You have the NHS, we have Medicare. What’s the difference?

Medicare

Medicare is a government-funded scheme which provides free or subsidized health care for individuals living in Australia. This fee for service model is quite different to other countries and covers two areas – care for patients, and payments to health professionals.  Here is a quick summary to help you understand both sides of the system, as a patient (if you move to Australia) and how the system would contribute to your remuneration as a GP.

Medicare for Individuals

 What does it comprise of?

There are two parts of Medicare. The first is the Medicare Benefits Scheme (MBS) which provides full or partly covered medical services to anyone who holds a Medicare card. The second part is the Pharmaceutical Benefits Scheme (PBS) which enables medications to be dispensed at a cheaper cost to the public.

As a UK citizen, do I qualify?

Yes, those on a temporary visa who are from a country that Australia has a reciprocal health cover agreement with are eligible for Medicare funding for personal health.

How is it funded?

Medicare is funded by Australian taxpayers. Every year when an Australians complete their annual tax return they are charged a Medicare levy based on a percentage of their income.

Why do I need private health insurance if I have a Medicare card?
If you are coming to Australia on a temporary visa, then you will need private health insurance as a visa requirement. However, once you are granted Permanent Residency you no longer require this. However, Medicare does not cover all health expenses, so many people chose to also take out private health insurance. If you are over the age of 30, your income will also be taxed at a higher Medicare Levy rate if you do not hold private health insurance.

What is the difference between Bulk Billed and Privately billed?

As a patient when you are bulk billed, this means the entire fee is covered by Medicare so you are not out of pocket for a consultation. However, if you are privately billed, the fee charged is higher than the Medicare rebate. Generally, in these instances, you may need to pay the full fee upfront and then claim a rebate back from Medicare, which is usually an automated process. This is also known as Mixed billing.

What does it cover?

Medicare covers a range of services; however, some may only be partially covered.

  • GP (primary care) and specialist services
  • Hospital treatment and accommodation
  • Diagnostic, imaging, and pathology service
  • Limited Allied Health, optometry, and dental services

Aside from primary care, it often provides low cost or free treatment to patients in a public hospital.  In a public hospital, you are unable to choose your practitioner, and may at times be treated by trainees and registrars, and experience long waiting period depending on the severity of your condition.  If you have private cover you would usually elect to be treated at a private hospital, and often be able to choose your practitioner, and be treated sooner than in a public hospital.

 

Medicare for Health professionals

 What is the MBS?

The Medicare Benefits Scheme (MBS) is the list of services and corresponding item numbers which are used to bill Medicare for the patient services you deliver. Every time you consult a patient you will bill the corresponding item number which has a scheduled fee attached. For a full list of these numbers please click here

Do I have to bill the scheduled fee?

No, health practitioners are free to set their own fee – provided they are NOT working in bulk billing practice.  So, if you charge a higher fee the patient may not be able to claim the whole fee back. For instance, if the scheduled fee is $50 and you charge $75 for that service, the patient will be $25 out of pocket.

Do all medical services have item numbers?

No, some services do not have an item number, this means the patient needs to pay the full fee for this service out of their own pocket

How much of the fee do GPs receive?

GPs in Australia are independent contractors meaning they are not on a salary. Instead, a GP will have an agreement with the clinic to receive a percentage of each billing – usually between 60-70% of billings.

Why do I need a Medicare provider number?

When you work in Australia as a GP you will need to obtain a Medicare provider number. This allows you and the clinic to claim Medicare rebates. If you do not have a provider number, your patient will not be able to access Medicare for your services. This also causes problems if you are wanting to refer your patient to other Health Practitioners as your referral may not be accepted if you do not have a provider number. Provider numbers are location specific so every time you move to a new practice you will need to apply for a new provider number.

Does Medicare require me to work Out of Hours / After Hours?

No, Medicare does not require GPs to do After Hours work, however, to incentivize GPs to work during the After Hours, the price for each item number is raised during this time period meaning you can earn a lot more income by participating in After Hours work.

 

Want to know how more about how Medicare is different to the NHS? Click here for more information

 

 

Sources:

http://theconversation.com/explainer-what-is-medicare-and-how-does-it-work-22523

http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/%20Parliamentary_Library/Publications_Archive/archive/medicare