Why should medical students know about the health system?
- Medicine is heavily subsided by taxpayers: education, medical services and salaries.
- The health of Australians (your future clients) and the nature of your future practice of medicine is heavily influenced by the way governments run health care
- You will likely have to help patients navigate the health care system
- Doctors frequently advise and lobby government about health issues an payment arrangements.
How do Australians pay for health care?
- Taxes
- The Medicare Levy and Medicare Levy Surcharge
- Private health insurance
- Paying directly (e.g. co payment for health care services, co-payments for PBS pharmaceuticals NOTE: bulk-billing care brings no out of pocket expenses)
- Over the counter and non-subsidised care
Who pays for the Medicare Levy, and how much do they pay?
The Medicare Levy is paid by all people with taxable income - 2% of taxable income for all taxypayers.
What is the Medicare Levy Surcharge?
Medicare Levy Surcharge payable if your income is above a certain threshold and you - or any of your dependants - don’t have an appropriate level of private health insurance hospital cover. Additional 1-1.5% for high income earners without private health insurance cover.
Name some health programmes administered by Medicare Australia?
- Medicare (Australia’s universal health care program)
- Pharmaceutical Benefits Scheme
- Australian Childhood Immunisation Register
- Australian Organ Donor Register
- Practice Incentives Program
- General Practice Immunisation Incentives Scheme
What does out-of-pocket costs mean?
The difference between the Medicare benefit and what the clinician/doctor charges you.
Define “Schedule fee”
Fee for a given service set by the Australian Government.
Define “Recommended fee”
Suggested fees set by the AMA (Australian Medical Association) as a guide for doctors
Define “Gap Amount”
The difference between the Medicare benefit and the schedule fee.
Define “The Medicare Safety Net”
Provides families and individuals with financial assistance for high costs for out-of-hospital Medicare Benefits Schedule (MBS) services once you meet a Medicare Safety Net threshold.
Might help individuals/families who might require frequent or costly health care.
What is Bulk-billing?
Where a doctor accepts the Medicare benefit as full payment.
What does Medicare pay for (Medicare benefits)?
- the full schedule fee for GP services
- 85% of the schedule fee for other out-of-hospital services
- 75% of the schedule fee for in-hospital services
- The difference between the Medicare benefit and the amount charged by the clinician is ‘out of pocket’ and covered by health insurance or the patient.
What is the Pharmaceutical Benefits scheme? (PBS)
- An early form of the PBS started in June 1948.
- The Commonwealth subsidises medicines on the Schedule (managed by the PBAC) so that Australians can access medicines at an affordable price.
- Requires a patient contribution (or co-payment) to provide some control to volumes and expenditure
- In 1983. a concessional category was introduced for co-pay
- In 1986, safety net arrangements were established to protect the chronically ill from huge medicines costs
- In 1990, a pharmaceutical allowance was included in pension payments
- The pharmaceuticals approved for subsidy are listed in the “Schedule of Pharmaceutical Benefits for approved pharmacists and Medical Practitioners”
What is Private Health Insurance?
- Private health insurance funds may cover costs for your treatment as a private patient in public or private hospitals, and can include services that Medicare does not cover, such as dental care, more optical care and ambulance transport (in some states)
- Like other forms of insurance (e.g. house, car), can help you to meet the costs of health care if you should need it (as a private patient)
What is Public Health Care?
- Administered by the government
- Funds raised through taxes
- Everyone shares the risk or burden of getting sick and needing health care
- Mostly free or very low cost
- No choice in doctor or providr
- Public hospital waiting lists
What is Private Health Care?
- Individuals pay some contribution to obtain health insurance
- Individuals in the fund share the risk of getting sick and needing health care
- Premiums can be quite expensive
- Can usually choose doctor or provider
- Can obtain more timely care
What is private health insurance rebate?
- Families and individuals that pay private health insurance premiums are eligible for the Private Health Insurance Rebate from the federal government.
- Rebates are tiered according to income and age group.
What is the Lifetime health cover policy?
Lifetime health cover is a government initiative designed to encourage you to purchase and maintain private patient hospital insurance cover earlier in life.
- If you decided to take out private hospital insurance, you can be charged 2% extra on insurance policies for every year after 30 which you do not have private hospital insurance.
What would happen in concerns to the lifetime health cover policy if you you got private health insurance at 30?
10 years after turning 30. According to the lifetime health cover, you will be charged a 2% increase for each year after turning 30. So you would pay 20% for for private health insurance. PHI company can charge base premium of + 20% . It is capped at 70%.
Why is there an international trend towards increasing health expenditures?
j
Why is there an international trend towards increasing health expenditures?
Ageing population; consumer demand for services; greater accessed to services.
What are some of the workforce issues in the medical field?
Rural and Remote
- decreasing number of health practitioners with increasing remoteness
- changing scope of medical practice - generalise (and drivers that foster and entrench sub specialisation)
Here are some cheeky definitions of Health systems. Feel free to challenge yourself and recite some of them yourself, or just flip it over and remember the general gist.
- All activities who’s primary purpose is to promote, restore and/or maintain health.
- People, institutions and resources arranged together in accordance with established policies, to improve the health of the population they serve, while responding to people’s legitimate expectations and protecting them against the cost of ill-health through a variety of activities whose primary intent is to improve health
Just for the heck of it, define what a GOOD health system is.
A good health care system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism, a well-trained and adequately paid workforce; reliable information on which to base decisions and polices; well maintained facilities and logistics to deliver quality medicines and technologies.
