Omari Gates
Australia's healthcare system is one of the best in the world, providing safe and affordable healthcare for all Australians. It is jointly run by all levels of Australian government – federal, state, and territory, and local. The system is a mix of public and private healthcare, with the public system providing free or low-cost access to healthcare services for eligible patients, and the private system offering choice outside the public system. Medicare is the main funding source for health services in Australia and the universal healthcare system, providing free public hospital care and substantial coverage for physician services and pharmaceuticals for Australian citizens, permanent residents, and people from countries with reciprocal benefits.
| Characteristics | Values |
|---|---|
| Type of system | Shared public-private model |
| Administered by | All levels of Australian government – federal, state, territory, and local |
| Funding sources | Government funding, private health insurance, and out-of-pocket payments by patients |
| Main funding source | Medicare, the national single-payer funding model |
| Medicare eligibility | Australian citizens, permanent residents, New Zealand citizens, and people from countries with Reciprocal Healthcare Agreements |
| Medicare coverage | Public hospital care, physician services, pharmaceuticals, and other services like GP visits, physiotherapy, community nursing, and basic dental services for children |
| Medicare components | Medicare Benefits Schedule (MBS), National Health Reform Agreement (NHRA), Pharmaceutical Benefits Schedule (PBS), and My Aged Care (MAC) |
| PBS coverage | Makes certain prescription medications cheaper, with further rebates for those with concession cards or high medicine expenses |
| Private health insurance | Encouraged through tax surcharges; the government contributes a rebate towards the premium for those with Medicare |
| Primary health networks (PHNs) | 31 organisations that coordinate health services in local areas, supporting community health centres, hospitals, GPs, nurses, and specialists |
| Specialist care | Pathology, imaging, diagnostic services, mental health services, cancer treatment, palliative care, and more |
| Emergency care | Dial triple zero (000) for an ambulance in a medical emergency; Emergency Departments (EDs) are mostly found in public hospitals |
| Health promotion and protection | Immunisation, vaccination, healthy lifestyle initiatives, cancer screening, and disease prevention programs |
| Life expectancy | One of the longest in the world |
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What You'll Learn
Public vs. private healthcare systems
Australia's healthcare system is a shared public-private model underpinned by the Medicare system, the national single-payer funding model. The public system is made up of public hospitals, community-based services, and affiliated health organisations largely owned and governed by state and territory governments. Australian citizens, permanent residents, and people from countries with Reciprocal Health Care Agreements (RHCA) can access care within the public health system for free or at a lower cost through Medicare (funded by tax). Medicare covers all of the cost of public hospital services and some or all of the costs of other health services, including GP services and some medical specialists.
The private system includes health service providers that are owned and managed privately, such as private hospitals, specialist medical and allied health, and pharmacies. Private health insurance gives Australians choice outside the public system, and while it is not compulsory, Australians are encouraged to buy it in addition to having Medicare. There are many different types of private health insurance policies, and different policies cover different costs, so it is important to understand your policy and whether you need to pay anything extra for your hospital visit. If you have private health insurance, you can choose to be treated in a public or private hospital. You can also choose to be a private patient in a private hospital even without private health insurance, but you will have to pay most of the fees yourself.
The Australian, state and territory, and local governments share responsibility for running the health system. The federal government pays for the cost of healthcare under the Medicare system, and the public hospital system is funded by the government, but also by health insurance when patients choose to use their private cover in a public hospital. State and territory governments fund most of the spending for community health services, and the Australian Government and state and territory governments share funding for public hospital services. The federal Minister for Health sets national health policy and may attach conditions to funding provided to state and territory governments. The funding model for healthcare in Australia has seen political polarisation, with governments being crucial in shaping national healthcare policy.
In 2016-17, Australia spent nearly $181 billion on health, about 10% of the gross domestic product. The Australian Government usually funds most of the spending for medical services and subsidised medicines. It also funds most of the $5.5 billion spent on health research in Australia in 2016-17.
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Medicare and universal healthcare
Medicare is the main funding source for health services in Australia and the universal healthcare system. It has been Australia's universal healthcare scheme since 1984. It is available to Australian and New Zealand citizens, permanent residents in Australia, and people from countries with reciprocal agreements.
Medicare covers all of the cost of public hospital services and some or all of the costs of other health services, including GP services, medical specialists, physiotherapy, community nurses, and basic dental services for children. It is made up of four distinct programs, each run by Services Australia:
- The Medicare Benefits Schedule (MBS), which subsidises a portion of each 'episode' of a health service.
- The National Health Reform Agreement (NHRA), which covers the cost of treatment in state and territory facilities, such as hospitals, by sharing the cost between the Australian Government and state and territory governments.
- The Pharmaceutical Benefits Schedule (PBS), which assists with the costs of some medicines and therapies. Without the PBS, medicines would be much more expensive.
- My Aged Care (MAC), which provides contributions towards the cost of aged care services.
The Medicare Benefits Schedule (MBS) is a list of all health services that the government subsidises. The MBS has a safety net, which helps to make sure you pay less for services once you reach a certain amount of out-of-pocket costs.
The Pharmaceutical Benefits Scheme (PBS) is another important part of Medicare. The PBS makes some prescription medicines cheaper. Independent medical experts advise on what is added to the PBS, and over 5,200 products are listed. People with certain concession cards or those who spend a lot on medicine can also receive further rebates.
Australia's health system operates under a shared public-private model underpinned by the Medicare system. State and territory governments operate public health facilities where eligible patients receive care free of charge. Primary health services, such as GP clinics, are mostly privately owned but attract Medicare rebates. Australian citizens, permanent residents, and some visitors and visa holders are eligible for health services under the Medicare system.
The public system includes public hospitals, community-based services, and affiliated health organisations, largely owned and governed by state and territory governments. The private system includes health service providers that are owned and managed privately, such as private hospitals, specialist medical and allied health, and pharmacies. The public system is funded by local, state, and federal governments, while the private system is funded by private health insurance. Many Australians have private health insurance, and the government provides a means-tested rebate to help with the cost.
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Funding and costs
Australia's health system is jointly run by the federal, state, territory, and local governments, along with private health insurers and individuals. The funding model for healthcare in Australia has witnessed political polarisation, with governments playing a crucial role in shaping national healthcare policy.
The public health system is funded by local, state, and federal governments, while the private system is funded by private health insurance, with individuals contributing towards the cost of their healthcare. Medicare is the main funding source for health services in Australia and the universal healthcare system. It is available to Australian citizens, permanent residents, and people from countries with reciprocal agreements. Medicare covers the cost of public hospital services and some or all of the costs of other health services, including GP visits, medical specialists, physiotherapy, community nurses, and basic dental services for children. The Pharmaceutical Benefits Scheme (PBS) under Medicare makes certain prescription medications more affordable. The PBS does not cover all medications and does not cover the full cost of medications it does cover. The National Health Reform Agreement (NHRA) covers the cost of treatment in state and territory facilities, such as hospitals, by sharing the cost between the Australian Government and state and territory governments. My Aged Care (MAC) provides contributions towards the cost of aged care services.
The federal government also regulates private health insurance, pharmaceuticals, and therapeutic goods. It provides a rebate towards the premium for private health insurance and charges a tax penalty on higher-income households that do not purchase private insurance. State and territory governments regulate and administer doctors, public hospitals, and ambulance services. They contribute their own funding for public hospitals, ambulances, public dental care, community health, and mental health care, in addition to federal funding. Local governments play a role in delivering community health and preventive health programs, such as immunizations, and regulating food standards.
The National Disability Insurance Scheme (NDIS) provides a national platform for individuals with disabilities to access funding and resources for medical management and social support. The Better Access Scheme within Medicare supports access to mental health services. Additionally, there are programs within Medicare that cater to the healthcare needs of Aboriginal and Torres Strait Islander Australians, as well as rural and remote populations.
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Hospitals and emergency care
Australia's health system is jointly run by the federal, state, and territory governments, and local authorities. The system is a mix of public and private healthcare, with the public system funded by the government and the private system funded by a combination of private health insurance and out-of-pocket payments.
The public health system includes public hospitals, community-based services, and affiliated health organisations, largely owned and governed by state and territory governments. Australian citizens, permanent residents, and people from countries covered by Reciprocal Health Care Agreements (RHCAs) can access care within the public health system for free or at a lower cost through Medicare, which is funded by taxes. Medicare covers the cost of public hospital services and some or all of the costs of other health services, such as GP visits, medical specialists, and community nurses.
Public hospitals provide high-quality medical care at low or no cost to people with access to Medicare. They are typically where individuals go in the case of a medical emergency. If non-urgent treatment is required, individuals can choose to be a public patient in a public hospital, but they may face longer wait times and may not be able to choose their doctor.
Private hospitals, on the other hand, are owned and managed privately. Individuals with private health insurance typically utilise the private system, although some may choose to use their insurance in a public hospital. Approximately half of Australians purchase private insurance to pay for private hospital care, dental services, and other services. The federal government encourages citizens to purchase private health insurance through tax incentives and penalties on higher-income households that do not have private insurance.
In the case of a medical emergency in Australia, individuals can dial triple zero (000) to request an ambulance. Medicare Urgent Care Clinics can also assist with non-life-threatening issues outside of normal business hours, such as minor infections, sprains, and back pain.
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Health services and providers
Australia's health system is jointly run by all levels of Australian government – federal, state, and territory, and local. It is a complex mix of service providers and other health professionals across a range of organisations. The system has two major parts: the public health system and the private health system.
Public Health System
The public health system is made up of public hospitals, community-based services, and affiliated health organisations, largely owned and governed by state and territory governments. Australian citizens, permanent residents, and people from countries covered by Reciprocal Health Care Agreements (RHCAs) can access care within the public health system for free or at a lower cost through Medicare, which is funded by taxes. Medicare covers all of the costs of public hospital services and some or all of the costs of other health services, including GPs, medical specialists, physiotherapy, community nurses, and basic dental services for children.
Public hospitals provide high-quality medical care at low or no cost to people with access to Medicare. They are usually the first point of call in an emergency. However, if you need non-urgent treatment and choose to be a public patient, you may need to wait longer for a space to become available, and you won't be able to choose your doctor.
Private Health System
The private system includes health service providers that are owned and managed privately, such as private hospitals, specialist medical and allied health, and pharmacies. It is funded by a combination of private health insurance and out-of-pocket payments by patients. Individuals are encouraged through tax surcharges to purchase private health insurance, and the government contributes a rebate towards this premium.
Medicare
Medicare is Australia's universal health care scheme and the main funding source for health services. It covers treatment as a public patient in a public hospital and 75% of the fee for doctors' services in hospitals if you're a private patient. It also includes the Pharmaceutical Benefits Scheme (PBS), which makes some prescription medicines cheaper. The PBS does not cover the full cost of all medications, and people with certain concession cards or high medicine costs can receive further rebates.
Primary Health Networks (PHNs)
PHNs are organisations that coordinate health services in local areas. There are 31 PHNs across Australia, supporting community health centres, hospitals, GPs, nurses, specialists, and other health professionals to improve patient care.
National Disability Insurance Scheme (NDIS)
The NDIS is a national platform that provides individuals with disabilities access to funding and resources for medical management and social support. It also offers support for family members to aid in caring for their loved ones.
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Frequently asked questions
The public health system and the private health system.
The public health system is made up of public hospitals, community-based services, and affiliated health organisations owned and governed by state and territory governments. Australian citizens, permanent residents, and people from countries with Reciprocal Health Care Agreements can access the public health system for free or at a lower cost through Medicare.
The private system includes health service providers that are owned and managed privately, such as private hospitals, specialist medical and allied health, and pharmacies. The private system is funded by a combination of private health insurance and out-of-pocket payments.
Medicare is Australia's universal health care scheme and the main funding source for health services in Australia. It covers the costs of public hospital services and some or all of the costs of other health services, including GP visits, medical specialists, physiotherapy, community nurses, and basic dental services for children. Medicare also includes the Pharmaceutical Benefits Scheme (PBS), which makes some prescription medicines cheaper.
To access healthcare in Australia, you can go through the public system, the private system, or a mix of both. If you are an Australian citizen or permanent resident, you can access the public system for free or at a lower cost through Medicare. If you are an international visitor, you generally won't have access to Medicare and will need to purchase private health insurance or pay out of pocket.
