Health Care in Australia

PDHPE: Core 1

The Role of Health Care

Aims of health care inAustralia

To provide public health services, including hospitals and administration.

To provide quality health facilities and services to meet the needs of all

Australians.

Organised, financed and delivered by both public and private sources.

Emphasis placed on diagnosis and treatment of illness by the medical

profession.

Health care in Australia mostly about clinical diagnosis, treatment and

rehabilitation.

A shift has occurred in the role of health care, from cure to prevention.

Range & Types of Health Facilities & Services Available

Classified in 2 ways:

InstitutionalEg. Hospitals, nursing homes, psychiatric hospitals

Non-InstitutionalAdmin and research, medical services, pharmaceuticals, health professionals - eg. physio, chiro

Responsibility for health facilities & services

Funding for health facilities and services comes primarily from the Australian Government, state/territory and local governments, non-government agencies and individuals

Responsibility for health facilities & services

Commonwealth GovernmentCommonwealth Government• Funding to state/territories• Medicare• Pharmaceuticals Benefit Scheme• Health promotion initiatives• Worksafe• Veterans

State and Territory GovernmentsState and Territory Governments• Delivery of health services including

administering public acute-care hospitals and psychiatric hospitals• Legislation and regulations for private hospitals, nursing homes and health professionals• Management of mental health programs, dental health services, home &community care, family health services, rehabilitation services

Local GovernmentLocal Government• Personal preventative programs (e.g. immunisations)• Environmental &hygiene regulations• Some home care operations and community health centres

Private sectorPrivate sector• Private hospitals• General practioners• Dentists, pharmacists, physios etc• Private sector, NGOS, eg Cancer Council, Diabetes Australia.

Responsibility for health facilities & services

Equity of access to health facilities & services

1. Access in rural and remote areas

2. Language support

3. Bulk-billing through MedicareBulk-billing occurs when a health practitioner directly bills Medicare for the amount payable for a service; the patient does not have to pay.

Health care expenditure vs expenditure on early intervention & prevention

Expenditure has increasedincreased due to:· Increase in population· Inflation especially in the 1980!s· Australia’s wealth ’ has increased in recent times· Medical research and technology· Population is getting older - they require more medical services

In real terms, it has gone up:· More expensive medical treatments· Well informed population, who value screening & preventative measures· Increasing age of the population

Health expenditure comprises recurrent and capital expenditure on hospitals, medical services, dental services, patient transport services, other health practitioner services, community and public health services, medications, aids and appliances, health research and the administrative systems that support these services.

(AIHW, 2007)

At the moment 90 % of the health care dollar goes

not to "health“ but to "illth“… ill people in the hospital and

acute-care sector.

Health care expenditure vs expenditure on early intervention & prevention

Health care expenditure vs expenditure on early intervention & prevention

If we are to cope with the challenges of a greying Australia…. we must also put more money into prevention stopping people needing medical treatment in the first place.

If we are to cope with the challenges of a greying Australia…. we must also put more money into prevention stopping people needing medical treatment in the first place. Much of the burden of

disease and associated costs are preventable, making disease prevention an important approach for improving the public’s health and to control health care costs

Much of the burden of disease and associated costs are preventable, making disease prevention an important approach for improving the public’s health and to control health care costs

DiscussDiscuss: “An Ounce of Prevention is Worth a Pound of Cure”

Impact of emerging new treatments & technologies on health care

There is no question that early detection and subsequent early interventionis proving to be a significant contributor to improving health status

There is no question that early detection and subsequent early interventionis proving to be a significant contributor to improving health status

A natural concern that often accompanies emerging treatments ortechnologies is the associated costs

A natural concern that often accompanies emerging treatments ortechnologies is the associated costs

since the 1980s, advancements havebeen made in the field of medical imaging that greatly enhance the capacityto detect many health concerns, including the presence of cancer.

since the 1980s, advancements havebeen made in the field of medical imaging that greatly enhance the capacityto detect many health concerns, including the presence of cancer.

Health Insurance: Medicare & Private

Health care is essentially provided provided in Australia in one of three ways:

1.through the public health care system2.through private health insurance3.through out-of-pocket expenses paid for by the individual directly

Health funding funding is a complex complex issue. Currently, the financing of health care in Australia

comes from 3 main sources: 1. the Medicare levy2. general taxes paid to various levels of government3. payments for private sector services.

What is health insurance?What is health insurance?

Health Insurance: Medicare & Private

Private Health Insurance Public health insurance

Eg. Medicare Eg. HCF, MBF, Medibank Private etc…

https://www.youtube.com/watch?v=7uRFFoTpVRw

Medicare: Public Health

Medicare, a government funded health system paid through taxes and a Medicare levy on incomes (1.5% + a further 1% for singles earning over approx $70 000 and couple earning over approx $140 000 who don’t have private cover)

Advantages· Affordable to all the pop’n· Equity in health care· Ease of access to the pop’n· Universality of coverage· Possibility of bulk billing· Special benefits for family

Disadvantages· Compulsory levy even if you don’t use it· No choice of doctor· No choice of hospital· Waiting time for selective surgery· Shared accommodation· The gap

Medicare & the PBS

The Pharmaceutical Benefits Scheme (PBS) was introduced by the Commonwealth Government in 1986. This scheme subsidises most prescription medicines bought at pharmacies in Australia. The major aim of the PBS is to allow all individuals, regardless of socio-economic status, access to necessary prescription medication.

Concession card holders (for example, holders of Pensioner Health Benefit cards) can purchase PBS medicines for a lesser amount—known as the concessional rate (approximately $5). General patients should pay no more than about $32 for each item. Once an individual, or family, has paid a set amount they are issued with a Safety Net Card. This enables the holder access to prescribed medicines free of charge, or at the concessional rate, for the remainder of the calendar year.

http://www.pbs.gov.au/pbs/home

https://www.youtube.com/watch?v=KKIsg3rX3V4

Medicare & Bulk Billing

Bulk Billing – is when the practitioner bills Medicare directly, accepting the Medicare benefits as full payments for the service.

The Medicare Safety Net

The Medicare Safety Net provides families and individuals with financial assistance for high out-of-pocket costs for out-of-hospital Medicare Benefits Schedule (MBS) services. Once you meet a Medicare Safety Net threshold, you may be eligible for additional Medicare benefits for out-of-hospital MBS services for the rest of the calendar year.

Private Health Insurance

Advantages· Payment of the gap· Doctor of choice· Hospital of choice· Accommodation of choice· Payment of ancillary services – chiro, physio etc…· Coverage for travel insurance and other benefits

Disadvantages· cost of services· already paying for health cover (Medicare)

Private Health Insurance

There are two types of private health insurance cover.

Hospital Hospital Cover covers your costs as an in-patient in a hospital

Ancillary (or extras)Ancillary (or extras)Cover is for the cost of other health services such as dental, optical, physiotherapy and a range of other therapies.

Private Health Insurance

Private Health Insurance

Private Health Insurance

Ancillary cover helps with the cost of services such as physiotherapy, dental treatment and optometry. Some funds offer packaged products that cover both hospital and ancillary services.

Private Health Insurance & ‘The Gap’

The Gap – Many people with private health insurance are concerned about the gap. The gap is the difference between what a health fund pays and what a particular medical service costs, which you must pay out of your own pocket.

Health Insurance: Private

Government Government incentives to incentives to take out take out Private Private Health Health InsuranceInsurance

30% rebate

Medicare Levy Surcharge

Lifetime Rating (Lifetime Health Cover)

The Federal Gov’t 30% Rebate

A 30 per cent government rebate is offered on private health insurancepremiums

The Medicare Levy Surcharge

A 1.5%Medicare levy is collected from all income earners who earn above a minimum amount in Australia.

An additional levy of 1% is imposed on high-income earners who :a) choose not to take out private health insurance or, b) do not have an appropriate level of private health insurance hospital cover.

Lifetime Health Cover (Rating)

A lifetime rating, which becomes applicable after the age of 30 years, was introduced. The government imposes a 2 per cent surcharge for each year a person does not take out private health insurance after the age of 30 years.

So, if a person waits until the age of 60 years to take out private health insurance, they can expect to pay a surcharge of 60 per cent on top of their annual premium each year (i.e. 2% °— 30 years = 60%).