CGP
08-10-2009, 10:28 PM
Another member suggested (wisely) that it might be instructive to discuss health care systems in other countries to see how they are maintained. Here is a brief overview of the Australian health care system - it's a mixed model whereby all citizens have coverage through Medicare (tax funded) and people can additionally choose to take out private insurance (for extra benefits) if they wish to and/or can afford to. There are a large numbe of both public and private providers of health care in Australia.
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1. PUBLIC HEALTH CARE SYSTEM: UNIVERSAL ACCESS
Medicare (http://www.medicareaustralia.gov.au/about/whatwedo/medicare.jsp)
Medicare is Australia’s universal health care system introduced in 1984 to provide eligible Australian residents with affordable, accessible and high-quality health care.
Medicare was established based on the understanding that all Australians should contribute to the cost of health care according to their ability to pay. It is financed through progressive income tax and an income-related Medicare levy.
Medicare provides access to:
- free treatment as a public (Medicare) patient in a public hospital, and
- free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only)
The Department of Health and Ageing (DoHA) is responsible for the policy development of Medicare and the Medicare Benefits Schedule. Medicare Australia is responsible for:
- ensuring Medicare benefits are paid to eligible health care consumers for services provided by eligible medical practitioners, and
- assessing and paying Medicare benefits for a range of medical services, whether provided in or out of hospital, based on a schedule of fees determined by DoHA in consultation with professional bodies.
Medicare Australia is also involved in detecting and preventing fraud and abuse of the Medicare system and registering and recording details of medical practitioners including:
- those eligible to have Medicare benefits paid for their services, or
- those not entitled to have Medicare benefits paid for their services but who are able to raise valid referrals or requests for specialist services for Medicare benefit purposes.
2. PRIVATE HEALTH CARE SYSTEM: PRIVATE ACCESS
Private Health Isurance: Australia (http://www.healthdirectory.com.au/Health_insurance/)
Australians enjoy universal public health insurance, Medicare, financed through progressive personal income tax and an income-related levy. They also have the option to take out privately funded health insurance to cover the costs of becoming a private patient in a private or public hospital, medical costs in hospital, and costs associated with services not covered under Medicare (such as ambulance, natural therapies and private dental care).
Health insurance funds offer hospital covers and ancillary covers and a combination of these.
Private health insurance is provided through organisations registered under the National Health Act 1953. There are two types of private health funds: restricted membership organisations (such as employees of a particular firm or industry) and funds open to the general public.
Private health insurance funds are registered with and monitored by the Private Health Insurance Administration Council, a statutory authority. Private health insurance providers adhere to the the Private Health Insurance Code of Conduct, a voluntary, self-regulatory industry code.
The Private Health Insurance Ombudsman deals with inquiries and complaints about any aspect of private health insurance. The Private Health Insurance Ombudsman is an Australian Government agency but acts independently in dealing with complaints and is independent of the private health funds and health service providers.
Australians under 65 years of age, eligible for full Medicare benefits, enjoy the Federal Government's 30% rebate on private health insurance premiums. The rebate is 35% for people aged between 65 and 69 and 40% for those aged 70 and over.
Australians who took out hospital cover before 1 July 2000 and maintain it, only pay a base rate regardless of their age, pursuant to the Federal Government's Lifetime Health Cover initiative.
Private health insurance organisations are regulated by the Federal Government to ensure affordable access to private health insurance for all through the principle of community rating. Pursuant to this principle, the insurance premium is the same regardless of the health status or claims history of a member or new member. Reinsurance supports the principle of community rating by sharing between health insurers the hospital and medical costs of high risk members admitted to hospital. Funds with a greater proportion of low risk members contribute into a reinsurance pool and those with a greater proportion of high risk members receive transfers from it.
At this link (http://www.healthdirectory.com.au/Health_insurance/), there are additional links to 45 private health insurance companies that operate in Australia.
Some of the biggest insurers are:
Medibank Private (http://www.medibank.com.au/)
MBF Australia (http://www.mbf.com.au/)
Health Cover Fund (http://www.hcf.com.au)
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1. PUBLIC HEALTH CARE SYSTEM: UNIVERSAL ACCESS
Medicare (http://www.medicareaustralia.gov.au/about/whatwedo/medicare.jsp)
Medicare is Australia’s universal health care system introduced in 1984 to provide eligible Australian residents with affordable, accessible and high-quality health care.
Medicare was established based on the understanding that all Australians should contribute to the cost of health care according to their ability to pay. It is financed through progressive income tax and an income-related Medicare levy.
Medicare provides access to:
- free treatment as a public (Medicare) patient in a public hospital, and
- free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only)
The Department of Health and Ageing (DoHA) is responsible for the policy development of Medicare and the Medicare Benefits Schedule. Medicare Australia is responsible for:
- ensuring Medicare benefits are paid to eligible health care consumers for services provided by eligible medical practitioners, and
- assessing and paying Medicare benefits for a range of medical services, whether provided in or out of hospital, based on a schedule of fees determined by DoHA in consultation with professional bodies.
Medicare Australia is also involved in detecting and preventing fraud and abuse of the Medicare system and registering and recording details of medical practitioners including:
- those eligible to have Medicare benefits paid for their services, or
- those not entitled to have Medicare benefits paid for their services but who are able to raise valid referrals or requests for specialist services for Medicare benefit purposes.
2. PRIVATE HEALTH CARE SYSTEM: PRIVATE ACCESS
Private Health Isurance: Australia (http://www.healthdirectory.com.au/Health_insurance/)
Australians enjoy universal public health insurance, Medicare, financed through progressive personal income tax and an income-related levy. They also have the option to take out privately funded health insurance to cover the costs of becoming a private patient in a private or public hospital, medical costs in hospital, and costs associated with services not covered under Medicare (such as ambulance, natural therapies and private dental care).
Health insurance funds offer hospital covers and ancillary covers and a combination of these.
Private health insurance is provided through organisations registered under the National Health Act 1953. There are two types of private health funds: restricted membership organisations (such as employees of a particular firm or industry) and funds open to the general public.
Private health insurance funds are registered with and monitored by the Private Health Insurance Administration Council, a statutory authority. Private health insurance providers adhere to the the Private Health Insurance Code of Conduct, a voluntary, self-regulatory industry code.
The Private Health Insurance Ombudsman deals with inquiries and complaints about any aspect of private health insurance. The Private Health Insurance Ombudsman is an Australian Government agency but acts independently in dealing with complaints and is independent of the private health funds and health service providers.
Australians under 65 years of age, eligible for full Medicare benefits, enjoy the Federal Government's 30% rebate on private health insurance premiums. The rebate is 35% for people aged between 65 and 69 and 40% for those aged 70 and over.
Australians who took out hospital cover before 1 July 2000 and maintain it, only pay a base rate regardless of their age, pursuant to the Federal Government's Lifetime Health Cover initiative.
Private health insurance organisations are regulated by the Federal Government to ensure affordable access to private health insurance for all through the principle of community rating. Pursuant to this principle, the insurance premium is the same regardless of the health status or claims history of a member or new member. Reinsurance supports the principle of community rating by sharing between health insurers the hospital and medical costs of high risk members admitted to hospital. Funds with a greater proportion of low risk members contribute into a reinsurance pool and those with a greater proportion of high risk members receive transfers from it.
At this link (http://www.healthdirectory.com.au/Health_insurance/), there are additional links to 45 private health insurance companies that operate in Australia.
Some of the biggest insurers are:
Medibank Private (http://www.medibank.com.au/)
MBF Australia (http://www.mbf.com.au/)
Health Cover Fund (http://www.hcf.com.au)