Health system explained
Navigating the health system can be confusing and when you actually need health care is when you
are least likely to have the time to learn about it.
In this section, you'll find some useful information to help you find your way and get the most from your health care.
The Australian health system
The Australian health system provides all Australian residents with access to affordable, accessible
and high-quality health care.* This Government scheme, known as Medicare, is typically referred to as
'public health care'. To find out more visit www.medicareaustralia.gov.au
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 services, dental, optical items, physiotherapy, prescription pharmaceuticals
(non-PBS) and a wide range of other services.
You can choose whether to have Medicare cover only or a combination of Medicare and private health insurance.
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 Australian 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 maintain 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?
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.
How is private health insurance regulated?
The Australian Government regulates private health insurers, who must be registered under the Private Health Insurance Act. The policies they sell must comply with statutory regulation. These are the only health insurance products which can be sold in Australia and attract a Government rebate (see Calculating your Premium).
Australia's private health insurers are also monitored and regulated by an independent statutory authority known as the Private Health Insurance Administration Council (PHIAC). A second independent authority, the Private Health Insurance Ombudsman (PHIO) HOTLINE 1800 640 695*, is a service to help consumers with private health insurance problems and enquiries.
All private health insurers are required to keep up-to-date standard information statements (SIS) of every resident product they sell. Visit www.privatehealth.gov.au to access these statements.
*Free call anywhere in Australia; mobile charges may apply.
Calculating your premium
Unlike other insurances, health insurance premiums are not calculated on 'risk' factors. The community rating
system means everyone pays the same premium for their private health insurance. Factors such as age, gender,
race, health status, lifestyle choices or claiming history cannot be taken into account in calculating your premium.
The Australian Government has a number of initiatives aimed at making it more affordable for Australians to take
up private health insurance. Find out more in our benefits section.
About to go to hospital?
We understand that going to hospital can be quite a daunting experience and you're probably not entirely sure
what to expect. Before you go, check out our Going To Hospital Guides.
* Medicare does not provide cover for ambulance services. Ambulance services in Australia are on a 'fee for service'
basis provided by State Governments, and because of the Australian geography may be expensive.
* Please note: overseas students and visitors on temporary visas are not eligible for Medicare benefits,
unless they are from a country with which Australia has a 'Reciprocal Health Care Agreement'. See the sections
on overseas students and overseas visitors for further information about health
insurance covers appropriate for your needs.