Topic 10 - 11 Flashcards
10 - Australia's health system 11 - Health information, technology and complaints
Medicare
Australia’s universal health insurance scheme, gives people access to healthcare that is subsided by the federal government
What does medicare cover?
- GP consultations
- tests and examinations to treat illnesses
- a limited no. of psych consultations, must be referred by GP & mental health plan
- all in hospital expenses - PUBLIC only
- 75% of schedule fee in private hospital
Medicare safety net
ensures that everyone who require frequent services covered by medicare, receive additional financial support
Patient co-payments
the payment made by the consumer for health products or services in addition to the amount paid by the government
Out of hospital expenses
costs for services such as doctors, specialists, tests and x-rays
In hospital expenses
costs for treatment and accomodation in a public hospital
Schedule fee
the amount that Medicare contributes towards certain consultations and treatments. The government decides what each item is worth and that’s what medicare pays.
Bulk billing
when the doctor or specialist charges only the schedule fee. The payment is claimed directly from Medicare so there are no out-of-pocket expenses
What is not covered by Medicare?
- private hospital costs (other than schedule fee)
- most dental examinations/treatments (unless some 2-17yr olds)
- ambulance services
- home nursing care/treatment
Private health insurance
a type of insurance for which members pay a premium in return for payment towards health-related costs not covered by medicare
Advantages of Medicare
- reduced cost for essential medical services
- choice of doctor for out-of-hospital
- available to all aus citizens
- covers tests & examinations, doctors’ & specialists’ fees & some procedures
- medicare safety net
Disadvantages of Medicare
- no choice of doctor for in hospital
- waiting lists for many treatments
- doesn’t cover alternative therapies or allied health
- often doesn’t cover full amount for most doctors
Medicare levy
2% tax for most Aus tax payers to fund medicare
Medicare levy surcharge
an additional 1-1.5% tax on high incomme earners who don’t have private health insurance.
- increases as income increases.
- encourages people to take out private health insurance
Pharmaceutical benefits scheme (PBS)
the aim is to provide essential medicine to people who need them, regardless of their ability to pay. Federal gov subsidises essential medicines, consumers make a co-payment.
PBS safety net
ensures that people who spend a large amount of money on PBS medications, receive additional financial support
Premium
the amount paid for insurance (a fee)
Advantages of private health insurance
- access to private hospital care
- choice of doctor in private/public hospital
- shorter waiting times for some procedures
- part/all services (dental, chiro, physio, optometry, dietetics) covered
- high income earners don’t have to pay medicare levy surcharge
- gov rebate
- lifetime health cover
Disadvantages of private health insurance
- expensive premiums
- can be gap costs for patient
- qualifying periods for some conditions before can make claim
private health insurance incentives
- private health insurance rebate
- lifetime health cover
- medicare levy surcharge
- age based discount
Private health insurance rebate
- up to 30% rebate on premiums
- ^income tested
Lifetime health cover
- people who take up private hospital insurance after 31 pay extra 2% on premium for every year over 30
- extra 2% lasts until person has had over for 10 years
- ^ so at 40 don’t have extra
Age based discount
- offers people aged 18-29 up to 10% off for hospital cover
- 2% reduction on premium for every year under 30 to max of under 10 percent
patient responsibilities
- provide relevant health info
- ask questions when don’t understand
- follow medical instructions
- report safety concerns
- treat medical staff with respect
- ask questions about costs before treatments
