The health system explained
Australia's health care system is a balanced mix of public and private sectors. On one hand, it gives everyone access to health care through Medicare (public sector). On the other hand, it allows people to choose, through their private health insurance, to be treated in the private sector.
Medicare - Australia's national public health care program
All Australian residents have access to Medicare. Medicare is partially funded by a levy on income and for eligible people it provides access to free treatment as a public (Medicare) patient in a public hospital, and free or subsidised medical treatment by practitioners such as doctors, specialists and participating optometrists.
Medicare does not provide cover for emergency ambulance assistance or ambulance transport to hospital. Ambulance services in Australia are on a 'fee for service' basis provided by State Governments, and because of the Australian geography may be expensive.
Pharmaceutical Benefits Scheme (PBS)
Australia also has a national system for subsidising listed prescription medicines. The PBS subsidises the cost of over 1,350 essential items, ensuring all Australian residents have access to necessary and lifesaving medicines at an affordable price. This scheme is only available to people who are eligible for Medicare.
Private Health Insurance
Private health insurance is available for those who wish to cover the costs of becoming a private patient. Private patients have more control in choosing their treating doctor in hospital and in some instances can reduce their waiting time for elective surgery by having treatment in a private hospital.
Private health insurance also offers cover for some or all of the costs of other services not covered by Medicare, such as ambulance transport, dental, optical appliances, physiotherapy, pharmaceutical (non PBS) and a wide range of other services.
Unlike other insurances, your premium is not affected by your age, health status or other risk factors. This is called community rating and it protects from having to pay higher premiums if we make a claim, or as we get older or if we get sick.
The Australian Government regulates private health funds but rules regarding membership vary between funds and in some cases will vary between States. All health funds have certain waiting periods and other conditions that apply before benefits are payable.
The Federal Government offers a rebate on private health insurance premiums. This rebate is available to Australian residents who are eligible for full Medicare benefits.
Lifetime Health Cover is another Federal Government initiative to encourage people to take out private health insurance early in life and continue to keep it.
The Private Health Insurance Administration Council has an easy to read booklet that explains the Australian health system. It’s called Insure? Not Sure.
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