Model: Australia
uses a combination of a public universal health care system and a private
health care system. Australia’s universal public health insurance is called
Medicare. The federal government pays a large part of the cost based on patient
fee schedules. Typical situation is that 100% of general practitioner
covered, 85% specialist covered, and 100% of public hospital costs covered. The
remainder of health costs is paid by the patient (out of pocket) unless the provider
chooses bulk billing. There are also other subsidies and benefits that patients
maybe entitled to depending on income.
Medicare does NOT cover private patient hospital costs,
overseas hospital costs, clinically unnecessary medical services, and ambulance
services.
Multi-tier: Two tier
system à For those with the means
to, the government encourages private health insurance. Private health
insurance itself is split into three types of coverage: hospital cover, general
treatment cover, and ambulance cover. The three are usually combined together
for a cohesive package, although they can be taken piecemeal.
Private health insurance is provided by a number of private
health insurance organizations called health funds; the largest health fund
being, Medibank.
The government encourages private hospital cover through incentives:
- Lifetime
Health Cover: If a person has not taken out private hospital cover by 1
July after their 31st birthday, when (and if) they do so after this time,
their premiums must include a loading of 2% per annum. The loading applies
only to premiums for hospital cover, not to ancillary (extras) cover.
- Medicare
Levy Surcharge: People with taxable income greater than a specified amount
(in the 2011/12 financial year $80,000 for singles and $168,000 for
couples) and who do not have an adequate level of private hospital cover
must pay a 1% surcharge on top of the standard 2% Medicare Levy.
- Private
Health Insurance Rebate: The government subsidizes the premiums for all
private health insurance cover, including hospital and ancillary (extras),
by 10%, 20% or 30%.
Most aspects of private health insurance in Australia are
regulated by the Private Health Insurance Act 2007.
Funding: Medicare
is funded by a levy of 2% taxpayer income. There are exceptions for low-income
earners. An additional 1% Medicare levy surcharge is added for high-income individuals
without private health insurance. The rest of the balance is paid off by
government revenue.
History: Early on
public hospitals = charity medicine, while private hospitals = wealthy
treatment, community based = fee-for-service. 1901 health care regarded as a
state, though national govt. granted quarantine powers. Most individuals had to
pay for their own health care services, not including charity medicine from
public hospitals. Post-WWII national government started to play stronger role.
After facing stiff resistance from conservative elements and multiple failed
national health insurance proposals, the Labour government under PM Whitlam introduced
the new health care system, Medibank, in 1975. The Health Insurance Commission
(HIC) was established to administer Medibank. Patients could bill the schedule
fee to the HIC and claim back 85% OR doctors could bill the HIC directly for
their patients for 85% of schedule fee as full payment, a process known as
“bulk billing.” Hospitals made cost-sharing arrangements with the states as
long as patients were guaranteed universal free access to public hospitals.
The new
government Liberal Coalition government (1975-1982) added the option to opt out
of Medibank and purchase private health insurance. Those part of Medibank had a
2.5% levy placed on them. System of health reestablished later and called
Medicare = subsidized access to doctor of choice (out of hospital), free public
hospital care, and subsidized pharmaceuticals.
Cost per capita: Latest
Wiki $3,866
Obama Care Comparison
Obama Care coverage has four different groups: employer
based, Government (Medicare & Medicaid), Market purchased insurance, and No
coverage.
Employer based is an old American system that will remain
mostly the same under the Affordable Care Act (ACA). The minute difference
being caps on out of pocket expense and free preventative care.
*Government requires companies with 50 or more full time
employees to offer employer based health insurance
Medicare remains mostly the same. Medicaid will cover will
expand depending on state legislature.
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