We’re going out on a limb and say that Australia has the most efficient (if not the best) healthcare system in the world. What makes this effective is the funding model (albeit with divided political opinions) which dynamically and economically services people across all demographics and financial standing.

How does it work?

Regulated by the Department of Health and funded by both state and federal entities, the Australian health care is a two pronged system made up of the public and private health sector.

The Public System

The public system is being taken care by Medicare which enable them access to GP (general practitioners) and hospital services. It provides financial assistance so that Australians can have low cost, if not free, access to medical and hospital care.

Under this, the government predominantly subsidizes the cost of medicines via the Pharmaceutical Benefits Scheme, a program of the government created for that purpose.

The Private System

The Private system provides access to a private treatment in either a public or private hospital or specialist services.

But there’s a catch. To allow them to private facilities, they need first to purchase a private health insurance, which levies a 1% tax on them. This takes off the burden and frees more room for the lower and middle class citizens to take advantage of the public system.

What Services Do I Have Access To?

The health care system enables citizens to have access on a wide range of services. In public hospitals, these include acute and moderately-acute care services, geriatric care for old people, palliative care for patients with serious illness, care for people with terminal illnesses, and emergency services.

What about Public Health Insurance?

Public health insurance is funded b by the government through Medicare. Instituted in 1984 and is administered by the federal government, it is additionally financed by a 2% tax levy on citizens earning above a threshold amount, and another 1% on high income earners without private health insurance. The rest is backed by the government.

If eligible, Medicare entitles citizens to a free treatment in a public hospital by general practitioners, free treatments by specialists if a GP refers the patient to a care plan, and claim benefits and payments for

What Do Private Insurance Have to Offer?

Currently, only 46% of Australians have private health insurance which can be purchased from any of the private providers. Unlike its public counterpart, private insurance allows a patent to choose where they can be treated and by which doctor. These private practitioners are mainly out-of-hospital medical services.  A third of total government expenses on health care goes to private insurance.

How Much Will The Government Cover On My Bill?

The federal government shoulders the following expenses:

1. Cost of the patient’s health services as stated on the Medicare benefits schedule. It normally includes:

• 75% of general practitioner’s cost
• 85% of specialist’s
• 100% of public in-hospital costs.

2. Other concessions or benefits the patient may be entitled to

3. Further benefits if they reach the Extended Medicare safety net general threshold, of which it will cover either 80% of the out of pocket costs or the benefit cap, whichever is the lower amount.

The remainder of the costs is then shouldered by the patient. Unless he/she goes for a bulk billing.

What Is Bulk Billing?

The patient may have an option to have a provider bill Medicare directly for any medical or health service the patient receives, this is called bulk billing. In this type of arrangement, two things happen:

1. A health care provider accepts the related Medicare benefit as complete payment for the service, and
2. Patient appoints their entitlement to a Medicare benefit to the servicing provider, allowing the benefit to be paid directly to the provider.

If a practitioner accepts bulk billing for a service, he/she undertakes to accept the related Medicare benefit as complete payment for the service. He/she cannot raise additional charges for that service.