AUSTRALIA’S HEALTHCARE
SYSTEM:
Unit 3, AOS 2, Outcome 2
Key Knowledge and Key Skills.
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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.
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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.
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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.
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The state and territory governments provide guidance and
direction to local authorities. They also provide a wide range of
health services:
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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
Federal Government.
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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
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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.
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Read pages 224 to 227 and complete the table
comparing the responsibilities of the 3 levels of
government.
Federal Gov
State Gov
Local Gov
Responsibilities
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You will need to know at least 3 from each.
Funding Healthcare.
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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.
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The funding contributions from each level of govt varies.
(With obviously the bigger the govt the more funding
they provide)
Funding Healthcare.
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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
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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.
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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.
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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
Responsibilities
Funding
State Gov
Local Gov
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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.
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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
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Values of the Australia’s healthcare
system.
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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.
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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.
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Medicare.
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The Medicare system has three main objectives:
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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.
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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?
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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?
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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-ofpocket’ 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.
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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.
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What is not covered by Medicare?
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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.
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List 2 advantages and 2 disadvantages of
Medicare.
Advantages
Disadvantages
Treatment is available for
little or no cost.
Long waiting lists for some
hospital services.
All Australians have access
to Medicare regardless of
age or income.
Doesn’t cover all health
services.
The Pharmaceutical Benefits Scheme.
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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.
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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.
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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.
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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.
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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.
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Lifetime health cover: