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Australian Healthcare: Medicare & Healthcare System

Disabled World: Revised/Updated: 2015/03/16

Synopsis: Information on the Australian Medicare and Healthcare System including the universal health insurance program.

Main Document

Medicare Australia

Australian Medicare plays an integral role in the Australian health sector. Australian Medicare's objective is to assist in providing health outcomes in Australia through a number of different programs. The programs associated with Australia's Medicare system include:

Health care - (healthcare) is defined as the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings. Health care is delivered by practitioners in allied health, dentistry, midwifery (obstetrics), medicine, nursing, optometry, pharmacy, psychology and other health professions. It refers to the work done in providing primary care, secondary care, and tertiary care, as well as in public health.

Primary care - Refers to the work of health professionals who act as a first point of consultation for all patients within the health care system.

Secondary care - The health care services provided by medical specialists and other health professionals who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists.

Tertiary care - Specialized consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.

Quaternary care - The term quaternary care is sometimes used as an extension of tertiary care in reference to advanced levels of medicine which are highly specialized and not widely accessed.

Home and community care - Many types of health care interventions are delivered outside of health facilities. They include many interventions of public health interest, such as food safety surveillance and distribution of needle-exchange programs for the prevention of transmissible diseases.

  • Australia's universal health insurance program, Medicare (including the compensation recovery program for Medicare and nursing home benefits)
  • Pharmaceutical Benefits Scheme
  • Australian Government 30% Private Health Insurance Rebate
  • Special Assistance Schemes (including Bali 2005 Special Assistance, London Assist, Tsuanami Healthcare Assistance Scheme and Balimed)
  • Australian Childhood Immunization Register
  • Australian Organ Donor Register
  • General Practice Immunization Incentives Scheme
  • Practice Incentives Program
  • Rural Retention Program HECS Reimbursement Scheme and General Practice Registrars' rural Incentive Payments Scheme
  • Claims processing and payments for the Department of Veterans' Affairs (including the Repatriation Pharmaceutical Benefits Scheme), the Office of Hearing Services and the Department of Western Australia.
  • Family Assistance Office in partnership with other Australian government agencies.

Medicare Australia is a prescribed agency working under the Financial Management and Accountability act of 1997.

It is a statutory agency under the Public Service Act of 1999 within the Department of Human Services. Medicare Australia works in partnership with the Department of Health and aging to achieve the government's Health Policy objectives. Medicare's activities are conducted within the Australian government's policy framework, set by the Department of Health and aging, the Department of Veteran's Affairs, as well as the Department of Families, Housing, Community Services and Indigenous Affairs and additional, relevant legislation.

Medicare for Individuals

Medicare Australia is a customer-focused organization that delivers government health programs to individuals in Australian communities. There are a number of programs offered through the Australian Medicare system; these include Medicare coverage itself, Pharmaceutical benefits, and the Australian Childhood Immunization Register. Other programs include the Australian Organ Donor Register, the National Bowel Cancer Screening Program (NBCSP), as well as the External Breast Prosthesis Reimbursement Program.

Medicare Australia contributes to the quality of health care in Australia via efficient payments, as well as through its expertise in health information and electronic business. They continue to protect both consumer privacy and confidentiality where personal health information is concerned. Medicare Australia uses both current and emerging technologies in order to improve customer service, as well as to assist consumers with connecting to the health sector. Over a twenty-five year period of time, Australia's Medicare system has become one of Australia's most trusted, experienced and dependable government agencies. The system has nearly six-thousand staff members throughout Australia serving in National and State headquarters and two-hundred and thirty-eight offices.

Aged Care

It is estimated that on any particular day one in every one-hundred Australians receives care in a residential care service, or through a community care package. Medicare Australia administers greater than six-billion dollars worth of Aged Care payments each year to approved providers across a range of community, residential, and flexible Aged Care programs. Medicare Australia's Aged Care payment responsibilities involve both the processing and payment of a number of things, including:

  • residential Aged Care subsidies and associated supplements for provision of high-level and low-level residential care
  • residential respite care subsidies and associated supplements for provision of short-term high-level and low-level residential care, to provide carers with relief from their caring role
  • community Aged Care package subsidies for provision of support to people with low-level complex health needs and their carers, to enable them to remain at home
  • flexible Aged Care subsidies including:
  • Extended Aged Care at home subsidies for provision of support to people with high-level complex health needs and their carers, to enable them to remain at home
  • Extended Aged Care at home dementia subsidies for provision of dementia specific support to people with high-level complex health needs and their carers, to enable them to remain at home
  • Transition care subsidies for provision of short-term rehabilitation care to recipients after care in hospital, pending access to longer term care.

The Australian Health System

The Australian Health System, widely regarded as being world-class in terms of its efficiency and effectiveness, is a mixture of both private and public sector health services providers and a range of funding and regulatory systems. These involve:

  • 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 health care providers, including regulation of health professionals and private hospitals.
  • Private practitioners including general practitioners, specialists and consultant physicians.
  • Profit and non-profit organizations and voluntary agencies.

Funding on the part of the Australian Government includes three major national subsidy schemes; Medicare, the Pharmaceutical Benefits Scheme, as well as the thirty-percent Private Health Insurance Rebate. The Pharmaceutical Benefits Scheme and Medicare cover every Australian, subsidizing their payments for private medical services, as well as for a large portion of their prescription medications. Under Medicare, the Australian and State Governments jointly fund public hospital services, providing free services to Australians who choose to receive treatment as public patients. While these options are available to Australians, government funding of the thirty-percent Rebate, as well as additional key incentives, support citizens choice to pursue and retain private health insurance.

Individuals make contributions to the health care system via taxation and the Medicare levy which is based upon their income, as well as through private financing such as through private health insurance. The goal of the National Health Care funding system is to provide every Australian, despite their personal circumstances, access to health care at an affordable cost or potentially at no cost, while presenting the opportunity for choice among individuals through substantial private sector involvement in delivery and financing. People make their contribution to the health care system through taxes and the Medicare levy based on their income, and through private financing such as private health insurance.



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