Health care in Australia is provided by both private and government institutions. The Minister for Health and Ageing, currently Nicola Roxon, administers national health policy. Primary health care remains the responsibility of the federal government, elements of which (such as the operation of hospitals) are overseen by individual states.
In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidizes prescription medications. In 2007-08, Australia spent 9.1% of GDP on health care, or A$4874 per capita.[1]
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The life expectancy of Australia in 1999-2001 was 79.7 years (77.0 years for males and 82.4 years for females). The infant mortality rate of Australia in 2000 was 5.2 per 1,000. The death rate of Australia in 2000 was 6.7 deaths per year per 1,000 people. The neonatal infant mortality rate of Australia in 2000 was 3.5 per 1,000. The postneonatal infant mortality rate of Australia in 2000 was 1.7 per 1,000.
Health care in Australia is universal. The federal government pays a large percentage of the cost of services in public hospitals. This percentage is calculated on:
Where the government pays the large subsidy, the patient pays the remainder out of pocket, unless the provider of the service chooses to use bulk billing, charging only the scheduled fee, leaving the patient with no extra costs. In some countries, this is commonly referred to as a copayment. Where a particular service is not covered, such as dentistry, optometry, and ambulance transport,[3] the patient must pay the full amount (unless they hold a Low Income Earner card, which may entitle them to subsidised access).
Individuals can take out private health insurance to cover out-of-pocket costs, with either a plan that covers just selected services, to a full coverage plan. In practice, a person with private insurance may still be left with out-of-pocket payments, as services in private hospitals often cost more than the insurance payment.
The government encourages individuals with income above a set level to privately insure. This is done by the those individuals being obliged to pay a surcharge of 1% of income if they do not taking out private health insurance, and a means-tested rebate. This is to encourage individuals who are perceived as being able to afford private insurance not to resort to the strained public health system.
The public health system is called Medicare, which funds free universal access to hospital treatment and subsidised out-of-hospital medical treatment. It is funded by a 1.5% tax levy on taxpayers with incomes above a threshold amount, an extra 1% levy on high income earners without private health insurance, as well as general revenue.[4]
The private health system is funded by a number of private health insurance organizations. The largest of which is Medibank Private, which is government-owned, but operates as a government business enterprise under the same regulatory regime as all other registered private health funds. The Coalition Howard government had announced that Medibank would be privatised if it won the 2007 election, however they were defeated by the Australian Labor Party under Kevin Rudd which had already pledged that it would remain in government ownership.
Some private health insurers are 'for profit' enterprises, and some are non-profit organizations such as HCF Health Insurance. Some have membership restricted to particular groups, some focus on specific regions - like HBF which centres on Western Australia, but the majority have open membership as set out in the PHIAC annual report. Membership to most of these funds is also accessible using a comparison websites or the decision assistance sites. These sites operate on a commission-basis by agreement with their participating health funds and allow consumers to compare policies before joining online.
Most aspects of private health insurance in Australia are regulated by the Private Health Insurance Act 2007. Complaints and reporting of the private health industry is carried out by an independent government agency, the Private Health Insurance Ombudsman.[5] The ombudsman publishes an annual report that outlines the number and nature of complaints per health fund compared to their market share.[6]
The private health system in Australia operates on a "community rating" basis, whereby premiums do not vary solely because of a person's previous medical history, current state of health, or (generally speaking) their age (but see Lifetime Health Cover below).[7] Balancing this are waiting periods, in particular for pre-existing conditions (usually referred to within the industry as PEA, which stands for "pre-existing ailment"). Funds are entitled to impose a waiting period of up to 12 months on benefits for any medical condition the signs and symptoms of which existed during the six months ending on the day the person first took out insurance. They are also entitled to impose a 12-month waiting period for benefits for treatment relating to an obstetric condition, and a 2-month waiting period for all other benefits when a person first takes out private insurance.[7] Funds have the discretion to reduce or remove such waiting periods in individual cases. They are also free not to impose them to begin with, but this would place such a fund at risk of "adverse selection", attracting a disproportionate number of members from other funds, or from the pool of intending members who might otherwise have joined other funds. It would also attract people with existing medical conditions, who might not otherwise have taken out insurance at all because of the denial of benefits for 12 months due to the PEA Rule. The benefits paid out for these conditions would create pressure on premiums for all the fund's members, causing some to drop their membership, which would lead to further rises, and a vicious cycle would ensue.
There are a number of other matters about which funds are not permitted to discriminate between members in terms of premiums, benefits or membership - these include racial origin, religion, sex, sexual orientation, nature of employment, and leisure activities. Premiums for a fund's product that is sold in more than one state can vary from state to state, but not within the same state.
The Australian government has introduced a number of incentives to encourage adults to take out private hospital insurance. These include:
Medicare Australia is responsible for administering Medicare, which provides subsidies for health services. It is primarily concerned with the payment of doctors and nursing staff, and the financing of state-run hospitals.
The Pharmaceutical Benefits Scheme provides subsidised medications to patients. The level of subsidy depends on the above noted tests. Low income earners may receive a card that entitles the holder to cheaper medicines under the PBS. A National Immunisation Program Schedule that provides many immunisations free of charge by the federal government, the Australian Organ Donor Register, a national register which registers those who elect to be organ donors. Registration is voluntary in Australia and is commonly recorded on a driver's licence or proof of age card are also managed by the federal government.
The Therapeutic Goods Administration is the regulatory body for medicines and medical devices in Australia. At the borders the Australian Quarantine and Inspection Service is responsible for maintaining a favourable health status by minimising risk from goods and people entering the country.
The Australian Institute of Health and Welfare (AIHW) is Australia's national agency for health and welfare statistics and information. Its biennial publication Australia's Health is a key national information resource in the area of health care. The Institute publishes over 140 reports each year on various aspects of Australia's health and welfare.
Public Hospitals Each state is responsible for the operation of public hospitals.
Healthcare Initiatives State based projects are regularly setup to target specific problems such as breast cancer screening programs, indigenous youth health programs or school dental health
The Australian Red Cross collects blood donations and provides them to Australian Healthcare Providers. Other health services such as Medical imaging (MRI and so on) are often provided by private corporations, but patients can still claim from the government if they are covered by the Medicare Benefits Schedule.
In an international comparative study of the health care systems in six countries (Australia, Canada, Germany, New Zealand and the United States), found that "Australia ranks highest on healthy lives, scoring first or second on all of the indicators," although its overall ranking in the study was below the UK and Germany systems, tied with New Zealand's and above those of Canada and the U.S.[9][10]
A global study of end of life care, conducted by the Economist Intelligence Unit, part of the group which publishes the Economist magazine, published the compared end of life care, gave the highest ratings to Australia and the UK out of the 40 countries studied, the two country's systems receiving a rating of 7.9 out of 10 in an analysis of access to services, quality of care and public awareness.[11]
Indigenous Australian health and wellbeing statistics indicate Aboriginal Australians are much less healthy than the rest of the Australian community. One leading indicator, infant mortality rates, including stillbirths and deaths in the first month of life, show Aboriginal child mortality is twice as high as non-indigenous child mortality.[12] Another revealing statistic is the 17-year gap in average life expectancy between indigenous and other Australians.
Cigarette smoking is the largest preventable cause of death and disease in Australia.[13] Australia has one of the highest proportions of overweight citizens in the developed nations in the world.[14]
Australian health statistics show that chronic disease such as heart disease, particularly strokes which reflects a more affluent lifestyle is a common cause of death.[12] Australians are prone to skin cancer with cancers affecting Queensland the most.[12]
Other issues include compensation for victims of asbestos exposure related disease and the slow development of HealthConnect. The provision of adequate mental health services and the quality of aged care, are other problems in some parts of the country.
14. Drury, V., & Inma, C. (2010) Exploring the need for cancer nurse coordinators in regional Western Australia: an action research study. Cancer Nursing. 33(1), E25-E30.
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