health system Flashcards
(22 cards)
health system
all activities whose primary purpose is to promote, restore or maintain health
Medicare
Australia’s universal health insurance scheme which provides all Australians with affordable, accessible and high-quality health care regardless of their financial position
Types of costs medicare covers
- Consultation fees for GP and specialists
- Tests and examinations needed to treat illness
e.g. pathology, blood test, eye test, x-ray - Surgical and therapeutic procedures
- SOME dental procedures
- Public hospital fees (accommodation, treatment)
- 5% of the schedule fee of private hospital fees
What is the schedule fee
Indicates the amount that medicare will contribute to selected procedures (the rest is called a co-payment)
Medicare safety net
extra financial assistance for those that incur significant out of pocket costs for Medicare services in a 12 month period
Advantages of Medicare
- Choice of doctor for out-of-hospital services
- Available to all Australian citizens
- Reciprocal agreement between Australia and other countries allows Australian citizens to access free healthcare in selected countries
- Covers tests and examinations, doctors’ and specialists’ fees and some procedures
- The Medicare Safety Net provides extra financial contributions for medical services once an individual’s or family’s co-payments reach a certain level
Disadvantages of medicare
- No choice of doctor for in-hospital treatments
- Waiting lists for many treatments
- Does not cover alternative therapies
- Often does not cover the full amount of a doctor’s visit
How is Medicare funded?
Medicare levy (2% tax on income)
Medicare levy surcharge (high income earners who can afford PHI but choose not to)
General taxation
The pharmaceutical benefits scheme (PBS)
An initiative to subsidise the cost of a wide range of prescription medications, providing Australians with vital medications at affordable prices
Key information regarding PBS
Government does not subsidise all medication - the Pharmaceutical Benefits Advisory Committee makes recommendations about new medicines or modification of medicines
National Insurance Disability Scheme (NDIS)
A national insurance scheme that provides for and supports people with permanent, significant disabilities and their families and carers. Aims to help those with disabilities live an ordinary life.
Requirements for NDIS
- Lifelong disability
- Substantially reduces the ability to participate effectively or complete tasks
- Impairment affects the capacity for social and economic participation
- Developed prior to the age of 65
- An Australian citizen or VISA
- Live in Australia
Types of assistance given by NDIS
- Access to community
- Maintain Informal Support
- Receive funded supports
- Access services and support
Process of NDIS
Begins with an individualised plan based on goals and aspirations that identifies the support needed
Private Health Insurance
A type of insurance under which members pay a premium (or fee) in return for payment towards health-related costs not covered by Medicare
Breakdown of fees
Medicare pays 75% of schedule fee + PHI pays majority of rest + patient may have to pay the gap
PHI incentives
- PHI rebate - Government refunds individuals who have PHI. Rebate depends on income (means tested)
- Lifetime health cover - People who take up PHI over the age of 31 pay an extra 2% for every year over 30. Encourages to take out earlier
- Medicare levy surcharge - People with a higher income pay a greater tax to medicare
Advantages of Private Health Insurance
- Enables access to private hospital care
- Choice of doctor while in public or private hospital
- Shorter waiting times for some medical procedures such as elective surgery
- More coverage on services (allied health)
Disadvantages of Private Health Insurance
- Costly in terms of the premiums that have to be paid
- Sometimes have a ‘gap’, which means the insurance doesn’t cover the whole fee and the individual must pay the difference
- Qualifying periods apply for some conditions (e.g. pregnancy)
- Policies can be complex to understand
Funding the health system
Relates to the financial resources that are provided to keep the health system adequately staffed and resourced so a high level of care is available for those who need it.
Areas that require funding
health care infrastructure
health care professionals
subsidised health services
personnel
essential medicine
medical supplies
support and assistive technology
increased access to PHI
public health programs
advances in technology and research
