How does the Australian healthcare system work?
Note that this is an extremely simplified explanation of the Australian Healthcare System. In reality, the system is much more intricate.
Australian healthcare system is undoubtedly one of the best in the world.
There are two parts to this:
Public system
- Which is fully funded through the State government and Medicare
Private system
- Most Australians will have some sort of private health insurance which will enable them to access the private health system.
- If your income is above a certain thresh-hold, you will be required to pay a ‘surcharge’ to the government if you do not hold private health insurance. This arrangement has been in place to encourage high income individuals to take out private health insurance and thus reduce the pressure off the public health system
What is Medicare?
- Medicare is Australia’s universal healthcare scheme.
- It is available to Australia citizens, permanent residents and people from countries with reciprocal agreements.
- Medicare covers the entire cost of public hospital services, services provided by GPs and specialists.
- The Medicare also includes the PBS or Pharmaceutical Benefits Scheme which provides subsidy on medicines.
How does the Private System work?
- Billing in a private healthcare system is slightly complicated with lots of rules and regulations. I am only going to talk about the very basics here, in a very simplified way.
- Say, you are having an outpatient Gastroscopy, for which the Specialist charges AUD100 from you.
- Medicare will contribute a pre-fixed amount eg AUD85
- Your private health insurance may contribute a part/full of the remaining AUD15, depending on your health insurance cover.
- Some specialists (or GPs) may choose to ‘Bulk’ or ‘Medicare’ bill- which means that they will only charge AUD85 for their services, which will come directly from Medicare (no out of pocket expenses).
Aussie IMG 