Taking care of your health and wellbeing is important. It can be stressful to know what to do when you’re sick and when you need medical care. You might also not know how much it will cost you to get help.
Sometimes you might need to go to the hospital. That’s why you’ll need to understand how the hospital system works, so that you can make the right decision for your health.
We understand how things work in the healthcare system. So, we’ve put together a guide to help you understand the ins and outs of the health system in Australia.
The Australian health system at a glance
Our health system is one of the best in the world. It’s designed to make sure that everyone has the same access to safe, quality, and affordable health care.
Through the Australian health system, you can access a range of health care from different providers such as:
- general practitioners (GPs)
- allied health workers
- specialist doctors/surgeons
- nurses.
Most Australians can get medical care through Medicare and the public hospital system. The public hospital system provides free or low-cost medical services to those who have Medicare.
You can also get private health insurance, which gives you more choices of hospitals and providers outside of the public system.
Of course, if you’re not eligible for Medicare, we’ve put together some information about the Australian health system if you’re an overseas visitor.
What are the two types of healthcare systems?
We have two types of healthcare in Australia. We have services in the public and private system. Depending on whether you have private health insurance or not, you could use public or private, or a mix of both.
We’ve broken these two systems down for you.
The public system
If you’re looking for low-cost or sometimes free medical services through Medicare (funded by taxes), this would be where you would look to.
The public health system includes public hospitals, community-based services, and health organisations mostly owned and governed by state and territory governments.
Public hospitals are usually the first place you go when you have an emergency. You can also go to a public hospital if you need non-urgent treatment with a specialist or other health professional.
Usually when you are a non-urgent patient, there may be waiting times for appointments. This can depend on the hospital and service you need.
Patients on waitlists are prioritised based on a range of things. Most will be seen depending on how quickly they need to be treated.
The private system
When you have private health insurance, you’d usually go to private service providers so you can get in quicker. With private health insurance, you pay a monthly premium and pay towards the cost of your health care in or out of the hospital. However, you can still access the private health system without insurance, it’ll just cost you more.
Private health providers are owned and managed privately. They include private hospitals, specialist medical and allied health, and pharmacies.
Their services are usually funded by a mix of government and private funding, including:
- private health insurance premiums – paid by customers
- private health organisations
- people paying directly for private treatment
- government incentives on private health insurance
- other government and private funding.
In the lead-up to, and during your hospital stay, you could get care from a few different health professionals. They might be from either the public or private system, or both
If you go through the private system for surgery, you’ll be able to choose your surgeon. You can also ask for a private room and usually will be waiting less for treatment or surgery.
What’s the difference between Medicare and private health insurance?
Medicare
Medicare is the government’s scheme to give the Australian public access to healthcare (paid through taxes).
Medicare covers:
- your treatment as a public patient in a public hospital
- 75% of the fee (Medicare Benefits Schedule) for doctors’ services in hospital if you’re a private patient
- all (what’s known as ‘bulk billing’) or some of the cost of going to a GP or specialist
- some (but not all) tests and check-ups your doctor orders for you
- the cost of some prescription medications if they’re listed on the Pharmaceutical Benefits Scheme (PBS).
The list for medical treatments is the Medicare Benefits Schedule (MBS). It’s a list of services that are subsidised by the government. Each service has a fee that has been decided by the government as suitable to charge for the service.
The fee set is not required for medical professionals to follow. That means some can charge above this threshold. If they charge above the threshold, you’ll have a ‘gap’ payment that you’ll be out of pocket.
Luckily, in Australia, there are a few different ways that you can pay for hospital treatment so that you can still get the quality health care you need.
Private health insurance
Private health insurance is optional. It gives more people more choices when it comes to their health care. You can also choose a level of cover to suit your personal needs.
There are usually three different kinds of cover you can get, such as:
- hospital cover, which covers hospital treatment and stays
- extras cover known as general or ancillary cover
- ambulance cover (included with hospital cover and some extras policies).
You can also join your hospital and extras cover. Sometimes you’ll get a better rate when you combine them.
Ambulance cover can sometimes also be included in your hospital or extras cover. You can also get cover directly from ambulance service providers.
Private health insurance tiers
You’ll also notice that health insurance is usually listed as basic, bronze, silver, or gold cover. In April 2020, it became compulsory for health insurance providers to categorise their hospital insurance policies into similar types of cover.
This means that each policy must meet a set of minimum requirements. These product levels set by the government help people compare policies across different providers more easily.
It’s easy to feel overwhelmed by all the information. So, spend some time talking with your family and healthcare provider about what’s going to be best for you.
Who do I see if I’m sick?
If you’re having a medical emergency that could be life-threatening, you should go to a hospital. If it’s not an emergency but you’re feeling sick and you want to see a medical professional, your first point of contact should be a doctor. They’re also known as a GP.
You’ll first meet with them for an appointment (sometimes called a consultation). At the appointment they’ll look at any problems you may be having and try to treat what they can while you’re there.
If needed, they can also organise tests and can refer you to specialist, hospital, or other care if they can’t help.
For example, if you fell and hurt your wrist quite badly with signs it could be broken, they may give you a referral for an x-ray.
If you had an issue with your heart and your GP felt that you needed to see a specialist, you may get a referral to a heart specialist (known as a cardiologist). There are a few things you need to know when going to a specialist.
If your injuries or health issues don’t need to be seen by a specialist, a GP can also refer you to an allied health professional. Allied health professionals are trained to manage physical and mental health. They include physiotherapists, psychologists, occupational therapists and more.
What next?
The Australian health system can be confusing, even for those who work in it. Don’t worry if you don’t know everything you need to know just yet.
We’re here to guide you through the process so that you can make informed decisions about your health. If you have questions or want to learn more, you can chat with our friendly customer service team.
If you’d like to learn more, you can also explore our other guides, including: