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Flashcards in Medicare Deck (28)
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1

What is public health?

The organised response by society ( governments) to protect and promote health and wellbeing, and to prevent illness, injury and disability.

2

What is the Biomedical; Model of health
Examples

The biomedical model focuses on the medical profession and aims to treat the biological aspects of the disease.
It is known as the quick fix approach as it involves the diagnosis, treatment and cure of a condition.

Examples: Blood tests
X-rays
Medication
surgery

3

Old public health

Government actions that focussed on changing the physical environment to prevent the spread of disease, such as providing safe water, sanitation and sewerage disposal, improved nutrition, improved housing conditions and better work conditions.

4

Preventative model (social) of health

The preventative model of health takes the factors of health into consideration and focuses on promoting healthy lifestyles.
It aims at stopping the illness from occurring and for early detection of illnesses.

Examples:
Sun Smart program
Breast screen program
Healthy eating pyramid.
National bowel cancer screening program

5

What are non-communicable diseases
Examples

Lifestyle diseases are often referred to as non-communicable diseases.
These diseases are defined as diseases linked with the way people live their life.
Non-communicable diseases include
Atherosclerosis, heart disease and stroke; obesity and type 2 diabetes; and diseases associated with smoking and alcohol and drug abuse.

6

What are non-communicable diseases?
Examples

Lifestyle diseases are often referred to as non-communicable diseases.
These diseases are defined as diseases linked with the way people live their life.
Non-communicable diseases include
Atherosclerosis, heart disease and stroke; obesity and type 2 diabetes; and diseases associated with smoking and alcohol and drug abuse.

7

What is Medicare

Medicare is a universal healthcare system that provides medical care to patients via their GP or hospital for little or no cost.

8

What is a schedule fee?

A fee set for a service by the Australian Government

9

What is bulk billing

Means that the doctor accepts the Medicare payment as full payment for the service, so there is no cost to the patient.

10

What is covered/not covered by medicare

COVERED:
Diagnostic tests (x-ray)
Doctor/GP visits
Eye tests
Pathology tests

NOT COVERED:
Cosmetic procedures
Private hospitals costs
Dental examinations
Physiotherapy
Ambulance services

11

What is the Medicare safety net?

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 the hospital. It provides for reimbursement of 100 per cent of the MBS fee for out-of-hospital services once the relevant threshold
has been met.

12

How is Medicare funded?

Medicare is funded by the Federal Government through 3 sources of income:
The Medicare Levy: this is an additional 2 % tax placed on the taxable income of most taxpayers. Low income earners are exempt from Levy.
2. The Medicare levy surcharge: People without private health insurance and earn above a certain amount have to pay an extra 1-1 ½ % tax.
3. General Taxation

13

Advantages and disadvantages of Medicare

ADV:
Choices of doctor for out of pocket hospital services
Available to all Australians
Covers test and examination, doctors fees and some procedures
Covers simple doctor visits or most of it

DISADV:
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 doctors visits

14

Pharmaceutical Benefits Scheme

What is it
How is it funded

The PBS was introduced in 1948 (before Medicare
was implemented) as a limited scheme that
provided free medication for pensioners, as well
as making 139 essential medicines free to other
members of the community.

The PBS is funded by the Commonwealth Government taxes.

15

Private Health Insurance
What is it?

Private health insurance is an insurance which members pay a premium fee for payments towards medical health costs NOT covered by Medicare. It provides cover for private hospital costs and optional extras cover is available.
It covers for services such as dentistry, physiotherapy, chiropractor.

16

Private Health Insurance
How is it funded?

PHI is generally funded by members through the premiums they pay. The cost of private hospital treatment is covered by Medicare (which pays 75% of the schedule fee), private health insurance companies (which pay the gap between what Medicare pays and the balance of the schedule fee) and individuals (who pay the different between what the hospital charges and the schedule fee as an out-of-pocket expense.

17

Private Health Insurance
What is covered by it

Private health insurance cover is generally divided into hospital cover, general treatment cover (also known as ancillary or extras cover) and ambulance cover.
General treatment policies cover treatments outside of hospital such as dental, optical, physiotherapy or pharmacy

18

How is PHI different to Medicare

The main differences are that Medicare only covers the cost of your treatment as a public patient and a set range of non-hospital health services. Private health insurance can give you more choice about the type of health services used and more coverage for different types of services.

19

What the three key PHI incentive schemes.

Private health insurance rebate
Medicare levy surcharge
Lifetime health insurance cover

20

NDIS stands for

National: The NDIS is being introduced progressively across all states and territories.
Disability: The NDIS provides support to eligible people with intellectual, physical, sensory, cognitive and psychosocial disability. Early intervention supports can also be provided for eligible people with disability or children with developmental delay.
Insurance: The NDIS gives all Australians peace of mind if they, their child or loved one is born with or acquires a permanent and significant disability, they will get the support they need.
Scheme: The NDIS is not a welfare system. The NDIS is designed to help people get the support they need so their skills and independence improve over time.

21

What does the NDIS do

They provide all people with disability with information and connections to services in their communities such as doctors, sporting clubs, support groups, libraries and schools, as well as information about what support is provided by each state and territory government.

22

Who is eligible for the NDIS

People aged between 7-65, an Australian resident, often need support from a person because of a permanent or significant disability, use special equipment because of the permanent or significant disability, and need support now to reduce future needs.

23

How is the NDIS funded

The NDIS is funded across all levels of government with the Federal government providing the 3 year roll out costs and 53% of the running costs in 2019-2020.

24

Australian Charter of Healthcare rights

A
S
R
P
I
P
G

They have the right to:
ACCESS - healthcare services and treatment
SAFETY - Receive safe and high quality health care that meets national standards and to be cared for in an environment that is and makes them feel safe
RESPECT - Be treated as an individual (dignity and respect) and have their culture, identity, beliefs and choices recognised
PARTNERSHIP - Ask questions and be involved in open and honest communication
INFORMATION - Clear info about their condition, risks, benefits, tests/treatments, given assistance when needed, access to health information etc
PRIVACY - Have their personal privacy respected, kept confidential and secure
GIVE FEEDBACK - Provide feedback or make a complaint without it affecting you, have concerns addressed

25

Responsibilities by consumers of healthcare

- attending any scheduled appointments or cancelling/rescheduling providers when they can't attend
- providing honest and accurate info about their health
- sharing any change of circumstance with their service provider in order to reduce any risk to their health
- informing health professionals if they decide at any time to change or stop treatment
- being respectful of healthcare staff and other people using services
- taking an active part in their healthcare decisions
- asking questions if they are unsure about anything
- speaking up if and when they are unhappy

26

Options for consumer complaint redress

- The Victorian Ombudsman
- Australian Health Practitioner Regulation Agency
- Health Complaints Commissioner, Victoria

27

Factors that can impact the knowledge an individual has in relation to health services.

Age, language barriers, SES and educational levels

28

A wide range of health services are available in Victoria to meet the health needs of individuals.
These include:

traditional medical or health services, community health centres, online services, telephone counselling services, mental health services, preventative health services and many other local programs