M a y 2 0 1 2 G M S e N E W S M e d i c a r e i n A u s t r a l i a

L e v e l 3 5 , U n i t 1 , M e n a r a S t a n d a r d C h a r t e r e d , J a l a n S u l t a n I s m a i l , K L

The healthcare system in Australia is a complex mix of Commonwealth and State Government funded services and services funded by private health insurance. How do doctors, physiotherapists, optometrists, dentists and other health professionals fit into this framework of public and private health services? Which health services are funded by the governments and which are pr ivately f u n d e d ? R e a d o n t o understand more about the Australian healthcare system.

Medicare pays a benefit to the user for various healthcare costs including:

• doctors’ and specialists’ consultation fees;

• tests and examinations your doctor orders for you;

• eye tests carried out by optometrists; and

• most surgical procedures

GLOBAL MIGRATIONM e d i c a r e i n A u s t r a l i a

HOSPITAL

MEDICAL SERVICES

AND GENERAL

TREATMENT

PHARMACEUTICAL AMBULANCE

AUSTRALIA HEALTH SYSTEM:HOW IT WORKS?In Australia, Medicare provides universal health insurance that delivers affordable, accessible and high-quality health care for citizens and permanent residents. However you can also choose to take out private health insurance to give you more health care options and to cover items which aren't covered on Medicare.

Below is a side by side summary of what is covered by private health insurance and what Medicare covers for hospital, medical services and general treatment, pharmaceutical benefits and ambulance.

Since 2007 funds have also been able to cover a variety of alternatives to hospital treatment, known as Broader Health Cover.

Compared with health systems in other developed countries, the Australian health system delivers us above-average health outcomes. Spending on health

is on a par with other prosperous countries. And despite the poor life expectancy of our indigenous people,

Australia still ranks well for healthy life expectancy. According to the World Health Organization,

Australians can expect to live an average of 74 healthy years.So, how do we achieve these health outcomes? Let’s take a look at the various components of the health system and how they fit together to deliver healthcare to the Australian population.At the core of the health system is the National

Health Act. This was passed in 1953 to regulate the provision of pharmaceutical, sickness and hospital

benefits and of medical and dental services. The Act covers nursing homes, the Pharmaceutical Benefits Scheme and registration of health funds..

W h a t i s c o v e r e d ?

Migration Agents Registration No. 0428740

M a y 2 0 1 2 G M S e N E W S M e d i c a r e i n A u s t r a l i a

L e v e l 3 5 , U n i t 1 , M e n a r a S t a n d a r d C h a r t e r e d , J a l a n S u l t a n I s m a i l , K L

HOSPITAL

PRIVATE COVER MEDICAREYou can choose to be treated as a private patient in either a public OR a private hospital.

You can choose your own doctor, and decide whether you will go to a public or a private hospital that your doctor attends. You may also have more choice as to when you are admitted to hospital.

If you choose to be treated as a private patient in a hospital (public or private), Medicare will cover you for 75% of the Medicare Benefits Schedule (MBS) fee for associated medical costs.

You can be treated as a public patient in a public hospital by a doctor appointed by the hospital.

You cannot choose your own doctor and you may not have a choice about when you are admitted to hospital.

You can choose to be treated as a public patient even if you are privately insured.

The remaining hospital and medical costs will be charged to you - some or all of these costs may be covered on your private health insurance, depending on your policy.

The remaining costs include  25% of the MBS fee for doctors' services and any amount the doctors charge above the MBS fee, plus some or all the costs of:

• hospital accommodation,• theatre fees,• intensive care,• drugs, dressings and other consumables,• prostheses (surgically implanted),• diagnostic tests,• pharmaceuticals, and• any additional doctor's fees.

As a public patient you will be treated at no charge.

Medicare does not cover:

• private patient hospital costs (for example, theatre fees or accommodation),

• medical and hospital costs incurred overseas,• medical services which are not clinically necessary,

or surgery solely for cosmetic reasons.

PHARMACEUTICAL

PRIVATE COVER MEDICAREUnder the Pharmaceutical Benefits Scheme (PBS), you pay only part of the cost of most prescription medicines purchased at pharmacies - this applies whether or not you hold private health insurance. The rest of the cost is covered by the PBS. You must present your Medicare card to obtain this benefit.

The amount you pay varies with the medicine, up to a standard maximum. People with concession cards have a lower maximum payment.

Under the Pharmaceutical Benefits Scheme (PBS), you pay only part of the cost of most prescription medicines purchased at pharmacies - this applies whether or not you hold private health insurance. The rest of the cost is covered by the PBS. You must present your Medicare card to obtain this benefit.

The amount you pay varies with the medicine, up to a standard maximum. People with concession cards have a lower maximum payment.

You can arrange private health insurance to cover many prescription medicines which aren't listed on the PBS. Most funds will require you to make a co-payment towards the cost and will have limits on how much you can claim.

Some prescription medicines are not listed on the PBS. You pay the full amount for these non-PBS items.

Migration Agents Registration No. 0428740

M a y 2 0 1 2 G M S e N E W S M e d i c a r e i n A u s t r a l i a

L e v e l 3 5 , U n i t 1 , M e n a r a S t a n d a r d C h a r t e r e d , J a l a n S u l t a n I s m a i l , K L

MEDICAL SERVICES AND GENERAL TREATMENT

Medical benefits are based on a list of standard fees for medical services — the so-called ‘Schedule fees’.

Despite these Schedule fees, doctors are free to set their own fees for consultations and procedures. They are covered by the Trade Practices Act. After all, just like hairdressers and plumbers, they need to cover their costs of being in business and hopefully make a profit, too!

Many doctors follow the Australian Medical Association’s list of suggested fees. This list has been indexed to keep up with costs and recommends higher fees than the Medicare Schedule fees.

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AUSTRALIA, we know Better!

PRIVATE COVER MEDICARE

If you visit a doctor outside a hospital, Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for a specialist - this applies whether or not you hold private health insurance. If your doctor bills Medicare directly (bulk billing), you will not have to pay anything.

If you visit a doctor outside a hospital, Medicare will reimburse 100% of the MBS fee for a general practitioner and 85% of the MBS fee for a specialist - this applies whether or not you hold private health insurance. If your doctor bills Medicare directly (bulk billing), you will not have to pay anything.

Medicare does not provide benefits for the following:

• most dental examinations and treatment,• most physiotherapy, occupational therapy, speech

therapy, eye therapy, chiropractic services, podiatry or psychology services,

• acupuncture (unless part of a doctor's consultation),

• glasses and contact lenses,• hearing aids and other appliances• home nursing.

You can arrange private health insurance to cover many of these services.

Medicare provides benefits for:

• consultation fees for doctors, including specialists,• tests and examinations by doctors needed to treat

illnesses, such as x-rays and pathology tests,• eye tests performed by optometrists,• most surgical and other therapeutic procedures

performed by doctors,• some surgical procedures performed by approved

dentists,• specific items under the Cleft Lip and Palate

Scheme,• specific items under the Enhanced Primary Care

(EPC) program

AMBULANCEPRIVATE COVER MEDICARE

In Queensland and Tasmania, emergency ambulance services are provided free by the State Government. New South Wales and Australian Capital Territory provide free ambulance cover for pensioners and low income earners.

In Queensland and Tasmania, emergency ambulance services are provided free by the State Government. New South Wales and Australian Capital Territory provide free ambulance cover for pensioners and low income earners.

If you do not fall into any category above you can arrange ambulance cover from the ambulance authority in your state or with a health fund.

Medicare does not cover the cost of emergency or other ambulance services.

Migration Agents Registration No. 0428740

www.PRforAUSTRALIA.comenquiry@PRforAUSTRALIA.com

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