Healthcare in Australia - National Health Policy

National Health Policy

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:

1. Whether the government subsidizes this service (based on the Medicare Benefits Schedule. Typically, 100% of in-hospital costs, 75% of General Practitioner and 85% of specialist services are covered.
2. Whether the patient is a concession or receives other benefits
3. Whether the patient has crossed the threshold for further subsidised the service (based on total health expenditure for the year)

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, 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 charging these (higher income) individuals a surcharge of 1% of income if they do not take out private health insurance, and a means-tested rebate. This is to encourage individuals who are perceived as able to afford private insurance not to resort to the strained public health system.

In addition, citizens of Australia are also often encouraged to use the private insurance system as a matter of convenience since "public hospitals may have long waiting lists, whereas you could get your treatment more swiftly in the private system."