Australian Health System

Australian Health System

Like most developed healthcare systems around the world, the Australian health system is a maze of public and private health providers, facilities and organisations. The Australian Federal Government has the primary role of developing national policies, regulations and funding of Australia’s public healthcare system and universal health insurance, Medicare. The state/territory governments are responsible for the delivery & management of public health services and for maintaining direct relationships with the majority of healthcare providers.

In addition to the public health system, there is a private health system operated by private healthcare providers and funded by private patients who pay for the services they receive. This private system largely includes specialist medical providers such as Cardiologists, private Surgeons, Neurologists etc. However, it also includes General Practitioners who charge patients a fee for their service rather than accepting payment from Medicare.

Medicare

Medicare is Australia’s universal health insurance organisation. It is regulated, operated and funded by the Federal Government to ensure all Australian residents have access to quality healthcare regardless of their financial circumstances. Through Medicare, patients can access diagnostic imaging, pathology services, emergency care, and public hospital services (including select surgery) with no out of pocket cost. General Practitioners who choose to accept a set Medicare Rebate for their services can also be accessed with no out of pocket cost to the patient.

Private Health Insurance

Although underpinned by the public health system, approximately one third of Australian residents also opt to take out private health insurance. The private health insurance system assists Australian residents with out-of-pockets expenses relating to medical services such as dental, optical and physiotherapy etc, commonly known as ‘extras’ cover. Private hospital cover allows Australian residents to choose their medical professional of choice and avoid the public hospital system waiting periods for surgery.

*Currently private health insurance does not subsidise the expenses associated with attending a private billing General Practitioner. However, patients can still access a Medicare Rebate for these services leaving the patient out of pocket the gap amount between the rebate value and full service fee.

Common Terms:

Medical Benefits Schedule (MBS)

The MBS is the list of clinically relevant medical, diagnostic and allied health services paid for or subsidised by Medicare. Each item on the MBS has a set rebate value which Medicare will pay.

Pharmaceuticals Benefits Scheme (PBS)

The PBS is the list of prescription medications which are subsidised by the Federal Government to improve affordability and access for patients.

General Practitioner (GP)

GP’s are Australia’s specialist doctors in primary healthcare and are typically a patient’s first point of contact regarding any health concerns. GP’s are commonly referred to as a family doctor or family physician in other countries.

Specialist

Medical professionals such as Cardiologists, Oncologists and Urologists are specialists in their chosen field of medicine. Patients requiring access to specialist medical professionals often require a referral from their GP.

Allied Health

Allied health refers to a range of health providers such as physiotherapists, psychologists, diabetic educators, podiatrists, dieticians and exercise physiologists.

Bulk Billing

Occurs when a doctor accepts the Medicare Rebate directly from Medicare for medical services provided so patients do not incur any out-of-pocket expenses themselves.

Private Billing

Patients who are privately billed are paying the doctors fee in full. Patients will then receive the relevant rebate from Medicare for the service they received, subsidising part of the fee they were charged.

Mixed Billing

A practice that provides a combination of Bulk and Private billing services for which a selection of patients, for example children, pensioners and health care card holders will be Bulk billed.