Australian Healthcare System

Australia has one of the best health systems in the world, and the general Australian population enjoys good health. The average life expectancy is 81.4 years, the 11 th highest in the world. Sadly, the status of Aboriginal and Torres Strait Islander Australians is significantly worse, with an average life expectancy of 62.4 years. In 2008, the Coalition of Australian Governments (COAG) committed to closing the gap in life expectancy by 2031.

The Australian healthcare system is universal. Its aim is to ensure that all Australians can access the health services they need regardless of financial circumstances. The universal public health system is run and funded by the Commonwealth, State and Territory governments and the governments of each state. The public health system is also complemented by a private health sector, which allows individuals more choices in health care.

The Australian healthcare system can be divided into three sections: - Public health sector - Medicare - PBS - Private health sector - Hospital - General - Patients and the Healthcare system

 The public health sector accounts for almost 70% of total health expenditure.  The two major components of the public health system are: 1) Medicare 2) Pharmaceutical Benefits Scheme

 Medicare is Australia’s universal health insurance scheme. It was introduced in 1984 to make health care affordable, accessible and of a high quality.  Medicare provides access to 1) Medical care in a public hospital without cost as a public patient 2) Free or subsidised treatment by medical practitioners, including specialists Medicare is available to residents of Australia who: Have Australian or New Zealand citizenship Hold permanent Australian visas Have applied for a permanent visa Medicare is also available to passport holders from countries with whom Australia has reciprocal healthcare agreements. People with chronic illness can also receive Medicare rebates for allied health services (eg. speech therapy, physiotherapy) under the Medicare program Allied Health Initiative.  Medicare is run by the Department of Human Services and funded by the Commonwealth of Australia.

 Medicare is financed through the income tax system. Individuals pay different sums depending on income levels.  Normally, the Medicare levy is 1.5% of taxable income, but it may vary depending on individual circumstances.  An additional 1% Medicare levy may be deducted if the individual does not have private health insurance.

 The Medicare Benefits Schedule (MBS) is a list of the Medicare services which the Australian government subsidises. Medicare benefits are only available for services listed in the MBS.  MBS is part of the Medicare Benefits Scheme managed by the Department of Health.  A medical practitioner can choose to set a higher fee for their services than the fee listed in the MBS. However, the Medicare benefit for the service will be the listed benefit. The difference between the fee charged by the medical practitioner and the listed MBS benefit is known as “the gap”.

 The Pharmaceutical Benefits Scheme(PBS) is an Australian government program that provides government subsidy for the cost of medicine for most medical conditions.  PBS is managed by the Department of Health and administered by the Department of Human Services.  You must have a PBS prescriber number to prescribe medicine under the PBS. This is administered by Medicare.  All Australian residents with a current Medicare card are eligible for PBS.  Overseas visitors from countries with a Reciprocal Health Care Agreement (RHCA) with Australia may also apply to access the PBS. Currently (as at January 2014), these countries are the UK, Ireland, New Zealand, Malta, Italy, Sweden, the Netherlands, Finland, Norway, Belgium and Slovenia.

Private health insurance provides patients with access to additional benefits, including choice of doctor, hospital and timing of procedure. Private health insurance does not cover in full the payment required for the majority of treatments, but it does provide patients with assistance to meet these costs. There are two main types of private health insurance: 1) Hospital Hospital cover provides assistance for in-hospital medical care and hospital costs such as accommodation fees. Most services listed under the Medicare Benefits Schedule (MBS) are covered by private hospital insurance. 2) General (also known as ancillary or extras cover) General insurance policies help to cover costs of non-medical health services such as dental, optical and physiotherapy treatments. Individuals with private health insurance can choose to be treated as a private patient in public or private hospitals.

 PrivateHealth.gov.au is an Australian Government website that explains how private health insurance works.  There is a specific section concerning private health insurance for overseas visitors.

General practitioners (GPs) Public hospitals Specialists Community- based services Private sector health professionals

GPs - Patients can choose their own GP - GPs’ fees are covered either fully or partially by Medicare, depending on the GP’s choice of billing. Public hospitals - Patients can access public hospitals’ emergency departments of their own accord, through ambulance services or through a doctor’s referral. Specialists - Patients generally see specialists after referrals from GPs. Community-based services - There are a range of community-based services in areas such as mental health and family planning, which can be directly accessed by patients. These are usually administered by each state or territory’s Department of Health. Other private sector health professionals - Dentists, physiotherapists and natural therapists are examples of private sector health professionals. - The fees for their services are usually covered by the patients or subsidised in part or full by private health insurance.

 Australian Government Department of Health   Australian Government Department of Human Services   Medicare (general site)   Medicare (for health professionals)  professionals/?from=banner professionals/?from=banner  Medicare Benefits Scheme (MBS)   Pharmaceutical Benefits Scheme (PBS)   PrivateHealth.gov.au 