The Australian healthcare system
Australia has a land mass roughly the same size as Western Europe or the USA (excluding Alaska). About 80% of the population live in cities resulting in large regions which have small, scattered settlements or are unpopulated.
Australia has one of the most affordable, accessible and comprehensive healthcare systems in the world. The Commonwealth Department of Health and Ageing promotes good health and ensure all Australians have access to key health and family services including:
- aged and community care services
- family and children's services
- disability programmes
- public health initiatives
- medicare and pharmaceutical benefits
- hospital and healthcare funding
- health services for Aboriginal and Torres Strait Islanders
- emergency services for people in crisis.
The Commonwealth has developed a broad policy of leadership and financing in health matters and focuses on the areas of public health, research and national information management while the states and territories are largely responsible for the delivery of public sector health services and the regulation of health workers in the public and private sectors.
The states and territories deliver public acute and psychiatric hospital services including school health, dental health, maternal and child health and environmental health programs.
All levels of government – plus consumers and the non-government sector – have some role in funding, administering or providing care for older people. Residential aged care is financed and regulated by the Commonwealth Government and provided mainly by the non-government sector (by religious, charitable and for-profit providers). The Commonwealth, states and territories jointly fund and administer community care (such as delivered meals, home help and transport).
Local government also plays an important role in the provision of services, for example through its responsibilities for sanitation and hygiene, food safety and water quality monitoring. This topic has a high political profile, with the prospect of recycled water and the water shortage around the world.
The Australian health system is widely regarded as being world-class, in terms of both its effectiveness and efficiency. The system is a mixture of public and private sector health service providers and a range of funding and regulatory mechanisms:
- the Australian Government, with the primary role of developing broad national policies, regulation and funding
- state and territory and local governments who are primarily responsible for the delivery and management of public health services and for maintaining direct relationships with most healthcare providers, including regulation of health professionals and private hospitals
- private practitioners including general practitioners, specialists and consultant physicians
- for-profit and non-profit organisations and voluntary agencies.
The Australian Government’s funding includes three major national subsidy schemes: Medicare, the Pharmaceutical Benefits Scheme and the 30% Private Health Insurance Rebate.
Medicare and the Pharmaceutical Benefits Scheme cover all Australians and subsidise their payments for private medical services and for a high proportion of prescription medicines. Under Medicare, the Australian and state governments also jointly fund public hospital services so they are provided free of charge to people who choose to be treated as public patients.
People make their contribution to the healthcare system through taxes and the Medicare levy based on their income, and through private financing such as private health insurance.
The aim of the national healthcare funding system is to give all Australians, regardless of their personal circumstances, access to health care at an affordable cost or at no cost, while allowing choice for individuals through substantial private sector involvement in delivery and financing.
Private health insurance can cover private and public hospital charges (public hospitals charge only patients who elect to be private patients in order to be treated by the doctor of their choice), and a portion of medical fees for inpatient services. Private insurance can also cover allied health/paramedical services (such as physiotherapist and podiatry services) and some aids and appliances (such as spectacles).
In addition to the Ministry of Health, NSW Health comprises Local Health Districts, the pillars, statutory health corporations and affiliated health organisations.
There are 15 Local Health Districts that are responsible for providing health services in a wide range of settings, from primary care posts in the remote outback to metropolitan tertiary health centres.
The Ambulance Service of NSW is responsible for providing responsive, high quality clinical care in emergency situations, including pre-hospital care, rescue, retrieval and patient transport services.
Websites of other public health organisations that provide statewide services are:
- Agency for Clinical Innovation
- Bureau of Health Information
- The Cancer Institute - a statutory body charged with substantially improving cancer control in NSW
- Children's Hospital Westmead
- Clinical Excellence Commission
- Justice Health & Forensic Mental Health Network
- The NSW Ambulance Service.
In both the public and private sectors the quality of health provided in Australia is high.
Most doctors are self-employed with a small proportion of salaried employees of Commonwealth, state or local governments. Salaried specialist doctors in public hospitals often have rights to treat some patients as private patients, charging fees to those patients and usually contributing some of their fee income to the hospital. Other doctors may contract with public hospitals to provide medical services. There are many independent pathology and diagnostic imaging services operated by doctors.
Public hospitals include hospitals established by governments and hospitals originally established by religious or charitable bodies but now directly funded by government. A small number of hospitals built and managed by private firms provide public hospital services under arrangements with state governments. Most acute care beds and emergency outpatient clinics are in public hospitals. Large, urban public hospitals provide most of the more complex type of hospital care such as intensive, care, major surgery, organ transplants, renal dialysis and specialist outpatient clinics.
Private hospitals are owned by for-profit or not-for-profit organisations such as large corporate or religious operators and private health insurance funds. Though in the past private hospitals tended to provide less complex non-emergency care, such as simple elective surgery they are increasingly providing complex, high technology services.
Separate centres for same-day surgery and other non-inpatient operating room procedures are found mostly in the private sector. Many public hospitals provide such services on the same sites as inpatient care.
NSW Health has been rolling out MPS (Multi-Purpose Service) facilities in the rural areas. These state of the art facilities are designed to replace existing facilities and house aged care, acute hospital care and community health services.
Specialised mental healthcare in the public sector is provided in separate psychiatric hospitals, general hospitals and community based settings. Historically, mental health services have operated separately to mainstream health services, but there have been many successful initiatives recently to mainstream mental health services.
Australia’s aged care system is structured around two main forms of delivery: residential (accommodation and various levels of nursing and/or personal care) and community care (ranging from delivered meals, home help and transport to intensive co-ordinated care packages for people who would otherwise need residential care). Residential services are mainly in the non-government sector, about half being operated by religious and charitable organisations.
Medicines or pharmaceuticals prescribed by doctors and dispensed in the community by independent private sector pharmacies are directly subsidised by the Commonwealth Pharmaceuticals Benefits Scheme (PBS). Public hospitals provide medicines free of charge and do not attract PBS subsidies. Non-prescription medicines are available from pharmacies and, in some cases, other suppliers such as supermarkets. The import and supply of medicines and medical devices is regulated by the Commonwealth Therapeutic Goods Administration (TGA) to ensure the quality, safety and effectiveness of the products.
For more information, please see: www.health.gov.au/ or www.health.nsw.gov.au/
Medicare was established on the understanding that all Australians should contribute to the cost of health care according to their ability to pay. It is financed through progressive income taxes and an income-related Medicare levy.
Medicare provides access to:
- free treatment as a public (Medicare) patient in a public hospital, and
- free or subsidised treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only)
- subsidies for prescribed medicines (with a safety net providing free medicines for the chronically ill).
Some services under Medicare and at public hospitals have long waiting lists - for this and other reasons many Australians have private medical insurance as well as being able to access the benefits of Medicare.
Medicare benefits are paid based on a comprehensive list of services and corresponding benefits; the Medicare Benefit Schedule (MBS). If the medical practitioner provides an eligible service such as a consultation at the MBS recommended fee the patient pays no fee at the point of care and this is often referred to as bulk billing. If the medical practitioner provides a service and elects to charge more than the MBS recommended fee the patient pays the higher fee and then claims back the MBS fee from Medicare.
Doctors in private practice are largely free to determine the number of rebateable services they provide and the fees they charge to patients.
More information about Medicare for health professionals is available using the Medicare eLearning service.
Medicare Provider Numbers
Any medical practitioner working in private practice in Australia must have a Medicare Provider Number. This will allow a doctor to:
- raise referrals for specialist services
- make requests for pathology or Diagnostic Imaging services
- prescribe medications.
Where the doctor satisfies the legislative requirements, their provider number may also be used to attract Medicare rebates for professional services rendered (that is, treatment of private patients).
International Medical Graduates (IMGs) are subject to Medicare Provider Number restrictions if they require the latter type of provider number listed above.
These Medicare Provider Number restrictions affect where an IMG can work in Australia and are determined by both residency status and when the IMG first registered in Australia.
Medicare Provider Numbers are issued by Medicare Australia, formerly known as the Health Insurance Commission (HIC), after an IMG has been offered a job and has obtained the relevant Medical Board registration.
Pharmaceutical Benefits Scheme
Australians have affordable access to a broad range of quality health services that are either free at the point of delivery or subject to substantial government rebates.
The two major national subsidy schemes, Medicare and the Pharmaceutical Benefits Scheme (PBS), subsidise payments for services provided by doctors and optometrists, and for many prescription medications bought from pharmacies.
Safety nets apply for Medicare and the PBS to protect Australians from high out-of-pocket costs for medical services and pharmaceuticals provided outside of hospitals. These two schemes are further integrated with social welfare arrangements, with larger rebates and/or lower safety net thresholds provided for individuals or families who receive certain income support payments (such as for unemployment or disability).
Additional information about the PBS can be found by accessing The PBS and You. This is a stand alone educational resource, comprising 33 units of education, that allows for individual, self-paced learning in the users own environment.
Are my family and I eligible to access Medicare benefits?
People who reside in Australia - excluding Norfolk Island - are eligible if they:
- hold Australian citizenship
- have been issued with a permanent visa
- hold New Zealand citizenship
- have applied for a permanent visa (excludes an application for a parent visa) — other requirements apply.
Reciprocal Health Care Agreements — the Australian Government has signed Reciprocal Health Care Agreements with some countries. Under these arrangements, residents of these countries are entitled to restricted access to health cover while visiting Australia. For more information go to the visitors travelling to Australia section of the Department of Human Services website.
How do I enrol?
To enrol in Medicare you need to fill out an enrolment form (PDF 193KB). Forms are also available from your local Medicare office.
If you haven’t yet applied for permanent residency in Australia or if you come here on a temporary visa, you should purchase health insurance cover to protect yourself and your family for any unforeseen medical expenses.
Australian private health insurance for overseas visitors is available from Australian registered health organisations, insurance brokers and general insurers.
