AUSTRALIA’S HEALTHCARE SYSTEM:

Unit 3, AOS 2, Outcome 2

Key Knowledge and Key Skills.

KK: Australia’s health system, including:– local, state and federal governments’ responsibilities for health and health funding– the values that underpin the Australian health system– Medicare, Pharmaceutical Benefits Scheme (PBS) and private health insurance

KS: Identify and explain key components of Australia’s health system

Responsibilities within the Australian Healthcare System.

The term ‘healthcare system’ refers to all of the health service providers such as doctors, nurses, specialists, other health professionals, hospitals, clinics, preventative health programs...

The provision and funding of health services is shared between different levels of government; Local State Federal

The Local Government. At the local level, each municipal council has a responsibility

to provide a safe environment for its community. This can be done through a range of projects: Organisation of immunisation programs Provision of community-based services such as maternal and

child health centres Collection and disposal of garbage and sewage Maintenance of public parks, pools and other public areas Ensuring roads and public areas are well maintained Providing a safe water supply Development of recreational and cultural facilities Ensuring the cleanliness of food storage and preparation in

shops and restaurants Monitoring compliance with tobacco laws, including smoking

in public places.

State and Territory Governments.

The state and territory governments provide guidance and direction to local authorities. They also provide a wide range of health services: Managing public hospital services Home and community care services for those aged under 65 years (and

Indigenous Australians aged under 50 years) Funding of community services such as maternal and child health

services School and workplace primary care programs Emergency services via hospital emergency departments Establishment and service of local hospital networks Ambulance service Disability services Community health services, such as those in the areas of children,

adolescents and family, general sexual health services and rehabilitation Provision of information and education programs promoting health

through government agencies such as VicHealth Investigation and control over pollution

Federal Government. The federal government is responsible for healthcare

that impacts all Australians: Management and funding of Medicare and the Medicare

Benefits Scheme Management and funding of the Pharmaceutical Benefits

Scheme (PBS) Regulation and access of private health insurance Establishment and management of the national after-

hours GP Helpline Full responsibility of aged-care and home and

community care services for those aged over 65 years (and Indigenous Australians aged over 50 years) in all states except Victoria and Western Australia

Full funding and policy responsibility for general practice

Federal Government. Full funding and policy responsibility for primary

healthcare, which covers services previously provided by states and territories, including community health centre primary healthcare, such as generalist counselling, primary mental healthcare services for mild to moderate mental illnesses, care for people with chronic illness.

Financial support to government and nongovernment health organisations

Purchase of vaccines Meeting Australia’s international responsibilities in

healthcare via AusAID Management of a quarantine service Management of national health programs

Responsibilities of each level of government.

Read pages 224 to 227 and complete the table comparing the responsibilities of the 3 levels of government.

You will need to know at least 3 from each.

Federal Gov

State Gov Local Gov

Responsibilities

Funding Healthcare. As well as being responsible for providing a range

of health care services, the 3 levels of Govt are also responsible for funding Australia’s healthcare services.

Funding for the healthcare system is shared between; the federal, state and territory governments. local government authorities. private health insurance funds and individuals.

The funding contributions from each level of govt varies. (With obviously the bigger the govt the more funding they provide)

Funding Healthcare. Public hospital services = funded by the

federal and state governments (Medicare levy assists with this)

Most of the funding by the non-government sector comes from the out-of-pocket expenses paid by individuals and private health insurance

State, territory and local Government

Receives funding from Federal and State governments and rate collection to provide funding for the local government responsibilities.

The money that is spent on healthcare by state, territory and local governments is directed towards the public hospital services and community health service such as maternal and child health services

Federal Government. Federal government funding on

healthcare has increased over the last few years as a result of private health insurance incentives.

Most is its money is directed towards medical services (GP visits covered by Medicare), public hospitals and pharmaceuticals.

Funding Healthcare. Read back through pages 224-227. On

your existing table, add in a new row for where the funding that each level of govt contributes goes to.

Eg. The Federal Government-directs its money towards medical services (GP visits covered by Medicare), public hospitals and pharmaceuticals.

Federal Gov

State Gov Local Gov

Responsibilities

Funding

Activity where students are to place services in the right column-which level of government is responsible for it??

Values of the Australia’s healthcare system.

The Australian Government has indicated 7 values that underpin Australia’s health system via the health system performance indicators.

Underpin-Support, strengthen, crucial. The 7 values of the healthcare system are:

Safe Effective Efficient Continuous Accessible Responsive Sustainable

Values of the Australia’s healthcare system.

SEECARS: Safe: Refers to the healthcare management or the

environment in which the healthcare is delivered being free or as limited from harm as possible.

Effective: Care, intervention or action that achieves the desired outcome; is relevant to the patient’s needs and meets the required standard.

Efficient: Care, intervention or action achieves the desired results with the most cost-effective use of resources.

Continuous: Ability to provide uninterrupted, coordinated care or service across programs, practitioners, organisations and levels over time.

Values of the Australia’s healthcare system.

Accessible: Ability of people to obtain healthcare at the right place and right time irrespective of income, physical location and cultural background.

Responsive: Services are client orientated. Clients are treated with dignity and confidentiality, and encouraged to participate in choices related to their care.

Sustainable: Capacity of the system to sustain workforce and infrastructure, to innovate and respond to emerging needs.

Medicare. Medicare is Australia’s universal healthcare

system that aims to: improve the access to healthcare for all

Australians and provide access to adequate healthcare at little or

no cost to all Australians in need of treatment, regardless of age or income.

Medicare is funded by the federal government, partly through contributions made to the healthcare system through a 1.5% Medicare levy paid by most taxpayers and based on taxable income-the amount of the levy depends on the amount earned.

Medicare. The Medicare system has three main

objectives: 1 To make healthcare more affordable for

all Australians. 2 To give all Australians access to

healthcare services with priority according to clinical need.

3. To provide a high quality of care.

Medicare. Everyone who lives in Australia and is

an Australian or New Zealand citizen is entitled to use Medicare services.

Anyone over the age of 15 years may be enrolled on their own Medicare card.

How does Medicare work? Medicare covers both in-hospital and

out-of hospital services. It provides free or subsidised treatment

by general practitioners, optometrists and certain diagnostic tests with the aim to cover at least 75% of the schedule fee.

Schedule fee-The fee set by the Australian Gov’t for a medical service.

How does Medicare work? Individuals can pay for medical treatment

either by bulk billing or by paying an account. Bulk billing is where the medical practitioner

bills Medicare directly. This means there is no ‘out-of-pocket’ expense for the patient.

If the medical practitioner does not bulk bill and charges a direct fee, a patient can pay the account and then claim the benefit from Medicare.

Occasionally the practitioner elects to pay more than the schedule fee, the patient will have to pay the difference.

The Medicare safety net. The Medicare safety net is a protective measure

designed to prevent patients having to pay high medical costs.

It covers a range of out-of-hospital costs including doctor and specialists’ consultations, ultrasounds, blood tests and x-rays.

When a patient’s gap amount reaches $421.70 in a year, they are eligible for the safety net, which will increase their Medicare benefits from 85% to 100% coverage of the Medicare schedule fee for any further out-of-hospital services for that year

What is covered by Medicare?

Doctors’ consultation fees as often as needed (including some specialists)

Treatment and accommodation as a public patient in a public hospital as a result of an emergency or after referral from a doctor

Tests and examinations needed to treat illness, including x-rays and pathology tests

Optometrist eye tests Most procedures performed by doctors.

What is not covered by Medicare?

General/most dental examinations General/most dental treatments Ambulance services Home nursing Physiotherapy and occupational therapy Speech therapy Hearing aids, contact lenses and glasses Medicines (except those covered by the Pharmaceutical Benefits

Scheme) Medical costs incurred overseas Medical examinations for employment purposes Medical services not clinically necessary Private hospital costs Acupuncture (unless part of a doctor’s consultation).

Medicare. List 2 advantages and 2 disadvantages

of Medicare.Advantages DisadvantagesTreatment is available for little or no cost.

All Australians have access to Medicare regardless of age or income.

Long waiting lists for some hospital services.

Doesn’t cover all health services.

The Pharmaceutical Benefits Scheme.

The Pharmaceutical Benefits Scheme (PBS) was introduced to subsidise the cost of a wide range of prescription medications, providing Australians with vital medications at affordable prices.

It is administered by Medicare Australia. The price an individual will pay for a medication covered

by the PBS will depend on their situation. General patients will pay up to $36.10 for medication covered by the PBS and concession card holders will pay $5.90 and the Australian Government pays the balance or the rest.

The PBS Safety set also ensures that individuals and families are protected from large expenses for medications

Private Health Insurance. Private health insurance is an additional

health insurance that can be purchased by families and individuals which provides them with additional healthcare services than those provided by Medicare.

There are different types and different levels of private health insurance and that will determine the type of additional services that are available. (Private insurance and Private hospital insurance)

Private Health Insurance. Private hospital insurance cover-enables patients

to have access to public or private hospitals with the choice of their own doctor or specialist. They may also have more choice about the timing of the treatment and may experience shorter waiting times.

Private insurance-covers a wide range of non-hospital healthcare services that are not covered by Medicare. These services may include dentistry; podiatry; occupational, speech and eye therapy and physiotherapy; as well as aids and appliances such as glasses and contact lenses.

Private Health Insurance Incentive schemes.

The federal government introduced the Private Health Insurance Incentives Scheme (PHIIS) to reduce the cost of private health insurance to individuals and families, and increase the number of people covered by private health insurance.

As a result this saw an increase in the number of people taking out private health insurance.

There are 3 main incentives: Private health insurance rebate. Lifetime health cover. Medicare levy surcharge.

Private Health Insurance Incentive schemes.

Private health insurance rebate: A refund on the costs associated with taking

out PHI. The rebate is based on ones age and income. Those who earn more receive a lower rebate.

Singles aged under 65 who earn $84 000 or less and families who earn $168 000 or less get a 30% rebate However, singles aged under 65 who earn between $97 001–$130 000 will only receive a 10% rebate and those earning over $130 001 will not receive any rebate

Private Health Insurance Incentive schemes.

Lifetime health cover: