SAC 2b Flashcards
(57 cards)
What is Medicare and how does it work?
It is Australia’s universal health insurance scheme. It subsidises healthcare.
What are the three main objectives of Medicare?
- To make healthcare affordable for all Australians
- To give access to all Australians with priority according to clinical need
- To provide high quality care
What are some things covered/subsidised in Medicare?
-Doctor/GP consultations
-Treatment and accommodation as a public patient in a public hospital
-Diagnostic tests (e.g blood tests, x-rays)
-Eye tests
-Up to 10 MH sessions by psychologist or psychiatrist
What are some examples of things that are not covered/subsidised by Medicare?
-Allied health services (e.g physio, podiatry, speech pathology
-Dental
-Glasses
-Cosmetic surgery
-Ambulance services
What does schedule of fees mean?
This is the fee is set by the government
-100% of the scheduled fee is paid by govt for GP services (buk-billing)
-85% of the scheduled fee is paid for govt for non-GP services (e.g specialists and you paid the rest (15%+)
What does bulk-billing mean?
This is where the government covers 100% of the schedule fee for a GP consultation > this is where there is no out of pocket expense for the patient
What does co-payment mean?
The payment made by the consumer for health products or services in addition to the amount paid by the government (i.e the extra 15% Medicare doesn’t pay)
Name three strengths of Medicare
- Available to all Australian citizens therefore as subsidised healthcare is accessible by all contributes towards increase in health outcomes nation wide
- Covers essential services (e.g GP appointments and blood tests) therefore reducing financial barriers for Australians to be proactive about maintaining/improving health
- Choice of doctor for out of hospital services therefore increasing mental health and wellbeing by lowering patient stress levels as choice/may be familiar with doctor
Name three limitations of Medicare
- Waiting lists for many treatments (e.g knee operations) therefore may increase patient stress and lower quality of life as wait for treatment (increased stress and increased YLD)
- Does not cover a range of allied health services (e.g physio) therefore individual may experience a lower quality of life (increased YLD) = increased time with pain from injury
- Often does not cover the full amount of a doctor’s visit therefore low SES individuals or families may not visit dr due to financial baries potentially causing negative health outcomes
How is Medicare funded?
It is funded by the Australian Federal Government. Specifically, through taxes.
-Medicare Levy
-Medicare Levy Surcharge
-General Taxation Revenue
Explain Medicare Levy
Most Australian income earners pay 2% of taxable income. This covers approx. 60% of the cost to run Medicare. (those with low income may be exempt)
Explain the Medicare Levy Surcharge
High income earners without private insurance pay an additional 1-1.5% (means tested)
Explain General Taxation Revenue
As allocated in budget
How is Sustainability reflected in Medicare
-Onlbasics (clinically necessary treatments) are covered therefore saving vital funds, ensuring that essential health care needs can be met now, and into the future (i.e future generations can also see doctors at subsidised cost)
-Adequate funding from Federal govt therefore heathcare system can continue to meet the healthcare needs of the population long term/into the future
How is Access reflected in Medicare
Medicare is Australia’s UNIVERSAL health care system with ALL residents (and some eligible overseas visitors) having access regardless of SES, age, gender, cultural background etc therefore providing accessible and affordable basic health care for all.
As Medicare is accessible it results in:
- Earlier diagnosis
- Earlier treatment
- Prevention of illness
How is Equity reflected in Medicare
Medicare funding is an example of equity > as the Medicare Levy is means tested, those wo earn higher incomes contribute whereas low-income earners may be exempt from this tax therefore removing disadvantage for low-income earners however still allowing them to access healthcare, closing the gap between the differences in SES
Explain the Medicare Safety Net in relation to Equity
-It provides extra financial assistance for those that incur significant co-payment cost s for Medicare services in a 12 month period (e.g chronic health issues)
-When a patient’s gap payment reaches a threshold in a year, they will be eligible and benefits will increase to 100% coverage
THOSE THAT NEED MORE GET MORE
It reflects principle of equity as it provides subsidies for those that need it most therefore closing the gap/removing disadvantage for those with chronic health issues and high medical costs
Explain the Child Dental Benefits Scheme in relation to Equity
It exists to provide financial support for basic dental services for children. It reflects principle of equity as it provides subsidised dental services for low income families therefore closing the gap/removing disadvantage for those families on Government benefits who would most likely not be able to access dental services for their children.
What is the PBS?
It is a Federal Government scheme that provides access to essential, prescription medicines at a subsidised cost. It gives all Australian residents and eligible overseas visitors access to prescription medicine in a way that is affordable, reliable and timely.
Around how many medications are included in PBS and what are some common egs?
Over 5000 essential medicines are listed on PBS - does NOT cover all
Common egs = antibiotics for infection, cholesterol lowering medication, anxiety medication, asthma medications
How is PBS funded?
It is funded by the Federal Government through general taxes. The co-payment is the amount individuals pay towards the cost of their PBS medicine.
What are three advantages of PBS?
- Available to all Aus citizens therefore as subsidised essential prescription PBS listed medications accessible by all contributes towards increase in health outcomes nationwide
- Covers essential prescription medication therefore reducing financial barriers for Australians to seek commonly used treatments (e.g antibiotics for infection)
- PBS Safety Net provides extra financial contributions therefore aiming to create an equitable healthcare system that acknowledges and supports those with high medical costs
What are two disadvantages of the PBS?
- Does not cover all prescription medications therefore an individual may experience lower quality of life (increased YLD) b/c can’t access medication
- Often does not cover the full amount of a PBS-listed prescription medication therefore the low SES individual/family may not seek treatment due to financial barriers reducing their ability to pay co-payments, potentially causing negative health outcomes.
How does the PBS represent Sustainability?
-Only subsidises essential prescription medications approved which is strictly regulated so not wasting funds on ineffective medications therefore funds/resources are available for current generations and will continue to be available for future generations medication needs as well
-Increases access to essential prescription medication therefore efficient treatment of diseases so less people spending extended periods of time in poor health therefore decreasing burden on healthcare system allowing services to be provided for both current and future generations
