aus residents, as well as foreign visitors covered by a Reciprocal Health Care Agreement
-the PBS provides timely, reliable & affordable access to necessary medicines for australians
aim of PBS
is to subsidise the cost of a wide range of prescription medications, providing australians with vital medications at affordable prices to ensure that optimal health outcomes & economic objectives are achieved
Repartition Pharmaceutical Benefits Scheme (RPBS)
-provides subsidised medication to war veterans & their dependents
-it provides similar coverage to PBS, but covers a wide range of pharmaceuticals
PBS safety net
protects individuals & families from large expenses for medications listed on the PBS
advantages & disadvantages of PBS
ADVANTAGES:
-it provides access to essential medication at a subsidised rate or in some cases no cost
-it enables access to medications from local pharmacies & does not require medications to be purchased from specialised services
-it includes the PBS safety net & the RPBS that further protect people from the high cost of medication
-it is available to all aus citizens regardless of age or income
DISADVANTAGES:
-it places a significant financial burden on the commonwealth gov
-it does not generally cover all medications
-for most australians, there is still a co-payment of $41
funding of PBS
the PBS is funded by the commonwealth gov through taxes (when a doctor prescribes a PBS-approved medication, patients pay the subsidised amount & the gov pays for the remaining cost of the drug
private health insurance (PHI)
is a subscription or policy for which a person pays to provide them with diff levels of cover
advantages & disadvantages of PHI
ADVANTAGES:
-it enables individuals to have access to private hospital care
-it helps the gov to address the increasing costs of medicare
-if extras or ancillary policies are purchased, an individual can access a wider range of services not covered by medicare
-it may result in shorter waiting times for some procedures, & can allow patients to select their own doctor in a public or private hospital
DISADVANTAGES:
-it is costly for individuals & families to pay for private health cover
-there can be out-of-pocket costs for some services in some policies
-there may be a qualifying or waiting period for some procedures
-individuals may feel that they are paying for a service they don’t use
PHI incentive schemes (purpose & 4 types)
-were developed due to declining number of people taking out or renewing PHI & the extra pressure placed on the public healthcare system
-purpose of the schemes is to reduce cost of PHI to make it more affordable & lighten the load on public hospitals
4 incentive schemes:
-private health insurance levy/rebate
-medicare levy surcharge
-lifetime health cover
-age based discount
private health insurance levy/rebate
-most australians with PHI receive a rebate from the gov to help cover the cost of their premiums
-australians who have PHI can opt to pay a reduced premium & the gov will pay the balance or they can pay total & then claim the rebate through tax return
-this rebate is means tested & the amount may vary depending on age
medicare levy surcharge
-the medicare levy is currently set at 2% of taxable income to help cover the cost of medicare services
-this surcharge was designed to encourage people to retain or take PHI & reduce demands on the medicare system
lifetime health cover
this scheme was implemented to encourage people with PHI to continue their cover throughout their lives
-under this scheme, anyone who does not have PHI with a registered health fund in aus before 1 july following their 31st birthday, & then decides to take out cover later in life, will pay an additional 2% loading on their premium for each year over the age of 30 when they join, with a max loading of 70%
