- This article describes the Australian universal health scheme Medicare. For information about the Australian Government health agency, see Medicare Australia. This article describes the Australian Government agency known as Medicare Australia For similarly named programs in other countries, see Medicare.
Medicare is Australia's publicly-funded universal health care system, operated by the government authority Medicare Australia. For a topic outline on this subject see List of basic Australia topics. Universal health care is health care coverage which is extended to all eligible residents of a governmental region This article describes the Australian Government agency known as Medicare Australia Medicare is intended to provide affordable treatment by doctors and in public hospitals for all resident citizens and permanent residents except for those on Norfolk Island. Norfolk Island ( Norfuk: Norfuk Ailen) is a small inhabited island in the Pacific Ocean located between Australia, New Zealand Residents with a Medicare card can receive subsidised treatment from medical practitioners who have been issued a Medicare provider number, and fully subsidised treatment in public hospitals. A Medicare Card is Visitors from countries which have reciprocal arrangements with Australia have limited access to Medicare.
Since 1999, the public health scheme has been supplemented by a Private Health Insurance Rebate, where the government funds at least 30% of any private health insurance premium covering people eligible for Medicare. Including these rebates, Medicare is the major component of the total Commonwealth health budget, taking up about 43% of the total. The program is estimated to cost $18. 3 billion in 2007-08. [1] This figure is projected to rise by almost 4% annually in real terms over the next few years. [1]
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History
Medibank
Medicare, originally called Medibank, was introduced by the Whitlam Labor Government on 1 July 1975, at the commencement of the Health Insurance Act 1973. Edward Gough Whitlam, AC, QC (born 11 July 1916 known as Gough Whitlam (ˈɡɒf goff is an Australian former politician and 21st "July 1st" redirects here For the Ayumi Hamasaki song see H (song. Year 1975 ( MCMLXXV) was a Common year starting on Wednesday (link will display full calendar of the Gregorian calendar. The introduction of Medicare was fraught: the Senate rejected the changes multiple times and they were passed only at a joint sitting following the 1974 double dissolution election. The Senate is the upper of the two houses of the Parliament of Australia. Year 1974 ( MCMLXXIV) was a Common year starting on Tuesday (link will display full calendar of the 1974 Gregorian calendar. This article deals with elections to the Australian Parliament.
Despite this hostile response to its introduction, Medibank/Medicare was supported by subsequent governments and has become a key feature of Australia’s public policy landscape. The exact structure of Medicare, in terms of the size of the rebate to doctors and hospitals and the way it has administered, has varied over the years. Although considerable changes were enacted after the Whitlam government lost power, the Fraser Government reviewed Medibank and decided to retain it despite the Liberal Party’s previous opposition. John Malcolm Fraser, AC, CH (born 21 May 1930 is an Australian Liberal politician who was the 22nd Prime Minister of Australia. In October 1976 the parliament introduced a ‘Medicare levy’ to help fund the program, a measure the Liberal party had previously refused to support under the Whitlam government.
1 October 1976 also saw the introduction of Medibank Private, a complementary government-owned private health insurance fund that provides cover for health treatment not covered by the universal scheme (which was then referred to as 'Medibank Public'). Events 331 BC - Alexander the Great defeats Darius III of Persia in the Battle of Gaugamela. Year 1976 ( MCMLXXVI) was a Leap year starting on Thursday (link will display full calendar of the Gregorian calendar. Medibank Private competes with all other private health funds on a commercial basis. In 2006 the then Coalition government announced that Medibank Private would be privatised after the 2007 election, claiming a conflict of interest in being both the regulator of the whole private health insurance industry and the owner of its largest single competitor. Year 2006 ( MMVI) was a Common year starting on Sunday of the Gregorian calendar. The Coalition in Australian politics refers to a pragmatic grouping of Centre-right parties that has existed in the form of a coalition agreement since 1922 Federal elections for the Parliament of Australia were held on Saturday 24 November 2007 after a 6-week campaign in which 13 However the incoming Australian Labor Party government pledged that it would remain in government ownership.
Current program
The title ‘Medicare’ was introduced in 1984 by the Hawke Government. Robert James Lee (Bob Hawke, AC (born 9 December 1929 was the 23rd Prime Minister of Australia and longest serving Australian Labor Party Prime Minister The Hawke Government reversed many of the Fraser Government’s changes, and this change in title also reflects the introduction of what can be considered the current Medicare system.
Funding and legal framework
Program funding
The original Medibank program proposed a 1. 35% levy (with low income exemptions) but these bills were rejected by the Senate, and so Medibank was originally funded from general revenue. In October 1976, the Fraser Government introduced a 2. 5% levy.
The program is now nominally funded by an income tax surcharge known as the Medicare levy, which is currently set at 1. 5%. [2] An exemption applies to low income earners. In practice the levy raises only a fraction of the money required to pay for the scheme. If the levy was to fully pay for the services provided under the medicare banner then it would need to be set at about 8%.
There is an additional levy of 1. 0%, known as the Medicare Levy Surcharge, for those on high annual incomes ($50,000+, expected to be increased to $100,000+ in the 2008 federal budget) who do not have adequate levels of private hospital coverage. This was part of an effort by the former Howard Coalition Federal Government to encourage people towards private health insurance. The Liberal Party of Australia is an Australian political party.
Constitutional framework
Section 51 (xxiiiA) of the Commonwealth Constitution was inserted following the successful referendum of 1946. Constitution Alteration (Social Services 1946 proposed to extend the powers of government over a range of social services It gave the Federal Parliament power, subject to the Constitution, to make laws with respect to: The provision of maternity allowances, widows’ pensions, child endowment, unemployment, pharmaceutical, sickness and hospital benefits, medical and dental services (but not so as to authorize any form of civil conscription), benefits to students and family allowances.
This power supports the Commonwealth operating the Medicare program, but not the entire Australian health system. The authority to operate public hospitals remains the province of the State and Territory governments. In practice, the state governments, as well as private doctors, act as pseudo-contractors. This is done by a provider number system controlled by the Commonwealth.
Privately run hospitals are also part of the Medicare system. Medicare benefits are payable for medical treatment provided to admitted patients of private hospitals as well as public hospitals. However, a patient in a private hospital (by definition, a private patient) would need private insurance coverage to help him or her meet any of the hospital charges such as accommodation costs, as well as some or all of the remainder of the doctor's charges above the 75% Medicare benefit.
Components
Medicare Benefits Scheme
Medicare funds (or reimburses) expenses related to services provided by medical practitioners. Eye examinations by optometrists are also covered. An eye examination is a battery of tests performed by an Optometrist or Ophthalmologist assessing vision and ability to focus on and discern Dental treatment is excluded except for certain surgical procedures that can only be performed in hospital by specially trained maxillo-facial surgeons.
Medicare benefits are available on a restricted basis for allied health services (such as physiotherapy or speech therapy) under the Enhanced Primary Care program, however most allied health and alternative medicine services are excluded from Medicare. Allied health professions are clinical Healthcare professions distinct from Medicine and Nursing. Recently acupuncture provided by a medical practitioner has been included [3]. History Antiquity In China, the practice of acupuncture can perhaps be traced as far back as
Each Medicare procedure has an MBS Fee (Medicare Benefits Schedule fee).
- For in-hospital treatment, i. e. medical treatment provided to an admitted patient of a hospital (which usually excludes treatment provided in an outpatient or accident/emergency department of a hospital), Medicare pays 75% of the MBS Fee. [4] If the patient has private patient hospital insurance, that must cover them for the remaining 25% of the MBS Fee (subject to rules such as waiting periods). If the doctor charges above the MBS Fee, some or all of the remaining charge may be covered by the private health insurance depending on the fund's gap-cover arrangements.
- For out-of-hospital treatment, i. e. treatment provided to a person who is not an admitted patient of a hospital, Medicare pays 100% of the MBS fee for general practitioner consultations and 85% of the MBS fee for specialist consultations. A practitioner may choose bulk billing, and charge only the relevant percentage of the MBS fee and thus making the service free to the patient. Bulk billing is a payment option under the Medicare system of universal health insurance in Australia. Doctors are not forced to bulk-bill and have discretion in charging their patients. The law prevents private health insurance funds from providing any coverage for the remainder of the charge after the Medicare benefit has been paid.
Treatment in a public hospital as a public patient is fully subsidised by Medicare. Regardless of means, every Australian is entitled to attend a public hospital and receive medical treatment free of charge. However, there may be a considerable waiting list for elective surgery. Treatment and hospital accommodation is free to the patient. This is funded through the Commonwealth-State Health Care Agreements.
For private patients in public or private hospitals, Medicare will cover 75 per cent of the Medicare Schedule fee for medical procedures. Private patients still need private hospital coverage to help with accommodation costs and other hospital charges.
The major issues with this part of Medicare are:
- to medical professionals – the rate at which the scheduled fees are set and how accurately they reflect running costs/support profit margins
- to patients – the availability of a bulk-billing doctor (free doctor), particularly in rural and regional areas.
The 'bulk-billing rate' is the percentage of doctors providing a free service. The Department of Health and Ageing (Australia) monitors bulk billing rates (see external sources). The Department of Health and Ageing is an Australian Government department The number of bulk-billing doctors has decreased. Some doctors may not bulk-bill at all; may bulk-bill only existing patients; or may bulk-bill only patients who can not afford to pay medical fees out-of-pocket. Out-of-pocket expenses are direct outlays of cash which are not reimbursed Whilst the majority of general practitioner services are bulk billed, the rate is lower in more affluent areas and in rural, regional and remote areas of Australia where there is a greater shortage of doctors and health care services, and there has been a trend of declining bulk-billing rates, particularly in rural areas. This decline can be linked to the low level of the scheduled fees and doctor’s desire to maintain their profitability. However, increasing scheduled fees would increase the cost of the program.
Medicare Safety Net
Due to low rates of bulk-billing, the Howard Government, after the 2004 election, introduced the “Medicare Plus Safety Net”. This system reimburses 80% of out-patient expenses. For health card holders or Family Tax Benefit recipients, the threshold (for the year 2007) is $519. 50. For other individuals or registered families, the threshold (for the year 2007) is $1039. 00. These figures are revised annually.
Medicare and private health insurance
Debates regarding Medicare focus on the two-tier system and the role of private health insurance. Controversial issues include:
- Whether people with means should take up private health insurance
- Whether rebates/incentives should be given in terms of private health insurance
- People with health insurance still accessing the tax-payer funded public system rather than relying on their insurance.
- People with private health insurance are still required to pay a 1. 5% levy on their taxes regardless of their income and usage of the system.
People who take up private health insurance are currently rewarded in a number of ways. They receive a Private Health Insurance Rebate that subsidises 30% of their insurance premiums, increasing to 35% or 40% for people over 65. Critics say that the rebate is an unfair subsidy to those who can afford health insurance, claiming the money would be better spent on public hospitals where it would benefit everyone. Supporters say people must be encouraged into the private health care system, claiming the public system is not universally sustainable for the future. Similarly, even after the introduction of the rebate, most private health insurance organisations have raised their premiums most years[1], somewhat negating the benefit of the rebate.
Approximately 43% of Australians also retain private health insurance, even though they are already entitled to free treatment in public hospitals. The major reasons for taking up health insurance despite the free public system are:
- Shorter waiting lists in private hospitals (especially for procedures such as joint reconstructions or heart bypass surgery, for which there are often long waiting times in public hospitals).
- Choice of hospital/physician in the private system;
- Improved accommodation facilities such as private rooms (although medical facilities are usually more extensive in the public system).
Some people choose to have private coverage for ancillary treatment, or "extras", (e. g. chiropractic, dental, optical, ambulance, etc - for which Medicare has limited or no cover) but use the Medicare system for hospital treatment.
The proportion of Australians with private health insurance was declining, but has increased again with the introduction of Lifetime Health Cover (where people who take out private hospital insurance later in life pay higher premiums than those who have held coverage since they were younger) and tax incentives to take out private cover (such as the Medicare Levy Surcharge).
Other health care programs
Pharmaceutical Benefits Scheme
The Pharmaceutical Benefits Scheme (PBS) subsidises certain prescribed pharmaceuticals. The Pharmaceutical Benefits Scheme or PBS is a program of the Australian Government that provides subsidised prescription drugs to residents of Australia The Pharmaceutical Benefits Scheme or PBS is a program of the Australian Government that provides subsidised prescription drugs to residents of Australia The PBS pre-dates Medicare, being established in 1948. It is generally considered a separate health policy to 'Medicare'. However, the PBS is now administered by Medicare Australia (formerly the Health Insurance Commission) under the Health Insurance Act 1973, with input from a range of other bodies such as the Pharmaceutical Benefits Pricing Authority.
State/territory programs
State and Territory Governments also sometimes administer peripheral health programmes, such as free dentistry for school students and community sexual health programmes. Dentistry' is the "evaluation diagnosis prevention and/or treatment (nonsurgical surgical or related procedures of diseases disorders and/or conditions of the oral cavity Within the framework of WHO 's definition of Health as a state of complete physical mental and social well-being and not merely the absence of disease or infirmity reproductive
See also
- Medicare card (Australia), on the card itself
- Medicare (Canada)
- Medicare (United States)
- National Health Service
External links
- MEDICARE ephemera digitised and held by the National Library of Australia
- Department of Health and Ageing Bulk Billing Rates
- APH Background Briefing on Medicare
- Medicare Benefits Schedule Online contains a searchable index of all fees
References
- ^ a b General Government Expenses, Budget 2007-08. A Medicare Card is This article refers to medicare a name for Canada's publicly-funded health insurance system for hospital and physician services This article refers to Medicare, a United States health insurance program The National Health Service is the name commonly used to refer to the four Publicly-funded healthcare systems of the United Kingdom collectively or individually (although
- ^ Australian Taxation Office (19th June, 2007). What is the Medicare levy?. Retrieved on 2008-02-15. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 590 - Khosrau II is crowned as king of Persia 1637 - Ferdinand III becomes Holy Roman Emperor
- ^ MBS Online
- ^ Medicare Australia (2nd November, 2007). How does Medicare work?. Retrieved on 2008-02-16. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 1249 - Andrew of Longjumeau is dispatched by Louis IX of France as his ambassador to meet with the Khan of the Mongols
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