Overview Of The Healthcare System

The Australian health system is a mixture of both public and private services which includes a universal public health system called Medicare.

Through the Medicare system, the Australian Government funds medical services, pharmaceutical benefits, health services to veterans and Aboriginal and Torres Strait Islanders and a range of other national health programs. The State and Territory governments are responsible for regulating the public provision of health services, including public hospitals, mental health and dental health services, population health and community health centres, ambulance services and health promotion.

Medicare

Medicare is a scheme that gives all Australian residents access to high quality health care. The Federal Government introduced Medicare in 1984 to ensure that all Australians have access to medical and hospital care when they need it with priority according to clinical need to which is more affordable for all Australians.

Medicare is available to all persons who reside in Australia and:

Hold an Australian citizenship
Have been granted permanent resident status
Hold a New Zealand citizenship: or
Have applied for a permanent resident visa (other requirements apply)

When admitted to a hospital, all people eligible for Medicare can access free treatment as a public (Medicare) patient in a public hospital. In Australia, there are two kinds of hospitals; Public hospitals (funded by the government) and private hospitals (some of which operate for profit).

If a patient is admitted to a public hospital as a public (Medicare) patient, Medicare provides access to:

free treatment as a public (Medicare) patient in a public hospital, and
free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only)

If a patient is admitted to a private hospital as a private patient, fees are charged by doctors and allied health professionals as well as the hospital, which charge the patient for accommodation, nursing care and other hospital services (e.g. operating theatres, medicines).

If the patient is eligible for Medicare as a permanent resident of Australia, the doctors’ fees generally attract Medicare benefits and the balance of fees will be met by the patient (e.g. personally and/or from private health insurance).

Free or subsidised treatment through Medicare helps to pay consultation fees for doctors who are GPs (general practitioners or family doctors), and specialists (doctors specialising in a specific branch of medicine, e.g. psychiatrists). It provides benefits to help pay for special tests and examinations, including eye tests undertaken by optometrists, most surgical and other procedures performed by doctors and some procedures performed by approved dentists, but does not cover services provided by psychologists.

There are other services that Medicare does not cover, including services such as; most dental services, ambulance services, home nursing, physiotherapy, occupational therapy, speech therapy, podiatry, chiropractic, acupuncture (unless part of a doctor’s consultation), cosmetic surgery, hearing aids, glasses and contact lenses and prostheses.

Medicare has online e-learning for health professionals to guide them through the Medicare system - http://www.medicareaust.com/MedicareandYou/

Or a Medicare Guide in the form of a PDF document can be downloaded at: http://www.medicareaustralia.gov.au/provider/business/education/learning-guides.jsp

Billing Arrangements by Doctors

In Australia, there are two methods of billing depending on the consultation.

Direct billing (also known as bulk billing). This is where the doctor charges Medicare directly, accepting the Medicare benefit as full payment (there are limitations to bulk-billing as set out in clauses 45 to 48 of the Australian Health Care Agreement 2003 to 2008). Patients will pay nothing and must sign a completed form once the consultation has ended, and be given a copy of the form.
Private Billing The other alternative is to issue patients with an account, which they pay and then claim the benefit back from Medicare. Alternatively, if the patient does not pay the account, Medicare will send a cheque payable to the doctor, which the patient then sends to the doctor along with any outstanding amount.

Issue of a Medicare Card

Issued by Medicare, any person eligible for Medicare will be issued with a Medicare card. This is a green plastic card that will include the holder’s name (and that of any other eligible family members) and Medicare number.

A Medicare card is required:

When a person visits a doctor
When a person wishes to make a claim for a cash benefit at a Medicare office
To make enquiries when claiming
To show at a hospital when a person chooses to be treated as a public patient; and
To show a pharmacist when a person takes a prescription to a pharmacy to be filled

Reciprocal Health Care Agreements

A number of countries, such as the United Kingdom, Finland, Ireland, Italy, Malta, the Netherlands, New Zealand and Sweden, have a Reciprocal Health Agreement with Australia which entitles citizens of these countries to limited subsidised health services for medically necessary treatment while visiting Australia.

Although overseas visitors holidaying in Australia are generally not entitled to a card, people visiting from these countries who have the agreement with Australia are. To check who is eligible for Medicare assistance you can contact Medicare at any Medicare Office or telephone: 132 011* (*call charges apply) or email to medicare@medicareaustralia.gov.au

Credits: some of this information was taken from “Medicare Australia” written by the Australian Government.