Medical Questions » Doctors Questions » Question No. 280
| Question: | I have just arrived in Australia and I am confused by Medicare and your health system. Can you explain it simply for me? The brochures I have read seem to be very complicated. |
| Answer: | Medicare is the only form of medical insurance allowed in Australia. You can take out health insurance to cover hospital fees, dental fees, medical appliances etc., but you cannot take out any other form of insurance to pay for doctors' fees. A levy of $1.40 for every $100 of your taxable income is added to your tax bill every year to pay for Medicare. This fund pays for about 20% of the costs incurred by Medicare. The balance is paid for out of the federal governments general revenue.
When you see a private general practitioner, specialist, radiologist or pathologist, a benefit can be claimed from Medicare. It is in this area that the greatest misconceptions arise. Doctors (like all other professionals and tradesmen) are entitled to set their own fees. These fees are usually within the limits set down by the Australian Medical Association. The federal government sets the refund a patient receives from Medicare for any particular service. These refunds are set without reference to the medical profession or any court of arbitration. There is thus a gap between the doctor' s fee and the Medicare refund that must be met by the patient.
A refund may be claimed by mail or in person from Medicare offices after paying the doctor; or a pay doctor cheque to pay Medicare' s part of the fee may be obtained first, and forwarded with the patient' s share of the fee to pay the doctor' s account.
Many doctors will direct bill Medicare, or bill the patient at the lower refund level when they see pensioners or disadvantaged patients. Very few doctors will direct bill all patients.
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