Medicare
What services does Medicare cover?
Medicare will pay all or some of the fees relating to many essential healthcare services. This includes consultation fees for doctors (general practitioners or GPs) and specialists (e.g. dermatologist, paediatrician), tests and examinations needed to treat illnesses, such as x-rays and pathology tests, and eye tests performed by optometrists.
What is private health insurance? How do you get it?
Private health insurance is a type of insurance for which members pay a premium (or fee) in return for payment towards health-related costs not covered by Medicare.
What is the PBS?
Medicines are now subsidised and consumers must make a patient co-payment.
What are three community services that promote health and wellbeing?
Doctors, dentists, hospitals, sport and rec, headspace, places of worship & volunteer organisations
Who do the Australian Charter of Healthcare Rights apply to?
The charter applies to the provision of healthcare in all settings within Australia, including public and private hospitals, general practice and other community environments.
How is Medicare funded?
Medicare is funded through three sources of income: general taxation — income collected through general income tax of all Australians; the Medicare levy; and the Medicare levy surcharge.
What are the 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
Depending on the level of cover, part or all of the services such as dental, chiropractic, physiotherapy, optometry and dietetics could be paid for
Helps to keep the costs of operating Medicare under control
High income earners with private health insurance do not have to pay the additional tax, called the Medicare levy surcharge
Government rebate for eligible policy holders
‘Lifetime Health Cover’ incentive
Who reviews the medications on the PBS list?
Available medications are reviewed regularly by the Pharmaceutical Benefits Advisory Committee (PBAC).
How can a sporting club help a persons spiritual health and wellbeing?
Sense of belonging, shared values
What does medical confidentiality mean? Provide an example
Medical confidentiality means that anything discussed between a doctor and a patient must be kept private
What is the Medicare Safety Net?
Medicare Safety Net ensures that people who require frequent services covered by Medicare, such as doctor’s visits and tests, receive additional financial support
What are the disadvantages of private health insurance?
Costly in terms of the premiums that have to be paid
Sometimes there are ‘gap’ costs for the patient, which means the insurance doesn’t cover the whole fee and the individual must pay the difference
Qualifying periods apply for some conditions before the individual can make a claim on their health insurance (e.g. pregnancy)
How much do you need to pay for medicines on the PBS list if you are NOT a concession card holder?
From 1 January 2018, you pay up to $39.50 for most PBS medicines or $6.40 if you have a concession card. The government pays the remaining cost of the medicines.
Who are St John Ambulance Australia? What do they do?
St John Ambulance Australia is an organisation dedicated to caring for Australians who are sick, distressed, suffering or in danger.
These volunteers are trained to provide life-saving first aid and CPR and care for all members of the Australian public.
What are the rights? (Provide 3 examples)
These basic rights are access, safety, respect, communication, participation, privacy and comment.
What is the schedule fee and how much will Medicare pay if an individual chooses to be admitted to a private hospital or as a private patient 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. If an individual chooses to be admitted to a private hospital or as a private patient in a public hospital, Medicare will pay 75 per cent of the Schedule fee for treatment by doctors and specialists.
What are the private health insurance incentives?
Private health insurance rebate
Lifetime Health Cover
Medicare levy surcharge
What is the PBS Safety Net?
PBS Safety Net ensures that people who spend a large amount of money on Pharmaceutical Benefits Scheme (PBS) medications receive additional financial support
What is headspace? What do they do?
headspace is the National Youth Mental Health Foundation, which provides mental health services to 12- to 25-year-olds.
Information and services for young people can be accessed through the headspace website, their online counselling services and at headspace centres, which are located across metropolitan, regional and rural Australia.
What are the three guiding principles of the Australian Charter of Healthcare Rights?
The charter of healthcare rights has three guiding principles that describe how it applies in the Australian health system:
Everyone has the right to be able to access healthcare and this right is essential for the Charter to be meaningful.
The Australian government commits to international agreements about human rights, which recognise everyone’s right to have the highest possible standard of physical and mental health and wellbeing.
Australia is a society made up of people with different cultures and ways of life, and the Charter acknowledges and respects these differences.
What are out of pocket expense costs? Provide an example.
Out-of-pocket expenses costs that patients must pay themselves
What is Lifetime Health Cover?
People who take up private hospital insurance after the age of 31 pay an extra 2 per cent on their premiums for every year they are over the age of 30. For example, a person who takes out private health insurance at age 40 will pay 20 per cent more than someone who first takes out hospital cover at age 30. The additional 2 per cent cost for the premium lasts until the person has had hospital cover continuously for 10 years. After that time, the premium returns to the normal cost. This encourages younger people to take up private health insurance when they are less likely to claim, and keep it for life.
How much do individuals or families have to spent on PBS medicines before they receive the PBS safety net?
Once they (or their immediate family) have spent $1521.80 (2018) within a calendar year on PBS-listed medicines, the patient pays only a concessional co-payment rate of $6.40 rather than the normal $39.50.
How does Maternal and Child Health Service promote health and wellbeing? Provide examples
All consultations with the maternal and child health nurse are free, and there is also a help line available 24 hours a day, 7 days a week. The nurse records children’s growth and developmental progress from birth through scheduled consultations up to 3.5 years old. At each visit, parents receive ‘tip sheets’ on topics such as safe sleeping and SIDS, making the most of childhood, vaccination, developmental milestones, play, dental hygiene and many more relevant topics. These are produced in several languages appropriate to the local population for each council area. When parents are educated about SIDS and vaccination, death and serious illness can be avoided, increasing the physical health and wellbeing of their children.
When can a doctor share medical information without the patients consent?
There are two situations where a health service such as a doctor, pharmacy, hospital, maternal and child health centre or other may be required to share medical information without the patient’s consent:
if the patient or someone else’s health and wellbeing or safety are seriously threatened (e.g. if a patient is unconscious and a paramedic, doctor or nurse needs to know whether the patient is allergic to any drugs)
when the information will reduce or prevent a serious threat to public health or safety (e.g. warning the public if there is an outbreak of a serious contagious illness).