Photographer : Wayne Mah |
How does the Australian health system work?The Australian health system is a huge beast! If you look at it simply, it is basically managed at two levels:
- national
- state/territory.
At the national level there is the Department of Human Services. It looks after Medicare Australia, which delivers Commonwealth (or Australian) Government health programs to the community. This means it’s in charge of funding health services and works with the government to develop national policies on health.
The state/territory governments are primarily responsible for delivering and managing public health services. So, state/territory governments fund and run public hospitals.
General practitioners (GPs), specialists and consultant doctors also provide medical services. The Commonwealth Government reimburses them through Medicare and bulk billing.
What is bulk billing?Bulk billing is the term given to the arrangement where doctors bill Medicare (i.e. the Commonwealth Government) for the full cost of providing some medical services to patients. Under this arrangement, the patient doesn’t pay anything. Medicare collects money to pay for these services through the Medicare Levy, which is a tax.
So what is happening to bulk billing?Basically, the number of doctors bulk billing is decreasing, and the cost to the patient is going up.
The Commonwealth Government and Medicare are responsible for setting the cost of a medical service, called the schedule fee. The government pays doctors between 75% and 85% of this fee, called a rebate. However, due to increasing costs, like insurance, many doctors have started charging more than what they are paid. The difference between what the doctor charges and what the government pays is often called the ‘gap’ and this is what the patient has to pay.
There is wide debate as to why fewer doctors are bulk billing. The Australian Medical Association (AMA)—an organisation representing doctors—argues that the schedule fee set by the government is not keeping up with the costs of running a medical practice and, as a result, doctors increasingly need to charge above the rebate level. However, the government argues there is an undersupply of doctors in some areas, which leads to below average bulk billing rates. The AMA agrees the general shortage of doctors country-wide is contributing to falling bulk billing rates.
What are the effects?The main effect is that the chances of finding a doctor that bulk bills is becoming less and less and, as a result, more people are having to pay to see a doctor.
There are also suggestions that the increasing cost of going to a GP is resulting in more people seeking treatment for minor medical problems at public hospitals. This puts added strain on the public system and results in less time spent on major health problems.
It also argued that the cost of seeing a doctor is impacting on the treatment of conditions like diabetes and asthma, which need careful long-term management.
How do I know this?Australian Medical Association (AMA),
http://www.ama.com.au Department of Human Services,
http://www.humanservices.gov.au/ Elliot, Amanda 2002, ‘The decline in bulk billing: explanations and implications’
Parliament of Australia Parliamentary Library,
http://www.aph.gov.au/library/pubs/CIB/2002-03/03C... Griggs, D & Atkins, C 2004, ‘The bulk billing crisis—a Victorian perspective’,
http://www.lhmu.org.au/lhmu/campaigns/medicare/fil... Medicare Australia,
About Medicare Australia,
http://www.medicareaustralia.gov.au/about/index.htm New Doctor 2001, ‘Medicare fact sheet 1: what is Medicare?’,
New Doctor, No. 75,
http://www.drs.org.au/new_doctor/75/fact_sheet_1.html 
