This page provides a general overview of the health care system in Australia. It includes information about:
The Australian Government provides health care insurance to citizens and permanent residents of Australia through Medicare. Under Medicare, you can receive free inpatient treatment in a public hospital. However, you can't choose your own doctor and you might have to wait for some services. Medicare also provides benefits for outpatient services, such as visits to GPs and specialists, but it doesn't cover dental, ambulance and private home nursing services.
Private health insurance is a contract between you and an insurance company where you pay the company to cover your medical expenses. The amount you pay (the premium) and what's covered depends on your policy. As a privately insured patient, you can choose your own doctor, and you can choose to be treated in a private or public hospital. However, private health insurance may not cover all your costs, so there may be some out-of-pocket fees.
Everyone's entitled to be treated as a public patient in a public hospital. If you have private insurance, you can choose to be treated in a private facility, or as a private patient in a public hospital.
You have a right to know whether you’ll have to pay for treatment and medication and, if so, what the costs will be. There may be fees you hadn’t considered – for instance, if you have surgery as a private patient, there will be fees for the hospital stay and the anaesthetist. Your doctors must talk to you about likely out-of-pocket expenses before treatment or before you go to hospital. This is called informed financial consent.
Medicare sets fees for medical services, called the schedule fee. Some specialists charge more than the schedule fee. They may, for example, set their fees according to the Australian Medical Association’s list of fees. The difference between the schedule fee and the higher doctor’s fee is called the gap fee.
If you’re treated as a public patient, Medicare pays for your care and treatment while in hospital, and follow-up care from your treating doctor.
For a private patient in a public or private hospital, Medicare pays 75% of the schedule fee for services and procedures that your doctor provides. Your doctor can choose whether to charge more than the schedule fee. If your doctor charges more than the schedule fee, your insurer may cover the gap or you may have to pay the difference.
Patients with private insurance will also be charged for hospital accommodation and items such as operating theatre fees and medicines. Private health insurance may cover some or all of these costs, depending on the policy.
Some private health insurance funds will only pay benefits for services at certain hospitals. Check with your fund.
A lot of cancer care is delivered outside hospital, such as when you see your oncologist or GP in their rooms for a consultation, and when you have tests, such as x-rays and pathology.
Some doctors bulk-bill for their services, which means they bill Medicare directly, accepting the Medicare benefit as full payment. Other doctors charge a consultation fee, which means you pay the account at the time of the consultation and claim the benefit through Medicare.
Medicare pays 100% of the schedule fee for GP visits and 85% of the schedule fee for visits to specialists.
If treatment is too expensive for you, there are a number of options:
The Medicare Safety Net subsidises costs once your expenses exceed a certain amount (called the threshold).
Individual patients are automatically registered for the program. You can contact Medicare to register as a family or couple and combine your medical costs so you're more likely to meet the threshold sooner.
Many drugs and medications – especially chemotherapy drugs – are expensive. The Australian Government’s Pharmaceutical Benefits Scheme (PBS) subsidises the cost of more than 2,600 prescription medicines.
On the PBS, concession card holders (e.g. people with a Seniors Health Card or Health Care Card) and veterans receive discounts on prescriptions. You can get PBS medication even if you're treated privately.
The PBS Safety Net helps you afford medication covered by the scheme. Once you pay a certain amount for medicine, the rest of your prescriptions that year will be discounted or free. Occasionally, a doctor may prescribe a medicine that's not on the PBS. Prescriptions for these medicines are known as private prescriptions and they may cost more. Private health insurance may cover some or all of the cost of a private prescription.
"I hit my PBS Safety Net 3–4 months into the year, then I paid nothing else because I’m a pensioner. I have a chemist who helps me keep track." — Jonathan