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The Australian Health System

Australia has universal healthcare – so citizens who need medical treatment should be able to get it when they need it, even if they can’t afford it. The system is an amalgam of public and private health cover and there are some specific quirks of law relating to overseas visitors and recent immigrants. This article outlines how the health system works and provides some useful links so you can work out how to make sure you’re covered if you need to see a doctor.

How the Health System in Australia Works

Responsibility for the health system in Australia is divided between the State and Federal Governments. The Federal Government looks after primary health care, while the hospitals are actually run by the states.

Australia has universal healthcare, which is funded by taxpayers, through an income tax levy. The tax, called the Medicare Levy, is about 1.5 per cent of your income (unless you’re a very low income earner, in which case it is completely free, or a very high income earner, in which case you pay an extra one per cent). In theory, this means when you need a doctor, you should be able to get one either for free in an emergency or at a subsidised rate if you need a General Practitioner (GP).

If you are entering Australia as a permanent resident you are eligible to join Medicare immediately and begin receiving free healthcare. People visiting on a visitor visa should consider taking out private health insurance. If you’re arriving on a 457 Visa, then you’ll have to meet the minimum level of health insurance required by the terms of that visa, and maintain it for the duration of your stay. More on Australia’s reciprocal healthcare arrangements with some countries is included in the Hospitals section below.

Medicare operates alongside a private health system, for those who want to take out private health insurance - something many people decide is a good option because they can get treatment instantly without going on waiting lists. However, if your life is in danger (like in an emergency) those reliant solely on the Medicare system will still get instant medical treatment. There are more details on this below.

As well as Medicare is something called the Pharmaceutical Benefits Scheme, or PBS. The PBS provides subsidised prescription medications to Australian taxpayers, registered with Medicare.

For a full rundown on how the areas of the Australian health system and how they interact, check out the Australian Government’s Health Services website.

Hospitals

There is a network of hospitals in cities and major town centres around Australia, providing a variety of services. Not all hospitals deal with accidents and serious injuries, so when you move to a new area it is worth finding out which hospitals have emergency departments before you find you actually need one.

There are both public and private hospitals in Australia. Hospitals tend to specialise in areas of treatment. In Western Australia, for instance, King Edward Memorial Hospital is a maternity hospital, Princess Margaret Hospital is a children’s hospital, Graylands Hospital looks after mental health and Hollywood Private Hospital looks after veterans and the privately insured.

The good news is, if something happens and you need to visit a hospital in Australia, we have reciprocal healthcare arrangements with many countries and you should be covered for emergency healthcare. You’ll just need your passport to receive free treatment. See the Medicare website’s Visitors to Australia page for details of your entitlements, how to enrol for Medicare and treatment outside hospitals, such as visiting a GP. Permanent visa holders are also covered by Medicare.

Doctors and Dentists

Unlike some countries, it’s not compulsory to register with a doctor in Australia. However, it is advisable to put your name down with a convenient surgery or medical centre as soon as you can, because you might find it hard to get an appointment when you need a GP otherwise. That surgery round the corner from your house might have a full patient list and not be able to take you on as a patient, and certainly won’t be able to squeeze you in on the day you really need to see a doctor.

The first time you visit a surgery or medical centre to see a GP, you will probably be charged a registration fee on top of the consultation fee.

Even if you sign-up to Medicare, you will probably find your doctor will bill you for your consultation. You will have to pay this amount and then claim a portion of that cost back from Medicare. You won’t get the full cost of the consultation back from Medicare – you pay what is called “the gap” between what the doctor charges and what Medicare will cover.

If you need to see a specialist doctor in Australia, you will need to see a GP first to get a referral. If you need to renew a prescription for medications prescribed to you by your doctor in your home country, you will need to see an Australian doctor and have them prescribe it for you. Therefore, it is an excellent idea to ask your family doctor in your home country write a letter outlining your medical condition and treatment regime, so you can show it to your new Australian doctor and ensure continuity of treatment.

Dentistry is not covered by Medicare (although there are Government-funded schemes for children and teens) so you’ll need to find your own dentist and pay for your consultations and treatment yourself. If you have private health insurance, you might be able to claim some of the costs of your treatment back, if you have opted for dental care cover. There are plenty of dentists in the phone book, or you can look online using this rather self-explanatory search engine called Find-a-Dentist.

Public versus Private

Whether you rely on the public health system (Medicare) or join a private healthcare company is very much up to you and your personal circumstances. It depends on your level of income (that is, whether you can afford private insurance) and your general level of health and risk to your health.

Many people rely on Medicare for the bulk of their health treatment, but buy private health insurance to cover dental or optical, for instance, depending on their needs. That’s because Medicare doesn’t cover everything. Medicare doesn’t cover ambulance services, occupational therapy, non-essential surgery and prostheses, for example, so you might want to buy private cover for these. For an idea of what Medicare covers, check out the Medicare’s website.

Private patients, whether treated in a public or private hospital, can choose which doctor will treat them. Medicare pays 75 per cent of the Medicare Schedule fee for the services and procedures provided by that doctor, but you will have to claim the rest back from your insurer. This is likely to include your hospital accommodation costs, theatre (operating room) fees and medications.

There are several major private health providers in Australia which offer special policies for people with temporary resident visas along with health insurance for migrants, and overseas students. The Federal Government provides some incentives to encourage people to take out private health insurance. For an objective outline of how the private health system in Australia works, check out the Australian Government’s Private Health Insurance Ombudsman website. For more information on how overseas visitors are affected, click on the Overseas Visitors link.

Choosing a Private Health Insurer

There are several websites to help you compare and select the best private health insurer and insurance policies (it’s worth noting most of these sites are run by insurance companies, so you might find the results slightly favouring one insurer). Try iSelect or MoneyTime.

Reclaiming Medical Fees

To make a claim from Medicare for medical expenses incurred, it is necessary to either visit a Medicare Centre (these are often in shopping centres) where they will give you cash in hand, or go to the Medicare website and fill in the electronic form and have the funds deposited directly into your account. You’ll need to keep the receipt from your medical centre or hospital so you can make the claim. You will also need to make sure you’ve already registered for a Medicare card.

Private insurers will have their own process for making claims but for more information on how to reclaim your expenses from Medicare, check out their Claims and Cover.

Visit our Life in Australia section for more articles related to Daily Life in Australia.

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