Thursday, January 20, 2005

Australia Healthcare Benefits.

The most assuring thing so far is the public healthcare system which is usually accessible to all PRs without a waiting period (I think). I have unwittingly utilised the public ER twice this year - each time (for the first times in my life) I was in such agony even though my life wasnt threatened and it was comforting to know that I could get help to make me more comfortable, without having to worry that I have no money to pay for it or get slapped with bill charging me 1.50 for every cotton swab that was used.
- elin comment to Australia Centrelink Benefits



The Australian Government Health Insurance Commission (HIC) is the organisation delivering government health programs to the Australian community. The primary programs are Medicare and the Pharmaceutical Benefits Scheme.


Medicare provides for:
  • payment for the the full Schedule fee for GP services
  • free treatment as a public (Medicare) patient in a public hospital
  • payment for 75% of the Schedule fee for private in-hospital services
  • payment for 85% of the Schedule fee for other private out-of-hospital services

The benefits you receive from Medicare are based on a Schedule of fees set by the Australian Government. Doctors may choose to charge more than the Schedule fee. Once payments reach a threshold of $335.50, your Medicare benefits will increase to 100% of the Schedule fee for any further out-of-hospital service in that calendar year.

Often the devil is in the details. So the question should be re-phrased as "what does Medicare not cover"?

Medicare does not cover for the following:

  • private patient hospital costs (for example, theatre fees or accommodation)
  • dental examinations and treatment (except as part of the Enhanced Primary Care)
  • ambulance services
  • home nursing
  • physiotherapy
  • occupational therapy
  • speech therapy
  • eye therapy
  • chiropractic services
  • podiatry
  • psychology acupuncture (unless part of a doctor's consultation)
  • glasses and contact lenses
  • hearing aids and other appliances
  • the cost of prostheses medicines (except for Pharmaceutical Benefits Scheme)
  • medical and hospital costs incurred overseas
  • medical costs for which someone else is responsible (for example a compensation insurer, an employer, a government or government authority)
  • medical services which are not clinically necessary
  • surgery solely for cosmetic reasons
  • examinations for life insurance, superannuation or membership of a friendly society

However, private health insurance usually takes up the role to cover many of these services.


The other important component is the Pharmaceutical Benefits Scheme.

Many medicines will cost much more than the price paid as an Australian. Some will cost hundreds of dollars, but the Australian Government will pay for most of it through the Pharmaceutical Benefits Scheme (PBS).

PBS contribution amounts as at 2005 (maximum amount patient pays per medication):

  • General patients $28.60
  • Concession card holders $4.60

In addition, when the total amount for your PBS contributions on your prescription record form reaches $874.90 in a calendar year, you can apply for a PBS Safety Net card. This means you and your family can get further PBS medicines for $4.60 for each item for the rest of the calendar year. For concession card holders, the threshold is set at $239.20 (52 prescriptions) in a calendar year, and further PBS medicines are free for the rest of the calendar year.



3 Comments:

Blogger elin said...

No system is perfect. I work in the healthcare profession as a physio and have worked both in SG and AU. I guess in evaluating a system is to think how it can meet your needs and your wants (both quite different). Medicare has met my current needs as a relatively fit and healthy 30y.o. - in the times when I have had the need to seek some medical help, I havent had to fork out any money to obtain adequate advice. Even when I had the need on one occasion just to get some medical advice as to how to manage a condition- not to get treatment for anything - I havent had to pay. Because I go public all the time (as oppose to the private system), it doesnt serve their purpose to overservice me - I dont get asked to come back again and again, I dont get asked to buy all sorts of medication for this and that. Such is the experience that I have directly and indirectly experienced. In times of emergency, I have been attended too adequately - properly triaged and when it hasnt been urgent I have been properly queued until my turn. And touch wood, luckily my problems have been straighforward so far, but I am confident that if I had more complex issues, I would have been properly followed up with and treated. And I am also confident that if I ever had the need for emergency treatment to save my life, I would be similarly adequately and competently treated. Of course there is always the other side of the coin. Because the system is essentially "free" to those who need it (as oppose to want it), there are those that abuse the system and clog it up, making it seem inadequate to those who utilise the system on a need-to as opposed to want-to basis. Yes social irresponsibility does exist here too. As far as non-life threatening procedures go, why should a social health system support that? Hence comes into play private health insurance. If one has a bung knee that stops one from playing tennis, should the public health system pay for him/her to get it fixed so that he or she can play tennis again? I dont know, but I dont think so. Come to think about it, I have even had my eyes checked at an optometrist without having to pay. I also have private health insurance, taken up this year. By choice cos (1) I get a tax rebate and (2) for every year after age 30 if I dont have private health insurance, when I take it up, my premium is higher. In a perfect world, I wont take up private health insurance until I am much older. But I guess the world is not perfect and anyway, I want to be and keep myself in a financial position to afford private health insurance.

January 20, 2005 6:55 AM  
Blogger KnightofPentacles said...

Thank you elin for the valuable insight from somebody who has experienced both systems.

There is more quantitative information about the waiting times at Perth hospital documented at Datapoints Perth 01 in comparison to the significant other's recent experience in TTSH (the largest A&E hospital in Singapore).

January 20, 2005 10:59 AM  
Blogger KnightofPentacles said...

elin has a followup post on this topic at her blog.

January 22, 2005 2:38 AM  

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