AUSTRALIA’s HEALTH CARE SYSTEM

1. AUSTRALIA’s HEALTH CARE SYSTEM

2. What you need to know • Key Knowledge • Australia’s health care system including • Local, state and federal governments responsibility for health including funding • The values that underpin the Australian health care system • Medicare, Pharmaceutical benefits scheme and private health insurance • Key skills • Identify and explain key components of Australia's health system

3. What do you already know????? • Think about your experiences with Australia’s health care system with the person next to you • Have you used a Medicare card before? • Are you insured under your parent’s private health insurance? • Did you know there were private and public hospitals? • Have you been to a public or private hospital? • Have you been on a waiting list? • Does your family’s doctor bulk bill?

4. Summary of responsibility and funding by levels of Government

5. Health Care • The ‘healthcare system’ refers to all of the service provides such as doctors, nurses, specialists, health professionals, hospitals, clinics, preventative health programs, research centres, pharmaceutical companies and private health insurance companies • The funding and division of responsibilities for these services is complex and is shared between Federal, State and Local governments and private sources

6. Funding of Australia's health care system

7. Funding of Australia's health care system

8. Breakdown of funding and responsibilities

9. The Federal government's responsibilities Role • The administration of Medicare • The administration of the Pharmaceutical benefits scheme (PBS) • Responsible for Quarantine - ensuring no biological or environmental hazards enter Aus – Eg: Swine flu, bird flu • Funding of the health system, states, hospitals, incentives, screening programs • Regulation of PBS, private health insurance and laws relating to food safety

10. Funding the health care system • Provides grants - So states / territories to run hospitals and health services • Runs National programs - such as NHPA, National mental health strategy, National palliative care strategy, Breastscreen, immunisation, • Private Health Insurance rebate • Funds and regulates aged care

11. The Federal government's responsibilities • Regulatory responsibilities • Regulating Pharmaceutical good - what medications will be available in Australia • Regulating the Private Health insurance industry – Including approving costs and increases and encouraging people to have health insurance • Monitoring food safety and regulations – Food standards Australia and New Zealand (FSANZ)

12. The state governments responsibilities / Role • Delivery of health service • Public hospitals • Psychiatric hospitals • School health curriculum • Public dental health (available only to concession card holders and adults with special needs • Maternal and child health • Implementation of • National mental health strategy • National palliative care strategy • Environmental health programs • Ambulance services

13. The state governments responsibilities • Regulatory responsibilities • Licensing GP’s • Licensing private hospitals and their relevant operating operations • Industry regulations – eg: tobacco and alcohol sale regulations • Legislation including road rules and smoking bans - Potential banning of smoking in public places

14. The local governments Role • Health inspections – restaurants and commercial kitchens • Waste removal – rubbish collections • Water quality • Maintaining recreational facilities • Environmental health – noise and air pollution etc. • Local by laws - laws specifically to do with the specific area • Delivering immunisation • Running maternal and child health • Meals on wheels • Municipal public health plans (MPHP)

15. Values of the Australian Healthcare System There are 7 values that “underpin” the Australian health care system (See Cars) • Safe • Effective – • Efficient - • Continuous • Accessible • Responsive – • Sustainable –

16. The values that underpin the Australian Health Care System

17. Effective Values of Australia’s health system Effectiveness relates to achieving desired outcomes in an appropriate timeframe. The outcomes could relate to the number of patients treated, the rate of improvement in a patient’s condition or the number of people screened for certain conditions. Immunisation rates Early stage breast cancer diagnoses

18. Efficient Values of Australia’s health system Efficiency An efficient health system is one that can achieve desired outcomes with a cost-effective use of resources. As resources are limited, they must be used in the best way possible so the benefits to the community are as large as they can be. This relates to getting value for money from the health system. Some interventions may be seen as inefficient in that the outcomes received do not reflect the amount of money invested.

19. Responsive Values of Australia’s health system The two aspects of this value are that people are treated with respect the health system is client orientated. This includes patient confidentiality, privacy and input into the treatment options. The health system should be centred around the user’s needs rather than the needs and wants of government bodies and lobbyists.

20. Accessibile Values of Australia’s health system Accessibility was defined by the National Health Performance Committee in 2001 as the ‘ability of people to obtain health care at the right place and right time irrespective of income, cultural background or physical location’. This value encompasses the value of equity. Every person who is eligible to use the health system should have the same access as everyone else despite barriers such as distance, discrimination and affordability.

21. Safe Values of Australia’s health system This value relates to reducing the risks associated with the delivery of health care. In order to achieve this value, health-care providers such as doctors and hospitals must evaluate potential risks to the safety of patients and decrease them as much as possible. Examples of risks include the risk of infection from the hospital setting and risks associated with the physical environment such as slippery floors and sharp objects.

22. Continuous Values of Australia’s health system Individuals may occasionally need to access various health-care services for the diagnosis and treatment of a condition. When this is necessary, the person may have to make various appointments and deal with numerous health-care professionals. The aim of this value is to increase the level of communication and planning between health professionals. This in turn, could make the process of care more manageable for the patient.

23. Sustainable Values of Australia’s health system This value is largely related to funding. Adequate funding is required to ensure that the health system can continue to evolve with the changing needs of the community. Investment in the workforce, research, monitoring and physical resources ensure that the health system can continue to improve while providing a high quality of care. If funding does not allow these aspects of the health system to continue, the health system as it is today will not be sustainable and the quality of care would decrease over time.

24. Medicare • What is Medicare? • Australia's universal health care scheme • Allows access to subsidised health care for all permanent residents • Reciprocal rights for NZ, UK, Ireland, Sweden, Netherlands, Finland, Italy, Malta, and Norway

25. What does Medicare cover? • Non hospital • Some or all of the fees for • Doctors , tests and examinations needed to treat illness, including; X –rays and pathology tests • Eye tests • Most surgical and therapeutic procedures performed by doctors • Some surgical procedures performed by approved dentists • In Hospital • All treatment in a public hospital, by doctors and specialists is covered by Medicare, including initial treatment and aftercare • In a private hospital or for a private patient Medicare will only cover 75% of the Schedule Fee. The other expenses of which there are many are covered by Private health insurance or by the patient

26. Medicare • What is not covered by Medicare? • Covers most necessary medical fees • Any cosmetic or unnecessary procedures are not covered examples???? • Treatment in a private hospital (will pay 75% of the schedule fee) • Dental examinations • Home nursing treatment • Ambulance services • ‘Alternative medicines’ or ‘extras’ • Chiropractic, Physiotherapy, acupuncture, massage, naturopathy, aromatherapy, podiatry, Osteopathy ect • Health related aids • Glasses, contact lenses, hearing aids, Protheses • Medical cost for which someone else is responsible • Eg: compensation insurer, an employer, governments or government authority (TAC)

27. Medicare • How is Medicare used? • Everyone receives a Medicare card • If not bulk billed patient generally makes the additional payment and then takes the receipt to a Medicare office to claim a refund • Refunds can now also be payed directly into the patients account at the doctors office and the patient pays the difference • Thirdly the patient can take a receipt of the services to Medicare who will make a cheque out to the doctor and the patient will pay the difference

28. Medicare Bulk billed GP consultation GP consultation requiring co payment.

29. Funding of Medicare • Funded by the federal government • Normal Taxation • Medicare Levy • Additional tax on most tax payers to fund Medicare • 1.5% of the taxable income • Low income earners are exempt

30. Medicare levy surcharge • Medicare levy surcharge • Extra tax for high income earners who don’t have private health insurance - This is an incentive for them to have private health insurance and thus reduces the pressure on the public system and Medicare funding • 1% to 1.5% of the taxable income in addition to the Medicare levy • Over $84,000 for singles 1% over 130,000 1.5% • Over $ 168,000 for families 1%, over 260,000 1.5%

31. Medicare safety net. • People who required frequent services receive additional financial support. • Once an individuals co payments reach $1221.90 services become cheaper.

32. Pharmaceutical Benefits Scheme • Started in 1948 when the aim of the government was to provide essential medicines to people regardless of their ability to pay for them • Aim is the same today however the medicines are now subsidised • Customers pay a co payment towards the medicines • From 1 January 2013, you pay up to $36.10 for most PBS medicines or $5.90 if you have a concession card. The Australian Government pays the remaining cost. • 4000brands of medicines available – changing all of the time • Some medicines not available which leaves a massive cost for patients • $9 billion was paid out in PBS in 2011- 2012

33. PBS Safety Net • In each year there is a threshold to ensure individual are not to burdened On 1 January 2011, the Safety Net thresholds changed from $324.00 to $336.00 (for concession card holders) and from $1,281.30 to $1,317.20 (for all other patients). • After reaching the Safety Net threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year

34. Private Health Insurance • Additional healthcare services not provided with Medicare • Covers generally combine “hospital and “extras” • The type of extra services depends on the type of private health insurance and level of cover • The more hospital and extras that a person has the higher the premium

35. Private Health Insurance • Examples of services • Private hospitals • Choice of doctor • Dentists • Podiatrists • Physiotherapy • Nearly all services are only covered up to a certain $ limit depending on the amount of cover

36. Private Health Insurance – Incentive Schemes • Declining numbers taking out PHI places extra pressure and costs on the public system and Medicare • The federal government has introduced some incentives to encourage people to take out PHI • This helps to make it more affordable and ease the burden on public hospitals

37. Private Health Insurance – Incentive Schemes • 30% premium rebate • All PHI holders are entitled to a 30% rebate on their PHI premium • Therefore, a 30% discount is applied • The rebate is now means tested • Lifetime health cover • This encourages people under 30 to take out PHI • If someone takes out PHI before they turn 30 they will pay lower premiums throughout their lives • Those over 30 when taking out PHI face an additional 2% charge per year (max 70% paid for 10 years)

38. Private Health Insurance – Incentive Schemes • Medicare levy • The Medicare levy is currently 1.5% of taxable income • An additional charge of 1- 1.5% is charged for those on higher incomes who do not have PHI • This is an additional way of encouraging people to take out PHI

39. Questions • 1. How does Medicare work to achieve health outcomes? (2marks) • 2. Outline how Medicare addresses the values that underpin the Australian Health care system? (4marks) • 3.Explain how Medicare may influence the health status of Australians. (3marks) • 4. What is private health insurance? (2 marks) • 5. Why would an individual be advised to take out private health insurance before turning 30. (2marks)