• Kayla Mastroianni

Australian healthcare: What's what?

It can be difficult navigating the maze that is the Australian Healthcare System when you or a loved one needs help.

From Public to Private Insurance, Medicare and Government Subsidies, let’s break down everything you need to know to successfully receive treatment.

The Public System

Consists of public hospitals, community-based services and affiliated health organisations largely owned by state and territory governments.

It can be accessed within the public healthcare system for free or at lower costs via Medicare (which is paid through taxes, but more on that later...).

The Private System

Includes health service providers that are owned and managed privately such as private hospitals, specialist and allied health services and pharmacies.

They are generally funded by both government and private entities including:

  • Private health insurance premiums (paid by customers)

  • Private health organisations

  • Paying directly for private treatment (out of pocket)

  • Government incentives


Another major part of the Australian Healthcare system.

It is the Government’s scheme to give the public acceptable and accessible healthcare and is funded by taxpayers.

Taxpayers over a certain threshold pay a Medicare Levy of 2%. If your income is below the threshold your Medicare Levy will be reduced. When you visit a doctor, Medicare will reimburse 100% of the fee under the Medicare Benefits Schedule.

When visiting a specialist, 85% of the fee will be reimbursed.

If your doctor bills directly to Medicare (bulk billing), you will not have to pay anything.

Medicare covers

  • Public treatment in a public hospital

  • 75% of the fee if you are a private patient

  • Some or all of the cost of going to a GP and the tests and examinations your doctor orders for you (referrals). These often include x-rays or blood tests

  • Reduced cost on prescription medications that are on the government list called the Pharmaceutical Benefits Scheme (PBS).

  • Specific allied health services under the Chronic Disease Management plan

The Medical Benefits Schedule is a list of services subsidised by the government.

Each service has a fee that the government believes is appropriate to charge.

Private health insurance

A type of cover that Australians can choose to give them more autonomy over their healthcare.

There are varying levels of healthcare that come at different prices and can cover things such as:

  • Hospital Treatment. Private insurance can help you pay for the cost of treatment, cost of stay and allow you to choose your doctor, hospital and date of admission.

Table on Healthcare system break down based on insurance

  • General treatment, also known as ‘Extras’. This is dependent upon your policy but generally includes additional health services such as optical, dental, physiotherapy and chiropractic services.

  • Ambulance. This is also dependent on your policy and the state you live in, however generally covers emergency, and sometimes non-emergency transport or treatment.

The Australian healthcare system is one of the best and most complex in the world.

And there is a wealth of information relating that can seem overwhelming.

The best advice we can give? Take the time to go through your healthcare and insurance options to find the care that is right for you and your family.

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