An introduction to the Australian healthcare system

8 November 2019

If you’re heading to Australia, it’s easy to be distracted by the colourful landscapes, unique wildlife and holiday weather. There’s so much you’ll want to see and explore, so whilst you’re deciding where to go first, it’s important to understand how the healthcare system works. This way, you’ll be able to make the most of your new surroundings, knowing how to get help if you need it. With a range of public and private care available, you can choose a combination of the different options, to find something that works for you. 

There’s a lot of variation too, which isn’t surprising with a land area nearly the size of Europe. Local governments are responsible for managing public hospitals, mental health services, breast cancer screenings and emergency services – so this means that you might see differences in the way these work, depending on where you’re staying.

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Medicare & public healthcare

Medicare is the publicly funded health system, which allows Australian residents to claim for treatment from any eligible medical providers (who must have a provider number). Funded by the Medicare levy, compulsory for most residents, the system offers free in-patient care and subsidised out-patient care (click here to find out more about these types of care). The service covers a basic level of care, including the cost of visiting a doctor and up to 85% of specialist costs - for residents. This means as much as 17% of total healthcare spending comes from out-of-pocket expenses¹, so this is important to bear in mind when considering healthcare costs.  

Only permanent residents are able to use the Medicare scheme. If you’re visiting from a country which has a Reciprocal Health Care Agreement (RHCA) with Australia, you might find you’re eligible for a certain level of care. Countries with these agreements include:

  • Belgium
  • Finland
  • Italy
  • Malta
  • Netherlands
  • New Zealand
  • Norway
  • Ireland
  • Slovenia
  • Sweden
  • UK 

Limited Medicare benefits may be available to you, such as emergency treatment in hospitals. Things like ambulance travel, subsidised medicines, and dental treatments are not included on the scheme. 

Emergency services in Australia

Local governments are responsible for managing and funding emergency services, so you’ll want to know what to do in an emergency, if you’re involved in one. The main number to call is 000, if you need an ambulance, police or fire engine. The operators will then connect you to the right service. It’s good to know that ambulance transport is not included in the Medicare benefits. In Queensland and Tasmania, residents usually don’t have to pay a fee, but in other states it can be expensive if you need to use the service. For example, the average cost of an ambulance journey is more than $1,100 in Victoria² – so many expats choose to take out insurance which covers this.  

It’s a good idea to make sure the address you’ve used to register with your mobile network is correct, as this can sometimes be used to help find you in an emergency. 

Access to healthcare in rural Australia

As Australia is such a big country, many of the main hospitals and clinics are located in large towns and cities. If you’re staying in a more rural area, you may have to travel a little further to get the care you need. In general, rural residents have slightly poorer access to regular health services, as well as specialist appointments. Whilst this is no surprise, the government has recognised this as an issue – and has introduced the ‘Stronger rural health strategy’.  This includes providing training opportunities in rural areas, as well as offering incentives for working in remote locations. The not-for-profit Royal Flying Doctor Service continues to help deal with these access issues, but there’s a long way to go as rural residents still have to wait around six days to see a GP³ (for non-emergency appointments). Many choose to take out private medical insurance that covers evacuation and repatriation, in case the treatment needed can’t be accessed in a local hospital or clinic.

Seeing the dentist

On the whole, dental treatment is not covered by Medicare, so the booking processes and treatment prices can vary between states and clinics. Public treatment is available to some adults (usually if you have a low income, you’re unemployed or retired) but the waiting times for this service have been known to reach two years for an appointment⁴. The government also subsidises some children’s dental care, but not everyone is eligible. You can check the Child Dental Benefits Schedule to find out more. Issues with accessing dental treatment have contributed to a high instance of tooth decay across the country: 90% of adults have suffered with this⁵. 

For private treatment, the average cost of a scale and clean is $118⁶, which can add up when you’re booking in regularly. It’s also worth knowing that many dentists will still charge you if you cancel less than 24 hours before your appointment time. 

Prescriptions and over-the-counter medicines

The way that medicines and prescriptions work in Australia, is generally quite similar to other parts of the world. You’ll need to visit your main doctor first, who’ll prescribe whatever medicine you need – so you can then go and collect it from your local pharmacy. This can take anything from no time at all, to a few days to be ready. You might be surprised to find that your usual prescription is available over-the-counter, and vice versa – so it can take a while to learn how to get the medicine you need. The exact prescription might be slightly different to what you’re used to elsewhere, so you’ll need to check with an Australian doctor to find out what the differences are and if your usual prescription is available. 

The cost of prescriptions is often subsidised by the Pharmaceutical Benefits Scheme (PBS), available to anyone with access to Medicare. . When you’re eligible for subsidised medicines, you pay up to a threshold of $40.30 for most medicines on the PBS, and $6.50 if you’ve got a concession card⁷ (similarly to public dental care, this is only available to some adults). Some pharmacists can charge small, additional fees for preparing and recording your prescription. Private prescriptions are also available, for those who don’t have access to Medicare or the PBS but prices vary, so many choose to shop around. 

Private health insurance in Australia 

As not everyone is eligible for Medicare, and other services like dental treatment do not meet the demand, private health insurance is increasingly popular in Australia. As many as 50% of Australian residents have private medical insurance, as well as many expats and travellers ³.This is either instead of or as well as access to Medicare and the public schemes. To try and reduce pressure on the public systems, the government offers a range of incentives to try and encourage residents to take out private medical insurance at a younger age. For example, the government adds an extra 2% to the price of insurance premiums, for every year that private insurance isn’t taken up, from the age of 31. This means that if a resident takes out private insurance at the age of 40, it will cost an extra 20% per year, until 10 years have passed, and the premiums return to normal⁸. As well as this, the public Medicare scheme increases its levies for those in higher income brackets, who do not have private medical insurance. For example, the basic charge of 2% of taxable income can increase to 3-3.5%, depending on income levels⁹. The government hopes that this will persuade residents to take out private health insurance, rather than paying increased levies. The overall aim is to continue providing public healthcare, available to those who need it most. 

Sources 

1. https://www.health.gov.au/about-us/the-australian-health-system 
2. https://www.abc.net.au/news/2018-07-20/ambulance-fees-around-australia/10015172 
3. https://transferwise.com/gb/blog/healthcare-system-in-australia 
4. https://www.justlanded.com/english/Australia/Australia-Guide/Health/Dentists 
5. https://www.abc.net.au/news/2018-03-20/dental-survey-finds-alarming-levels-of-tooth-decay-australia/9562546 
6. https://www.choice.com.au/health-and-body/dentists-and-dental-care/dental-treatment/articles/dental-fees 
7. https://www.humanservices.gov.au/organisations/health-professionals/services/medicare/pbs-safety-net-pharmacists/about-eligible-customers/pbs-safety-net-thresholds 
8. https://www.ato.gov.au/Individuals/Medicare-levy/Private-health-insurance-rebate/Lifetime-health-cover/ 
9. https://www.ato.gov.au/Individuals/Medicare-levy/