How Does the Health Care System in Australia Work?

Good question.

And one that I’ve not yet got my head fully around even though I have now lived here almost 6 years. I’ve had quite a few close encounters of the medical kind since being here though, so I can sum it up my own few words.

It works very well, but it is more expensive getting treatment.

Last week I described what happened when Mrs Bobinoz broke her leg, today let’s be a little more specific about health care in Australia.

Visiting the doctor

my doctorWhenever I’ve needed to see my doctor I’ve never had to wait too long for the appointment. On arrival at the reception, I’ve usually been seen pretty quickly as well, on average I’d say between 20 and 30 minutes wait.

When I do have my consultation with the doctor, it’s really laid-back, he appears to have all the time in the world to chat and deal with my problems. It’s not like he’s itching to push me out of the door with a prescription and say “NEXT!” as fast as he can.

But that’s only my experience with my doctor in an outer suburb of Brisbane. What happens in Sydney, Melbourne or even Tin Can Bay for that matter, I don’t know. But what you might like to know is that according to KFF.org there are 38.5 doctors for every 10,000 people in Australia whereas there are only 27.7 per 10,000 in the UK. (USA is 24.2.)

I do have to pay to see my doctor though; it used to be $70 per visit but has recently gone up to $80. Not all doctors charge the same; I’ve heard there’s a doctor not far from me who only charges $45. I’m sure some charge more than $80 as well. So it probably pays to shop around for a doctor.

Medicare does give me a rebate on that though of $35.60, so I end up paying $44.40.

Who is Medicare?

Operated by the government, Medicare is Australia’s health care system. Australian residents get issued with a Medicare card which has to be presented for all medical encounters.

Medicare is funded publicly via an income tax surcharge which is used to give rebates for certain health care costs. A good example is the money I get back after visiting the doctor. Rebates can also be available for certain specialist consultation fees, tests, examinations, eye checks, x-rays and some surgery.

Medication

pillsYou will have to pay for your own prescription as we always called it back in the UK, but ‘script’ as it is referred to here. Many necessary medicines are subsidised by the Pharmaceutical Benefits Scheme (PBS). That’s another scheme operated by the Australian Government to ensure that Australian residents can afford to pay for a wide range of essential medications.

Those on a low income will get a ‘concession’ and will therefore get their medicines at a lower cost, sometimes as low as $5.80 per script.

Emergencies

sickThe closest I’ve come to testing this one out was when I splashed chlorine in my eye, and I’m really not keen to test it out further.

In other countries, notably the USA, you hear stories (hopefully exaggerated) of people being in serious accidents and paramedics searching their bodies for their private healthcare cards before doing anything.

I honestly don’t know if that is true or not, but I do know that it doesn’t happen here.

If you are in an accident and need emergency treatment, you will get picked up by an ambulance and they will try to find out if you have private health insurance that covers hospital care or not. If you do, they’ll probably take you to the nearest private hospital, if you don’t then they’ll take you to the nearest state hospital.

Either way you will get treated. You may have to pay for the ambulance ride, see my post Ambulance Fees in Australia – State to State.

Private health insurance

So, I’ve mentioned private health insurance, is it essential?

No, but it is useful and there are incentives from the government to get it by way of tax relief.

Competition is rife in the private healthcare market and there are plenty of providers with lots of very complicated plans. We use Medibank Private who were government-owned but have since been privatised. They compete with the other privately owned health funds. I couldn’t tell you if they are the best option though, they are run like any other business and pay tax and are regulated in the same way as the private health funds.

I believe there are two kinds of private health insurances, the more expensive one covers hospital treatment and the cheaper one, which we have, just covers general treatments like physiotherapy, dentistry, psychology, prescription spectacles and the like.

We pay $91 per month for a family policy which is tax deductible. We probably get our money’s worth just from prescription glasses and dentistry.

It has to be remembered though that whichever insurance policy you go for, it’s highly unlikely it will cover everything. They are just insurance policies that have limits and some things simply aren’t covered.

Comparing insurance policies is probably a nightmare, which is why I have never tried to do it either for this website or for my own personal benefit.

More information

There, that was easy, wasn’t it? Except its way more complicated than that. Also, this is just my experience explaining how I see the Australian health care system based on what has happened to me since I’ve been here.

If you really want to know how it works, I have some suggested reading for you. These are the best websites I’ve found on the subject:

Conclusion:

I have been very happy with the health care system here so far, at all levels we have been treated speedily, professionally and successfully. It does cost more though than we have been used to in the UK with the NHS.

It takes some getting used to, paying for the doctor after your consultation and I have been known to “do a runner” by forgetting to pay after a visit and just walking out.

No police showed up though, I just got a polite letter in the post a couple of days later.

Sometimes though, when the service is so much quicker I do think that it’s worth paying the money, so I don’t have too many complaints.

Maybe as I get older and more goes wrong with me, perhaps I might find myself waiting for a replacement hip or something, I might not have the same opinion.

I might even get downright grumpy. Hopefully the PBS will subsidise my happy pills.

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{ 32 comments… add one }
  • Mrs. Narang June 16, 2016, 9:37 pm | Link

    Hi, my 3year old son is undergoing burns treatment at Lady Cilento. He went through skin grafting surgery on his hand 7 months ago.The doctor is talking of another surgery but I as a mother am not convinced and feel that he doesn’t need any more surgery. I heard that surgeons are highly paid in this country. They earn huge from each surgery. Could that be the reason for his pressing for surgery? How and where can I get a second opinion? Please do reply to me. Thanks.

    • BobinOz June 17, 2016, 7:05 pm | Link

      Sorry to hear about your son. This isn’t a question I could possibly answer though, although I’d be very surprised if any doctor would put a three-year-old through an operation that wasn’t needed.

      As you say, they do earn very good money, and I don’t think they’re short of patients, so it wouldn’t make sense for this surgeon to perform an operation unnecessarily.

      All you can do, I think, if you do have concerns, is to try and find another doctor who specialises in burns to get that second opinion. Good luck, Bob

  • Tom Richmeyer May 22, 2015, 2:57 am | Link

    We are both 66 and covered by USA’s Medicare. We’re considering relocating as our daughter, son in law and 4 grandkids live in NSW. Does our US healthcare transfer in any sense of the word?

    • BobinOz May 22, 2015, 9:13 pm | Link

      I don’t think so Tom, but I suggest you talk to your USA Medicare people about this and ask them if the benefits you have accrued in their system can be transferable in any way.

  • Shells Bells February 12, 2015, 6:57 am | Link

    This has been a very interesting read for me, but as ever I still feel clueless about repeat prescriptions, blood tests and endocrinologists, as a type 1 (insulin dependant) diabetic. I’m sure it’s all quite manageable, but even with such clear information, it always seems so scary. I think I’m spoilt in the UK with free prescriptions, blood tests and specialist care. It terrifies me to think that access to some of these things could be restricted 🙁
    lots more research to do but still, this has been a very good read so thanks to all involved, and thanks Bob!!

    • BobinOz February 12, 2015, 9:58 pm | Link

      Well, I can tell you that repeat prescriptions are no problem, the doctor will normally give you maybe three, sometimes six repeats in one go, so it’s like getting a pad of prescriptions that last for a few months or more. Even when they run out, getting more is straightforward.

      I have never paid for a blood test, I’m pretty sure they are free everywhere (anyone know any different?) but I have no idea about endocrinologists. I’m off to Google right now to find out 🙂

  • Jules February 4, 2015, 6:34 am | Link

    Thanks Bob!

    Yes, as you say, very much a swings and roundabouts situation…

    Our council tax for a medium (very small by australian standards) 3 bedroom semi in NE England is $2,600.

    VAT here is of course 20% and fuel duties on petrol are one of the highest in the world at around 70% (I am told).

    Employers national insurance is another “dirty secret” tax that is not talked about or acknowledged much here. Employer NI just goes into the standard government spending hole. Not a defined superannuation scheme that builds up towards an individuals retirement. State OAP pensions in the UK are paid POOR – Pensions Out Of Revenue, which means that if you contributed 50 years worth of NI, there is didly squat sitting in a pool/fund for you to draw on. It just gets paid out of current taxation.

    Another tax which everyone tends to forget about here is the tax of having to heat your home (a large chunk of energy prices are the UK’s slavic devotion to green taxes). Our annual gas/electric bill is around £1,500, a significant chunk of which just goes up the chimney as wasted heat (central heating boilers are not overly efficient).

    My family in Brisbane says if you get the right solar installation, you can run your air-conditioning virtually for free (the sun shines in the warmest hours when you need it’s free power the most of course!).

    I’ve also done some very extensive grocery research and in direct conversion terms, our average basket of goods comes out at around 15-20% cheaper in Australia (Coles/Woolworths) than it does here at Tesco. My family in Brisbane have started doing a lot of shopping at Aldi and say that it’s even better. If you figure in your yakka measure of money earned for time worked, Australia is probably even cheaper for food.

    I think on balance, you probably get a slightly better deal…. but then you have all that sunshine too, which swings heavily in your favour!

    All the best, Jules.

    • BobinOz February 4, 2015, 5:50 pm | Link

      Some fascinating figures Jules, a bit of an eye-opener.

      The one that shocks me the most is that £2600 a year council tax, that would be over $5000 for me here and yet I’m only paying $1200 at the moment. As for your electricity/gas, I’m paying about the same here each year, but as you said, I have purchased solar power and now they pay me. You can read about that here…

      http://www.bobinoz.com/blog/15243/solar-power-in-australia-does-it-work/

      My research on supermarket prices tends to suggest there’s really not much in it, so I’d be surprised if in reality your shopping bill came to 20% less here, but then I suppose it does depend on what you’re buying. By the way, we have Aldi here as well, and they are cheaper than Coles/Woolworths. All in all though, I’m happy with those swings and roundabouts, and I’d rather be here than back in England.

      Cheers, Bob

  • Jules January 31, 2015, 9:49 pm | Link

    Hi Bob,

    This thread hasn’t been commented on in a while, but I was wondering whether you could answer a question?

    You say that you would sum up the Australian Healthcare system as “It works very well, but it is more expensive getting treatment.”

    However, do you know, does that take into account all factors such as taxes? For instance, we pay very high taxes in the UK, some of the highest in the world for that matter, and our stealth taxes are second to none (Fuel Duty, Excise duty, VAT rates, council taxes etc.).

    So you might have to pay something for Medicare topups etc. But is that offset by other savings in taxes in Australia?

    Because at the end of the day, no matter what Ed Milliband may say, the NHS is not “free”, it is taking a significantly large amount of all of our taxes to run it.

    • BobinOz February 2, 2015, 2:46 pm | Link

      I take your point Jules, it’s very much a case of swings and roundabouts when comparing our two countries for the cost of living.

      But, of the taxes you mentioned, our fuel duty is much lower than the UK’s, but tax on cigarettes and alcohol is higher. Our VAT equivalent, GST, is currently 10% which is significantly lower than in the UK. I pay around $1300 a year for my rates, that’s for a four bedroomed detached house. I think that also compares favourably with the council tax in the UK.

      As you say, nothing is really free, you are paying for the NHS somewhere along the line, but it is difficult to work out where and therefore if Australian healthcare is or isn’t more expensive.

      Cheers, Bob

  • Celia Newlands March 25, 2014, 12:28 pm | Link

    Hi Bob,
    Have you looked into the LHC (Lifetime Health Care) system? It basically means that if you are either a Permanent Resident or a Citizen, and you don’t take out Private Hospital Cover (Extras cover doesn’t count) by age 31, if you ever change your mind and want to take Private Hospital Cover at a later date, you will be charged LHC Loading – 2% extra for every year you are over the age of 31…… See link below http://www.health.gov.au/internet/main/publishing.nsf/Content/health-privatehealth-lhc-providers-general.htm

    • BobinOz March 25, 2014, 5:12 pm | Link

      Hi Celia

      Yes, I am aware of this, I mentioned it in my free e-book “20 Reasons Why…”

      Also, anyone coming to this country as a permanent resident over the age of 31 has 12 months in which to take out the insurance without penalty. So if someone arrives at age 40 they do not pay the loading unless they wait till there are over 41 to take out cover and then they will get hit with all of the loading.

      So if you want private health insurance, get it sorted within the 12 months of arrival.

      Cheers, Bob

  • Steve February 13, 2014, 11:23 pm | Link

    You better believe they are sent a bill. Pretty hefty by all accounts. That is one thing that is not exaggerated. That is one of the things that The Affordable Health Care act (Obamacare) is designed to try and get a grip of.
    The checking pockets probably comes from the fact that many folks carry a medicard in their wallets with a list of medications, allergies etc on it. Something I think you will find happens in Oz as well. 🙂

    • BobinOz February 15, 2014, 12:47 am | Link

      Yes, I thought as much. Probably why Americans who come here to Australia say our health service is fantastic. Going through people’s stuff checking for medications and allergies etc, that makes sense as well.

  • Steve February 12, 2014, 10:36 pm | Link

    Just to let you know Bob. I am a brit that grew up in Oz but lived in the US for 20 years and worked as a 911 Paramedic there for many years. The stories about the Paramedics looking for insurance prior to treatment is a complete fabrication. No idea where it originated but the US law is that ALL people that call 911 will be transported, if they want; to an appropriate facility and at an absolute minimum treated until in a stable condition regardless of ability to pay. And that was before “Obamacare”.
    Found your site because I may be uprooting from Sweden and heading to Brisbane next year. Too damn cold here!

    • BobinOz February 13, 2014, 9:58 pm | Link

      Well, I have to say Steve, the stories did seem quite extreme. Paramedics rifling through people’s pockets looking for health cover evidence?

      I’m glad to hear it is an exaggeration and thanks for clearing that up for us. But tell me, people who are picked up, transported, treated until stable, are they then sent a bill for that?

      Good to hear you are Brisbane bound, don’t forget to sell your bobble hat and your coats before you leave.

      Cheers, Bob

  • Grant February 5, 2014, 1:50 am | Link

    Hi Bob,

    Just thought I’d share a few things. Growing up in Australia I have had a lot or visits to the dr and unfortunately to hospital. My dr currently bulk bills all my visits (ie, I have no gap to pay). There are a number of medical centres around who bulk bill all patients, some will only bulk bill concession card holders. You’ve probably seen in the media lately the uproar about proposed charge of a six dollar fee in these cases. This is not yet legislated.

    Even with private health cover, we still have the right to be treated in the public system if we choose. If we need essential things like X-rays, ultrasound etc, these can be bulk billed ask your dr if unsure. However if we just want to have something done, we may have to pay. If we need urgent medical attention though, like me recent heart attack, we can choose public or private. I nominated public even though I have basic hospital cover. I did this as my basic hospital cover would have had a surcharge for stays in hospital. And it didn’t cover heart conditions. I spent six days in hospital, was transported to another hospital for specialized testing by ambulance and back again all at no cost. I did have to pay for me medications prescribed when I was leaving, but everything else was included.

    So if your a citizen or permanent resident and unsure, you can always say public. If you determine later you are covered by your health fund, you can change over and be treated as private anyway. The only draw back to public, is any elective or non-urgent treatment is likely to be something you’ll have to wait for. All in all, shop around for a general practitioner. If you want one who bulk bills in your area, a quick google search should be helpful.

    You can also check out humanservices.gov.au for Medicare and pharmaceutical benefits scheme info in more detail.

    Grant

    • BobinOz February 5, 2014, 6:00 pm | Link

      All very good information Grant and absolutely spot-on as well.

      I remember playing six a side football a few years back when a friend of mine had a nasty collision with a goalpost, he ended up with concussion.

      The ambulance arrived, took them a good 20 minutes or so to bring him round, and one of the first things they asked him when he came to was “private or public?”

      “Public” he mumbled, and off he went in an ambulance to the nearest public hospital.

      The next day when I saw him I questioned him on this, because I knew he had private health insurance.

      “Yes, but if I tell them that, the private hospital will run all sorts of tests, I will be in there all night and I’ll probably still end up having to pay the gap. Better off going public, they will asked me how many fingers they are holding up and if I get it right, they’ll let me go home. No charge either.”

      Maybe he wasn’t that concussed after all 🙂

      Cheers, Bob

  • Erin December 7, 2013, 3:05 pm | Link

    Reading this as I’m signing up for our new Affordable Care Act and deciding whether I want a $1500 or $3000 or $6000 deductible before I get to pay $60 to see my specialist doctors (on top of the $300 individual monthly premium) so I’m just going to put your healthcare on the list of things to not worry about until I get there. 🙂

    • BobinOz December 9, 2013, 3:25 pm | Link

      Affordable Care Act, that’s the US thing, right? And why is it called ‘Affordable Care’ exactly? 🙂

  • Steve November 14, 2013, 11:46 am | Link

    Well done Bob in trying to answer the complex question about how the health care system works in Australia. Having been in Canberra for over two years and my wife and I accessing public and private health services, I’m not entirely sure how it works either!

    We’ve both had good and bad experiences with the NHS in the UK and here in Australia too, so to compare the services in each country is difficult. The comparison that can be made is of course is the cost of medical services in Australia and the UK – much pricier here in Australia at the moment, but the long term NHS reforms will see more costs being past onto its patients.

    My wife will be having an operation here in Canberra in two weeks. It will be done privately after a wait of four months. The waiting list for public patients is 12 months. Waiting lists are a reality wherever you reside!

    • BobinOz November 15, 2013, 2:42 pm | Link

      Thanks Steve, yes it is a complex question and one I know I have come nowhere near to comprehensively answering.

      Interesting that you mention the NHS reforms, I’ve only read briefly about it, but it can only mean higher costs coming soon in the UK. Waiting lists are everywhere, I waited 12 months in the UK (15 years ago) to have my cruciate ligament repaired.

      But all done totally free when it did eventually happen, so no complaints really.

      I hope your wife’s operation goes well in a couple of weeks time, I’m sure you have insurance to cover it, but I also bet it doesn’t cover everything and you will end up having to top up with some kind of four figure sum.

      Cheers, Bob

  • Renee November 4, 2013, 11:10 pm | Link

    That’s weird that you can’t go to any doctor, I have to drive across town to get to a bulk billing doctor. Because of that I take my kids to a child health clinic for needles and checks.

    • BobinOz November 5, 2013, 4:22 pm | Link

      Well, I’m talking NHS doctors, not private doctors. If you are willing to pay, you can probably go anywhere in the UK, but if you want to use an NHS doctor then you have to pick one within the designated area for your home address.

  • Renee November 2, 2013, 4:21 pm | Link

    I’m an aussie and I just like your blog because an outsider opinion is interesting.

    I am a low income earner and I have a healthcare card which gives me the $5.60 medication haha. I go to a doctor who bulk bills meaning it’s completely free to me with my health care card (it goes with my parenting payment) but a pension card does the same thing. The problem with bulk billing doctors is there aren’t very many (because they only get the $35) and you have to wait longer and it’s more like what you described in the UK.

    Also if you don’t ask you don’t receive and a while ago the dr we had been going to (great dr) changed from bulk billing to bulk billing just for kids and aged pensioners but since we had been going to him for a while I asked if he would be willing to bulk bill and he said yes and continued to see us as he had before.

    • BobinOz November 3, 2013, 9:47 pm | Link

      Thanks Renee, glad you like my blog especially as you are an Aussie 🙂

      That’s another really interesting point and it also makes sense. My doctor seems to have all the time in the world, but then he charges $80 a visit. My part of that is $44.

      But I am learning that some doctors charge only what Medicare refund which is $35.60, but it makes sense that those doctors are in more of a hurry to maybe deal with their patients and that they will have more of them, so the queues will be a little longer.

      As the old saying goes, “you gets what you pays for”.

      It also depends what’s convenient as well, I’ve been told that if I drive about 15 minutes away I can get a doctor for $45. But 15 minutes there, 15 minutes back, and maybe a longer wait because he’s cheaper, plus of course the cost of the petrol. I might save $35, but that’s the average hourly wage, roughly speaking, in Australia.

      So it’s probably not worth it.

      None of this happens in the UK, you have to go to a doctor within your area, so your choices can be restricted to just one or two doctors practices. Here you can go anywhere.

      Cheers, Bob

  • Nick November 1, 2013, 7:08 pm | Link

    Yes, in our case there is no gap to pay. I just sign a Medicare form and leave, It is brilliant. I’ve no idea what the doctor charges, only that Medicare cover it all.

  • Nick October 31, 2013, 10:23 pm | Link

    Note that some doctors provide a “bulk-billing” arrangement whereby the doctor accepts the Medicare payment as full payment for a consultation and Medicare pays the doctor directly. My doctor in Perth does this for some of his appointments and I’ve found it to be quite satisfactory especially as I generally just want a repeat script to be issued. However, just this week he removed a small lesion from my finger, which involved 6 stitches and the removed tissue being sent for a histology test, all at no cost to me. The major difference I’ve found is that scans, X-rays etc do cost considerably more than the Medicare limit (and are not covered by my private health insurance) but they can usually be arranged in a very short time. Much quicker than I experienced with the NHS.

    • BobinOz November 1, 2013, 1:56 pm | Link

      Well, my doctor does bulk billing but I still have to pay the gap as Medicare only pay for $35.60 and my doctor charges $80.

      So, are you saying your doctor only charges $35.60 in total and therefore there is no “gap” as it’s called? If that’s the case, that’s brilliant!

      Interestingly our experience is completely different on those scans and x-rays, we’ve always handed over our Medicare card and it has covered everything, no extra money to pay. So our experience is the opposite to yours somehow, so things are clearly different from doctor to doctor and from diagnostics lab to diagnostics lab.

  • Anne October 31, 2013, 1:20 pm | Link

    I have only been to the doctor once since I arrived in Australia 3 years ago and it was a pleasant experience. I showed up at my nearest medical centre (no need to register – I can go to a different one next time if I want to), waited 20 mins, saw a young lady doctor who examined the mark on my face which I thought might need further investigation (it didn’t). She then suggested I have a cervical smear test while I was there as I was entitled to one every year at my age. So I did. Then she gave me the number of Breastscreen QLD and encouraged me to make an appointment. There was no time pressure – she would have talked to me for as long as I wanted. I paid $70 and with the rebate it was about $35 – a bargain!

    • BobinOz October 31, 2013, 9:30 pm | Link

      Hi Anne

      Well, I’ve not yet been offered breast screening or a cervical smear test :-), but other than that I’m glad to hear your experience has been very similar to mine.

      I remember my doctor in the UK ended up putting a sign up in reception basically requesting that people visit with only one ailment at a time, so if, for example, you had a bad back and an ear infection, then you would need to make two appointments.

      Here there seems to be no such rush to push you out the door to see the next patient, doctors seem to be happy to discuss many problems, even, as in your case, things you haven’t turned up to talk about. My doctor has even had time to tell me jokes on more than one occasion.

      I really liked my doctor in the UK, I was with him for about 25 years, but this is a totally different and better experience.

      As you say, it’s so good it makes it worth the money.

      Cheers, Bob

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