health AOS topic 6

• Health system


  'all the activities whose primary purpose is to promote, restore and or maintain health'
• Australia's health system


  The responsibility of the government and also the private sector
• Components of Australia's health system

  • Public Health Insurance (including public hospitals, Medicare, PBS & NDIS)
  • Private Sector (including Private Health Insurance, Private Hospitals etc)
• Medicare


  Australia's universal health insurance scheme, provides all Australians and people from countries with a reciprocal agreement access to basic healthcare subsidized by the government
• What is covered by Medicare?


  • Pathology – blood and urine tests
  • X-rays
  • Eye tests
  • Accommodation and treatment in public hospitals
  • Dental services for some children
  • GP and specialist consultations
  • 75% of the schedule fee for treatment in a private hospital
• What is not covered by Medicare?

  • Most Private Hospital costs (beyond 75% of the schedule fee)
  • Most dental
  • Home nursing or treatment
  • Ambulance
  • Most allied health services (physio, OT etc)
  • Alternative medicines (including chiro, massage, naturopathy, acupuncture)
  • Glasses & contact lenses
  • Hearing aids
  • Artificial limbs
• Scheduled Fee


  The amount that Medicare will contribute to a range of medical services- updated each year on the Medicare benefits scheme
• Patient co-payment


  Difference between scheduled fee and medical services set fee
• Bulk Billed


  Schedule fee is the same as the amount that doctor charges, patient has no out of pocket expense
• Medicare safety net


  Once an individual or family has contributed a certain amount of their own pocket to Medicare services in one financial year, further financial support is provided by the government making Medicare services cheaper for the remainder of that year. ($ 700 for singles and $1000 for couples and families in 2017)
• How is Medicare funded?
• Advantages & disadvantages of Medicare
• Medicare may promote health status of Australians

  By subsiding doctor's consultations, more Australians can receive check-ups which can identify any health issues, such as diabetes. These concerns can be monitored and treated which reduces the risk of premature death and decreases mortality rates in Australia.
• Medicare may promote health and wellbeing of Australians


  By providing fee-free treatment in public hospitals, Australians can receive treatment or surgery for serious health concerns such as cardiovascular disease which is a leading cause of death, therefore increasing life expectancy in Australia
• Pharmaceutical Benefits Scheme (PBS)


  A vital component of the Australian Health System; the PBS provides essential medications at subsidized prices, with patients who have a Medicare card making a co-payment to cover the rest of the costs. In 2024, the patient co-payment for most medications was $31.60 or $7.70 for concession cardholders. The PBS safety net exists to protect people from large expenses. Once an individual or their immediate family have spent $1647.90 in a calendar year, they then only pay the concession price
• Not all drugs are covered by the PBS – eg rare cancer drugs (reviewed for approval 3 times a year)
• More than $10.8 billion was paid via the PBS in 2022
• National Disability Insurance Scheme (NDIS)

  A national insurance scheme that provides services and support for people with permanent, significant disabilities and their families and carers. It is jointly funded by Australian and participating state and territory governments.
• Eligibility for NDIS


  • Under age 65
  • Australian citizen
  • Have an impairment that is permanent
  • Your impairment effects your social capacity and carry out daily activities
• Focus of NDIS


  • Create an individualized plan for NDIS participants
  • Access mainstream services & support (Education/Work/Medical Care)
  • Access community & supports (Sporting Clubs/community groups)
  • Maintain informal support arrangements (Family and Friends support)
  • Receive reasonable and necessary funded supports (Equipment)
• Difference between PBS and NDIS

  The PBS provides subsidised medications, while the NDIS provides individualised support and services for people with permanent disabilities
• How the NDIS can promote health outcomes in Australia

  The NDIS aims to assist participants through an INDIVIDUALISED PLAN to: Access mainstream services & support (Education/Work/Medical Care), Access community & supports (Sporting Clubs/community groups), Maintain informal support arrangements (Family and Friends support), Receive reasonable and necessary funded supports (Equipment)
• Private Health Insurance (PHI)


  An optional, additional type of insurance under which members pay a premium (fee) in return for payment towards services not covered by Medicare. It works in addition to Medicare, not in place of it. It gives Australian's more choice in regards to healthcare. People can opt for hospital cover, extras (eg dentistry, physio, chiro, massage, optical) or both. Premiums are calculated based on the level of coverage a consumer wants.
• Advantages & Disadvantages of PHI

  • Lifetime health cover
  • Medicare levy surcharge
  • The PHI Rebate
• Policy or practice from the old public health

  • 1
• Discovery from the biomedical model of health

  • 2
• Action area of the Ottawa Charter


  • 3
• Service that Medicare covers


  • 4
• Service that PHI covers

  • 5
• The role of Australia's health system in promoting health
• Funding relates to the financial resources that are provided to keep the health care system adequately staffed & resourced, so a high level of care is available for those who need it.
• Funding the health system means more people can receive treatment by reducing the costs the individual must contribute.
• As a result, more people can access healthcare and receive treatment for a range of conditions, reducing morbidity and mortality rates.
• What funding helps to do

  • Build & maintain hospitals & medical technology
  • Train staff & maintain professional standards
  • Subsidize health services (through Medicare)
  • Personnel – administerative & support staff
  • Essential medicines – including those on the PBS
  • Medical supplies
  • Support & assist the NDIS
  • Subsidise the cost of PHI
  • Public Health programs – ie Quit & LiveLighter
• Total expenditure on health in 2014-2015 was $161.6 billion, representing an average expenditure of $6846 per person.
• Over time, these costs have increased, due to An ageing population & therefore more chronic health issues which need to be addressed, Increasing incomes, a growing economy & rising expectations – people demand more of the healthcare system, More expensive technologies & services
• Responsibility for funding the healthcare system is shared between federal & state governments, and the private sector, including private health insurance & individual contributions
• The main government contributions are made via Medicare, the PBS & the NDIS.
• How Medicare may promote health outcomes for Australians in relation to funding

  By Medicare funding treatment in public hospitals, Australians are more likely to be able to be treated for a range of conditions such as diabetes. This can treat symptoms of the condition, enabling people to complete daily tasks adequately which can promote physical health and wellbeing. By providing some funding for doctors' consultations, more Australians can access GP services. This can mean that health concerns such as skin cancer can be detected and treated earlier. This can premature deaths and therefore mortality rates. By funding pathology such as x-rays, more accurate diagnosis can be made which can mean that more appropriate treatments can be provided. This can reduce the time Australians live with condition such as a broken bone, so they can get back to their normal activities faster, such as spending time with family and friends, promoting social health and wellbeing.
• Sustainability


  Meeting the needs of the present without compromising the ability of future generations to meet their needs. Relates to the capacity to provide a workforce & infrastructure to respond to current & emerging needs of the Australian people.