one tier , single payer? Two tier?

talaxandra · Jun 6, 2008

I'm very happy with our system, provide the government's commited to maintaining it (unlike the previous federal governemnt, who were keen to erode it).

An overview:

All citizens are covered by Medicare, which is funded by a 1.5% tax on all income earners who earn enough to pay tax. It covers all costs of eye exams (limited to one every two years), and anything related to admision in a public hospital, outpatients and rehab services.

In addition all approved medications are subsidised by the Pharmaceutical Benefits Scheme (PBS), and annual costs are capped so that people on a number of drugs don't have to pay for PBS-subsidised medications once they reach the cap. The co-pay fee is reduced for anyone on a pension or concession.

Medicare wholly covers the cost of certain GP visits (bulk billing), but most GPs charge a higher fee, at least for some of their patients, who pay the difference between this and the Medicare coverage. In most case this works out to

Waiting lists for elective surgery range from a few months to over two years, depending on the type of surgery and the location of the patient and facility. For those who prefer to choose their own physicians and surgeons, who don't want to wait, and who prefer the more attractive surrounds of a private hospital, private health insurance is an alternative. Having private health insurance doesn't preclude citizens from using Medicare-funded resources.

The federal Liberal government introduced a three pronged stronger incentive for private health insurance - Lifetime Health Cover (where those who join private funds after the age of thirty are charged an additional rate for every year they wait), and a 30% rebate on private health insurance costs coupled with a second Medicare levy of 1% for those who earn over $50,000 a year. The new federal Labor government are increasing that threshold to $100,000 for singles, $150,000 for couples. There's some controversy about this, with concerns that a high number of people will drop out and increase strain on the private sector. My suspicion is that those who do drop out will be mostly young people who don't use many health resources and those who are in financial straits. The idea behind the rebate was that it would compensate to a degree the cost of fees, but since its introduction provate health funds have all increased their premiums.

I've chosen not to take out private insurance, even though I'm (well) over 30 and earn over $50,000, because I agree with universal health care and am (somewhat) hapy to pay extra to subsidise it and because I didn't want to submit to the carrot-and-stick push to private health insurance and because I'd rather be treated in a public hospital.

A few years ago I had elective orthodontic surgery in a private hospital - I was charged a night's stay, although I left from recovery (apparently recovery costs are included in theatre charges). I was happy with the treatment, and it wouldn't have been done in the public system - all up it cost around $4,000. Which is still less than if I'd been paying for private insurance all along!

Last year I fractured a finger and was treated through the public system - I was fast tracked through triage, x-rayed, seen by OT, fitted with a temporary splint and booked in for surgery within two hours. I had a reduction and K-wire within a week, twice weekly OT appointments for a month and fortnightly for another three months, and weekly plastics outpatients for a few weeks and then a follow up to remove the k-wire when it was infected (that appointment took place a day after I reported the infection). The only cost to me was for meds - Endone for pain relief and a course of oral anti's, for a total of around $25.

In the interests of full disclosure - I was treated at my hospital, and did therefore get a couple of perks: the theatre coordinator came to my ward so I could fill out the preadmission paperwork, I was first case, and the resource nurse of the day surgery unit (a friend) looked after me rather than allocating me to an agency nurse. I also didn't always have to wait in outpatients but on occasion was paged when they were ready to see me (but I didn't get seen any faster than other patients) and - more a function of being a nurse than an employee - I didn't have to front to the OT as often because she was happy I could reliably do my exercises.

When I read about the US health care system, and particularly read the heated threads about universal health care vs a private system, and about the percentage of GNP consumed vs quality and quantity of coverage, I'm in no doubt that, despite its many flaws, I prefer our system to yours :)

Sorry for so rambling on - hope it's helped.

nyapa, RN · Jun 7, 2008

That's very well summarized Talaxandra. The only thing is that dental care is not covered by Medicare, unfortunately.

Also, those who are on pensions receive their medications on the PBS system at $4.95 per script, whereas those who are not on pensions pay is it 35$ now?

Doctors who work in the public system also work in the main in the private system.

I think that ppl on private cover now are there because they choose to be. Private cover is more expensive under the Coalition / current system than public health care. I'd rather pay the extra Medicare levy. So I don't think there will be any loss of ppl going from the private to public.

Like you I'm pro public. Certainly here there are more nurses per patient in the public system, than in the private.

But there are those who prefer the private system, and I hope they put their point of view here as well.

Jay

talaxandra · Jun 7, 2008

Why thank you, Jay! I did forget to mention that the care is another reason why I'd rather go public - more nurses, who have more support, more doctors, more equipment (like scanners, not necessarily more obs equipment etc).

My father was seriously ill several years ago and went private - he had a lovely single room, nice meals, and ended up with six consultants. He was also: sent homw febrile and readmitted two days later, rang his consultant about the unilateral leg swelling he'd developed (after two weeks basically resting in bed with no DVT prophylaxis) and was told it was a side effect of a new cardiac drug, and was not physically examined for six weeks. By which time the false aneurism (caused by an angio performed with a post-re med consent and without a full history, which would have disclosed the presence of a hernia repair metal mesh cover) had leaked so much blood into his psoas muscle he needed a full laparotomy in addition to the femoral vein ligation (required for friability after six weeks of heparin infusions commenced to treat the finally-diagnosed DVT). He was in hospital for three months. In ICU (only intubated a day or so but there for a week) the only pressure care he got was from me or my ex-nurse mother - I've rarely felt a spongier heel, caused by him being unable to straighten his knee because of the infected blood collection around his psoas.

He was readmitted to a private hospital last year - hourly eyedrops the nursing staff told him to administer, to "encourage self care" (no clock in the room and on high dose narcotics with opiate naievity), no wash of any kind even offered for four days, no DVT prophylaxis (too unwell to get out of bed, overweight smoker, drowsy, known history of DVT), and an IV I had to remove after five days.

Sure you might get VRE colonisation in the public system but at least we'll pick it up, and even give you a wash from time to time!

This isn't to say the private system's terrible or that their nurses are crappy, but there aren't ratios and there aren't junior doctors who do comprehensive exams at the drop of a hat. And the public system's far from perfect - but it's what I want to use if I have to be in hospital in the first place.

nyapa, RN · Jun 7, 2008

Why thank you, Jay!

Sorry, didn't mean to sound facetious. I could never lay out the information as well as you did.

talaxandra · Jun 7, 2008

No - I was being sincere! That's the downside off online communication: nobody can tell your tone I really was pleased you thought my (very long) explanation was good, swear!

bassandtea · Jun 9, 2008

As Talaxandra mentioned private cover is available in addition to what we receive under medicare. Private cover can include hospital cover and/or "extras" cover. There are a number of people that only take out "extras" cover under private health insurance.

Extras cover typically includes dental treatment and may cover part of the cost of optical care (eg. prescription glasses). Depending on the policy it may also cover some specialist and alternative treatments.

As I wear prescription glasses I find that having extras cover is handy to have - it might not cover all of the costs of getting new glasses, but it makes it much easier for me to afford.