Comprehensive Analysis of Medicaid Health Cover in Australia

This essay provides an overview of Medicaid health cover in Australia, also known as Medicare, a government scheme providing subsidized healthcare to citizens and permanent residents. It covers doctor visits, specialists, and lab tests but excludes services like ambulance transport and dental. Eligibility includes Australian citizens, permanent residents, and those with reciprocal healthcare agreements. The essay explains the Medicaid Benefits Schedule (MBS), which sets fees for medical services, and the Pharmaceutical Benefits Scheme, offering affordable medications. It highlights bulk-billing practices and the program's focus on low-income earners. The essay also discusses the limitations of the current system, such as the lack of ambulance cover, specialist fees, and waiting times in public hospitals, and suggests potential improvements to ensure optimal patient care, including covering ambulance charges, specialist visits, and reducing waiting times.

RUNNING HEAD: MEDICAID HEALTH COVER IN AUSTRALIA
Medicaid health cover in Australia
Name
Institution
Course
Date

2
MEDICAID HEALTH COVER IN AUSTRALIA
Medicaid health cover in Australia
Medicare is a scheme started by the Australian government to provide healthcare services
to all Australian citizens and some of the permanent residents. The initiative is under the
department of human services and works by providing free or subsidized healthcare to the
citizens. It covers doctor visits, specialists and in some cases, healthcare specialists such as
dentists. Under the Medicare cover, all Australian citizens have access to free medical services
from public hospitals. All those covered by Medicare are given a Medicare card, which is
presented to the hospital every time a patient goes to the hospital. Medicaid covers lab tests
performed on the patient, pharmaceutical bills and the fees payable to the doctor. The medical
cover, however, does not include medical nursing services, provision of glasses or contact lens,
ambulance transport and acquisition of hearing devices.
Those eligible for Medicare healthcare services include Australian or New Zealand
citizens, permanent residents of Australia, those who have applied for permanent residency,
those covered by ministerial order, those having a resident return visa and those people covered
by a reciprocal healthcare agreement with another country. Those who are over 15 years old are
eligible to apply for their personal Medicaid card. Children under 15 years have access to their
parent’s Medicaid cover. Those babies born in Australia are automatically enrolled in Medicaid
health insurance.
Medicaid operates using a Medicaid Benefits Schedule (MBS), which assigns a fee to all
the medical services provided by the healthcare facilities in the country. The government does its
assessment on the current costs of medical care and decides on a reasonable fee for the various
medical services. The MBS schedule fees are then set based on the value of the medical services.
The MBS covers all the costs of treatment, including medical tests on a patient and the

3
MEDICAID HEALTH COVER IN AUSTRALIA
consultation fees for seeing the doctor. The amount of money that is reimbursed by Medicaid is
dependent on the MBS schedule fee for that particular treatment. Patients can even get a 100 per
cent reimbursement of the medical charges. Those patients seeking the services of a specialist get
reimbursed 85 per cent of the MBS fees allocated for seeing the specialist. Those seeing a
general practitioner get 100 per cent reimbursement of the MBS fees allocated for the particular
treatment. Most doctors charge according to the charges set by the MBS structure, but specialists
and other healthcare professionals can charge more than the costs on the MBS structure. Patients
seeking these services are then forced to pay the exceeded amounts using their cash.
Pharmaceutical Benefits Scheme is a program under Medicaid that was set up to provide
affordable medication to all the people under Medicaid cover. Under the scheme, the prices of
most of the prescription medicines are subsidized. The health consumer status of a patient
determines how much a patient pays for the prescription drug (Nicholas et al 2011).
Some of the doctors bulk-bill. The term means that they accept full payment of the
medical services through the Medicaid program. Doctors mainly take bulk-billing for children
and low-income earners. Specialists rarely accept bulk-billing and patients mostly end up paying
for the services from their own pockets.
The main target for Medicaid health services is low-income earners. The service ensures
that all Australian citizens have access to a medical cover. High-income earners under the
program pay additional charges for Medicare covers. Australian citizens pay for the insurance
cover through a two per cent medical levy and are administered through the tax system. Low-
income earner and the pensioners are however exempted from the charges. Discounts for
families also exist to help all the people to take up healthcare insurance. The government also
funds the program from general revenue (Morong et al 2017).

4
MEDICAID HEALTH COVER IN AUSTRALIA
Although Medicaid has been successful in providing healthcare insurance cover for
almost all Australian citizens, it has failed to reach its goal in the provision of medical care to the
Australian people. Medicare does not cover for emergency transport of patients using
ambulances, home nursing services, dental services and even acquisition of hearing devices by
patients. Being a national medical health insurance, it should fully cover a patient to ensure that
they need all the medical treatment they need. Ambulance transport should be covered under
medical insurance because it is essential for critically ill patients who require specialized
medication in other health facilities or even transportation of patients during emergencies. Some
of the income earners have been unable to access medical care in hospitals during emergencies
due to the lack of fees to pay for transport by ambulances. Delays during the transportation of
patients have been seen due to the issue of payment of the service. Ambulances help the patients
access the health services provided and the cost of transport by ambulances should be covered
under the Medicaid health insurance.
Medicaid health insurance is discriminative to the citizens. Whereas the low-income
earners are exempted from the two per cent payment of the medical levy, the high-income
earners are subjected to an additional charge of 1.5 per cent. Being a national initiative to provide
health coverage for all, the high-income earners should not be forced to seek for private
insurance covers by imposing additional charges on them. Fees imposed for the national health
cover should be equal for all the workers.
In the current years, there has been an increase in the number of diseases affecting the
people. Most of the patients have been forced to seek the services of health care specialists. Most
of the healthcare specialists do not bulk-bill, and patients are forced to pay hefty fees from their
pockets. Many people have refused to specialized medical services due to the high cost

5
MEDICAID HEALTH COVER IN AUSTRALIA
associated with specialists. Under Medicare, all the citizens receive a medical cover to visit
specialized medical professionals (Bodenheimer et al 2010).
Provision of a healthcare cover may not be helpful to the patients if they have to wait for
long to receive treatment. In public hospitals, patients seeking elective procedures, have to wait
for even more than a year. As the governments strives to provide medical cover to all the
citizens, it should also ensure that public hospitals have enough personnel and equipment to
reduce the waiting time for patients.
In conclusion, Medicaid had helped to ensure that all Australian citizens have access to
healthcare services. Low-income earners have had access to healthcare at zero cost. Through
Medicaid, Australia has managed to be among the countries with the best medical healthcare
services in the world (Clement et al 2009). However, Medicaid policy needs some changes to
ensure optimum care for the patients. Ambulance charges should be covered under Medicare,
specialist visits should also be covered and the waiting time for the patients in public hospitals
should be reduced to ensure the treatment to patients is timely

6
MEDICAID HEALTH COVER IN AUSTRALIA
References
Clement, F. M., Harris, A., Li, J. J., Yong, K., Lee, K. M., & Manns, B. J. (2009). Using
effectiveness and cost-effectiveness to make drug coverage decisions: a comparison of
Britain, Australia, and Canada. Jama, 302(13), 1437-1443.
Morong, J. J., Martin, J. K., Ware, R. S., Colditz, P. B., & Robichaux, A. G. (2017). Comparison
of In-Hospital Maternal Mortality Between Hospital Systems in Queensland, Australia
and Louisiana, United States. Ochsner Journal, 17(3), 243-249.
Nicholas, R., Lee, N., & Roche, A. (2011). Responding to pharmaceutical drug misuse problems
in Australia. A Matter of Balance, National Centre for Education and Training on
Addiction, Flinders University, South Australia.
Bodenheimer, T., & Pham, H. H. (2010). Primary care: current problems and proposed solutions.
Health Affairs, 29(5), 799-805.