Medicare
What is Medicare?
Australia's Universal Health Insurance Scheme. Available to all Australian residents and countries with a reciprocal agreement. Provides subsided essential health care.
What does the PBS stand for?
Pharmaceutical Benefits Scheme
What are the four key components of the Australian Healthcare system?
-Medicare
- PBS
-NDIS
-Private Health Insurance
What does the NDIS stand for?
National Disability Insurance Scheme
Define Private Health Insurance
Insurance where individual pay a premium for services not covered by Medicare. E.g. hospital cover, allied health
1- List something that is covered by Medicare?
2- List something that is NOT covered by Medicare?
1- Treatment within a public hospital
2- Ambulance Cover, Allied Health services, Glasses, or elective cosmetic surgery
Describe the role of the PBS.
Australia’s subsidising scheme for essential medicines. Over 5000 medicines included.
Name two countries that have a Reciprocal Healthcare agreement with Australia?
New Zealand
UK
Italy
Belgium
Finland
Malta
Netherlands
Norway
Slovenia
Sweden
Republic of Ireland
How is NDIS funded?
By Federal and State/Territory governments.
How is PHI funded?
Individual premiums (some reinvested back into system)
What is it referred to when people who need frequent services covered by Medicare (such as GP's) begin to receive additional financial support, as they have already paid a certain amount of out-of-pocket expenses for these services.
Medicare Safety Net.
-Once a family hits this, services become cheaper.
Outline what occurs once an individual reaches the PBS safety net
Once an individual has spent a certain amount of money within a calendar year on PBS medicines, future medications will only cost them the concession co-payment rate ($7.70). Or if they were already concession rate, medicines become free.
What does it mean by schedule fee?
An amount set by the government for each medical service. Example: Schedule fee for a doctor's consultation is $41.20
Describe the role of the NDIS
Supports all Australian citizens with a permanent or significant disability to achieve their individual goals.
Describe what is covered by PHI?
Any additional out-of-pocket expenses?
Access to Private Hospitals and ambulance cover- level of cover depends on your level of insurance (Gold, silver, bronze etc). May have extra's to partially pay for allied health services not covered by Medicare.
Private hospitals do usually charge more than schedule fee for services; PHI company pays the majority of the fee but can leave patients with gap fee.
1- Provide an advantage and disadvantage of Medicare?
Advantage- Free treatment in public hospitals that is available for all Australian citizens + those with a reciprocal agreement.
Disadvantage- Waiting lists for many treatments or no choice of doctor.
How is the PBS funded?
Federal Government- General Taxation
What is a patient co-payment or Gap fee?
When you have an out-of-pocket expense or gap between the cost of the service and the schedule fee ( that covered by Medicare)
Who is eligible for NDIS funding?
Under 65 years of age
Australian citizen/permanent visa
Permanent or significant disability
1- Describe 2 advantages of PHI
2- Describe 2 disadvantages of PHI
Advantage- Reduces strain on Public system + Shorter wait times + choice of doctor
Disadvantages- expensive + qualifying waiting periods + services are depending on level of cover.
How is Medicare Funded?
1- General Income Tax
2- Medicare Levy (2%)
3- Medicare Levy Surcharge (1-1.5%) for those without private health insurance
Describe how the PBS supports the health and wellbeing of individuals and their families.
Example: Individuals or families don't have to pay as much for lifesaving medicines, helping to reduce financial stress.
When an individual is able to afford their medicine as a result of the PBS, they're able to live their life without the worry of going without it. This helps the individual to develop a sense of purpose in life.
What does it mean by Bulk billing?
When the doctor only charges the SCHEDULE FEE as FULL payment for the service. Hence, no out of gap fees (out-of-pocket expenses).
Describe how the NDIS supports the health and wellbeing of individuals and their families.
Individuals receive funding to help support their individualised plan and goals. This may provide individuals with opportunities such as accessing community groups or sporting clubs in which they wouldn't have been able to otherwise thereby helping to increase their support network.
Explain two incentives to get Private Health Insurance.
1. Medicare levy surcharge (1-1.5%)- higher income earners with PHI don't have to pay the surcharge.
2. Lifetime health cover- encourages people to get PHI earlier in life and maintain cover. After 31 years of age, you will be charged an extra 2% on their premium every year for 10 years.
3. PHI rebates- Fed government will pay a % of the premiums you paid for your PHI. Amount depends on income (higher income= lower rebate).
4. Age based discount