How does the Australian health system fund and provide healthcare?
The role of Medicare, the Pharmaceutical Benefits Scheme, the National Disability Insurance Scheme and private health insurance in promoting health and wellbeing, and how each promotes funding, sustainability, access and equity
VCE HHD Unit 3 AoS 2 on Medicare, the PBS, the NDIS and private health insurance and how each promotes funding, access and equity.
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What this dot point is asking
This dot point asks you to describe Medicare, the PBS, the NDIS and private health insurance, and to evaluate each against four criteria: funding, sustainability, access and equity. You must know what each scheme covers, what it does not cover, and how it helps or hinders these four areas.
Medicare
Medicare is Australia's universal public health insurance scheme, giving citizens and permanent residents access to free or subsidised medical care. It is funded by the Medicare levy (a percentage of taxable income), the Medicare levy surcharge on higher earners without private cover, and general taxation.
Medicare covers consultations with doctors, tests and examinations, and treatment in a public hospital as a public patient. It does not cover most dental, ambulance, glasses, physiotherapy or treatment as a private patient. The bulk-billing system lets a doctor accept the Medicare benefit as full payment so the patient pays nothing.
The Pharmaceutical Benefits Scheme (PBS)
The PBS subsidises the cost of a wide range of prescription medicines so they are more affordable. Patients pay a set co-payment and the government pays the rest, with a lower co-payment for concession card holders. The PBS Safety Net reduces the cost of medicines further once a person or family reaches a spending threshold in a year.
The National Disability Insurance Scheme (NDIS)
The NDIS provides funding and support to eligible people with a permanent and significant disability, helping them access services, equipment and support to participate in everyday life. It is individualised, so funding is based on each person's needs and goals.
Private health insurance (PHI)
Private health insurance is optional cover that individuals can buy. Hospital cover allows treatment as a private patient with a choice of doctor and shorter waits for elective surgery; extras (ancillary) cover helps pay for services Medicare does not, such as dental, optical and physiotherapy. Government incentives include the rebate, Lifetime Health Cover loading and the Medicare levy surcharge.
When evaluating, name the scheme, state what it provides, then assess it against funding, sustainability, access and equity with a specific example.
Exam-style practice questions
Practice questions written in the style of VCAA exam questions on this dot point, with worked answer explainers. The year tag is the paper they imitate, not the source.
2023 VCAA8 marksa. Identify two services covered by Medicare. (2 marks)
b. In relation to funding and equity, discuss how Medicare promotes the health and wellbeing of Australians. Refer to a different dimension of health and wellbeing in each part of the answer. (4 marks)
c. Private health insurance can be expensive. Outline two reasons why Australians may choose to purchase private health insurance. (2 marks)
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Part a (2 marks): Name any two, for example consultations with a general practitioner, and tests/examinations needed to treat illness such as X-rays and pathology (1 mark each). Public hospital treatment as a public patient is also acceptable.
Part b (4 marks): Funding (about 2 marks) - Medicare is funded mainly through the Medicare levy (2% of taxable income) and general taxation, which spreads the cost across the population so that treatment is affordable; this reduces stress about medical bills, promoting mental health and wellbeing. Equity (about 2 marks) - Medicare gives all eligible Australians access to bulk-billed or subsidised care regardless of income, so disadvantaged groups can still see a doctor and treat illness, improving physical health and wellbeing. Use a different dimension in each part.
Part c (2 marks): Two reasons, for example avoiding long public waiting lists for elective surgery, and choice of doctor and private hospital, plus avoiding the Medicare Levy Surcharge or Lifetime Health Cover loading (1 mark each).
2022 VCAA6 marksa. Outline two aspects of the National Disability Insurance Scheme (NDIS). (2 marks)
b. Describe how the NDIS promotes health and wellbeing in terms of both equity and access. (4 marks)
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Part a (2 marks): Two aspects, for example the NDIS provides funding and support to eligible Australians under 65 with a permanent and significant disability (1 mark), and it is individualised, with participants receiving a tailored plan to fund supports that help them pursue their goals (1 mark).
Part b (4 marks): Equity (about 2 marks) - the NDIS directs extra resources and individualised funding to people with disability, a group with greater need, helping to reduce the health gap between them and the rest of the population, which promotes fairness and improves their health and wellbeing. Access (about 2 marks) - by funding aids, equipment, therapy and support workers, the NDIS removes financial and practical barriers so participants can obtain the services they need, when and where they need them, improving physical and social health and wellbeing. Address both equity and access explicitly.