A world-class system
The healthcare system in Australia is one of the best in the world, and the assistance services on offer are not far behind, according to Roger Allnutt, who assessed the situation for international travellers heading Down Under
First published in ITIJ 112, May 2010
The healthcare system in Australia is one of the best in the world, and the assistance services on offer are not far behind, according to Roger Allnutt, who assessed the situation for international travellers heading Down Under
The island continent of Australia is roughly the same size as Western Europe, yet has a population of just over 22 million. About 80 per cent of the country’s population lives in cities – such as Sydney, Melbourne, Brisbane, Adelaide and Perth – that are mainly located on the coastal edge, principally along the eastern and southern part of the continent. There are large regions that have only small, scattered towns or are unpopulated.
Settlement of Australia by people now known as Aboriginal and Torres Strait Islander peoples or Indigenous Australians, occurred tens of thousands of years ago. Settlement by people from Great Britain, and subsequently other countries, began in 1788, resulting in a present day population with a diversity of ethnic backgrounds.
In the nineteenth century, Australia was governed as a number of British colonies. Since 1901, though, Australia has been an independent nation with a federal system of government, with origins in the British system of government and law. The Constitution established a Commonwealth (federal) Government, giving its Parliament powers in specified fields.
Originally, the only Commonwealth health power was in quarantine matters. However, in 1946, the Constitution was amended to enable the Commonwealth to provide health benefits and services, without altering the powers of the States in this regard. Consequently the two levels of government have overlapping responsibilities in this field.
The States and Territories are primarily responsible for the delivery and management of public health services, and for maintaining direct relationships with most healthcare providers, including the regulation of health professionals
The Commonwealth currently has a leadership role in policymaking, particularly in national issues like public health, research and national information management. The States and Territories are primarily responsible for the delivery and management of public health services, and for maintaining direct relationships with most healthcare providers, including the regulation of health professionals.
Australia is a developed country with a generally high standard of living, and a high standard of medical facilities and care. It also has a strong and innovative medical research tradition responsible for a number of important breakthroughs that have benefited patients around the world.
Healthcare delivery
The States and Territories deliver public acute and psychiatric hospital services and a wide range of community and public health services, including school health, dental health, maternal and child health, and environmental health programmes – the State and Territory governments directly fund a broad range of health services, and the Commonwealth funds most medical services out of hospital, and most health research.
There is also a large and vigorous private sector in health services. The Commonwealth Government considers that strong private sector involvement in the provision of health services and financing is essential to the viability of the Australian health system. For this reason, the Commonwealth Government provides a 30 per cent subsidy to individuals who acquire private health insurance and has introduced additional arrangements to foster lifelong participation in private health insurance plans.
Private health insurance can cover private and public hospital charges (public hospitals only charge patients who elect to be private patients in order to be treated by the doctors of their choice), and a portion of medical fees for inpatient services. Private insurance can also cover allied health/paramedical services, such as physiotherapists’ and podiatrists’ services, and some aids and appliances, such as spectacles.
A mix of public and private sector providers deliver health services – the quality of healthcare provided is high in both sectors. The majority of doctors are self-employed, although a small proportion consists of salaried employees of the Commonwealth, State or local government. Salaried specialist doctors in public hospitals often have rights to treat some patients in these hospitals as private patients, charging fees to those patients and usually contributing some of their fee income to the hospital. Other doctors may contract with public hospitals to provide medical services – there are many independent pathology and diagnostic imaging services operated by doctors.
Public hospitals include hospitals established by governments and hospitals that were originally established by religious or charitable bodies but are now directly funded by the government. There are a small number of hospitals built and managed by private firms providing public hospital services under arrangements with State governments, although most acute care beds and emergency outpatient clinics are in public hospitals. Large urban public hospitals provide most of the more complex types of hospital care such as intensive care, major surgery, organ transplants, renal dialysis and specialist outpatient clinics.
Private hospitals are owned by for-profit or not-for-profit organisations such as large corporate operators, religious operators, and private health insurance funds. In the past, private hospitals tended to provide less complex non-emergency care, such as simple elective surgery. However, some private hospitals are increasingly providing complex, high technology services. Separate centres for same-day surgery and other non-inpatient operating room procedures are found mostly in the private sector, although many public hospitals provide such services on the same site as inpatient care.
As mentioned, the quality of healthcare in Australia is high. The first point of contact for most patients is to see a general practitioner, and if more detailed advice is required, a patient can be referred to a specialist. Although the number and availability of general practitioners varies across Australia, most large hotels in the major cities have arrangements with doctors who would be available for consultation for travellers in need of medical care – the patient would be expected to pay the practitioner after the consultation.
A mix of public and private sector providers deliver health services – the quality of healthcare provided is high in both sectors
The largest and most comprehensive hospitals are located in the major cities and these offer a wide range of treatments. The top hospitals (and many of these are also teaching hospitals) are equivalent to the best in the world. Outside the major cities, while the standards in smaller regional hospitals are still high, the range of treatment options may vary. However, for most travellers, the need for hospital treatment is usually the result of an accident such as a broken limb from a fall, for example, or a more major accident, such as a road accident. In these cases, the traveller should first seek, or would be taken to, a nearby accident and emergency section of a hospital – usually a public hospital.
The emergency department of the hospital would then usually issue an account for the services rendered, including both charges for the treating doctor(s) and for the costs of the hospital stay. It would be up to the patient to cover these costs and seek reimbursement from their insurer. It is up to the individual hospital to determine the fees charged; there is no ‘set’ fee for specific services across the country, or, as in the US, ‘usual, customary and reasonable’ charges.
For emergency treatment for patients from countries with which Australia has a reciprocal agreement, however, these fees would be waived. Unlike some other countries where evidence of capacity to pay is required as a prerequisite before treatment is commenced, no patient needing emergency care in Australia would be denied treatment. There are some innovative solutions to health issues arising out of Australia’s unique history and needs.
The aim of the national healthcare funding system is to give universal access to healthcare while allowing choice for individuals through a substantial private sector involvement in delivery and financing. The major part of the national healthcare system is called ‘Medicare’. Medicare provides high-quality healthcare that is both affordable and accessible to all Australians, often provided free of charge at the point of care. It is financed largely from general taxation revenue, which includes a Medicare levy based on a person’s taxable income.
When Medicare began in 1984, the Medicare levy was introduced as a supplement to other taxation revenue to enable the Commonwealth Government to meet the additional costs of providing the same level of care for the whole population.
In addition to the RFDS, each state and territory operates other medical retrieval systems to bring patients to major hospitals for medical treatment
The Medicare levy is paid by individuals at a basic rate of 1.5 per cent of taxable income above certain income thresholds. Taxpayers on high incomes who do not have private health insurance pay an additional one per cent of taxable income as part of the levy.
Private health insurance is an important component of funding of heathcare in Australia, providing about 11 per cent of total national healthcare funding. For insured people, it provides added benefits such as choice of doctor, choice of hospital and choice of timing of procedure. Private insurance can also assist with meeting the costs of private sector services which are not covered by Medicare, such as dental, optical, physiotherapy and podiatry services.
Air ambulance cover
Australians, and people who visit the country, are lucky to have at their service the Royal Flying Doctor Service (RFDS), which began as the dream of the Rev. John Flynn, a minister with the Presbyterian Church. He witnessed the daily struggle of pioneers living in remote areas where just two doctors provided the only medical care for an area of almost two million square kilometres. Flynn’s vision was to provide a ‘mantle of safety’ for these people and by 1928, his dream had become a reality with the opening of the Aerial Medical Service (later renamed the Royal Flying Doctor Service) in Cloncurry in outback Queensland.
Over the next few years, the RFDS began to expand across the country. By the 1950s, the RFDS was acknowledged by former Prime Minister Sir Robert Menzies as “perhaps the single greatest contribution to the effective settlement of the far distant country that we have witnessed in our time.”
Today, the RFDS operates a fleet of 53 fully instrumented aircraft with the very latest in navigation technology. It operates 21 bases across Australia, delivering rural healthcare to remote areas by aircraft. Every day, the RFDS takes the finest care to Australia's furthest corners so that anyone who lives, works or travels in remote and rural Australia can enjoy the best of health.
In addition to the RFDS, each state and territory operates other medical retrieval systems to bring patients to major hospitals for medical treatment. The CareFlight Group, for example, is one of Australia’s largest air medical retrieval operations, carrying out more than 3,000 domestic and international missions each year. CareFlight integrates its own full-time critical care doctors, air crews and dedicated medical helicopters and retrieval jets to dramatically reduce response times, significantly improving patient outcomes.
There are other companies providing similar services and these include CareFlight International, Mediflight and Ozevac. These companies become involved if the insurer of the patient contacts the company for assistance or the patient initiates contact directly if they do not have travel insurance. For example, Ozevac uses some of the latest medical equipment with Learjet air ambulances that come equipped with Lifeport stretchers. Expert doctors and nurses are specifically chosen to meet the individual needs of each case.
The Australian Red Cross Blood Service is a national not-for-profit organisation that forms part of Australian Red Cross. It is supported by the governments of Australia and is responsible for providing the Australian community with safe, high-quality blood and blood products, and organ and bone marrow services for transplantation. It does this with the support of more than half a million voluntary blood donors. Rigorous screening takes place before donations of blood are taken and no payment is made to the donor.
International travellers
Because Australia has a high quality healthcare system, with low costs compared to some other developed countries, it is an excellent destination for patients seeking treatment that they cannot access in the country where they live. People wishing to visit Australia for this purpose should, before arriving, obtain the appropriate type of visa and make arrangements for treatment and payment.
Eight countries have reciprocal healthcare agreements with Australia. These are: Great Britain, Finland, Ireland, Italy, Malta, the Netherlands, New Zealand, and Sweden. Visitors (but not visitors studying in Australia) from these countries are eligible for Medicare assistance for immediately necessary medical treatment (but not for prearranged treatment). Under the agreements, hospital treatment is provided only if the patient elects to be a public patient.
The terms of the various agreements differ. The major differences are that the agreements with Ireland and New Zealand cover only hospital treatment and pharmaceutical benefits, and the agreements with Italy and Malta cover only the first six months from the date of arrival in Australia.
Note that reciprocal healthcare agreements do not cover treatment if the purpose of the visit to Australia is to have treatment.
Other visitors are not eligible for Medicare and should arrange for comprehensive health insurance to cover unexpected healthcare costs during their visit to Australia. The regulated private insurance used by people eligible for Medicare is inappropriate for this purpose since it does not usually adequately cover doctors’ fees for in-hospital medical services. People coming to Australia for the purpose of having treatment should ensure that they are fully informed about the costs they will need to meet.
People coming to Australia for the purpose of study are required to purchase special low cost health insurance known as Overseas Student Health Cover.
Assistance matters
There are several assistance companies operating in Australia to aid travellers in need. Mondial Assistance Australia has built up a network of over 1,600 medical specialists, including air ambulance services, spanning the entire nation. According to the company, “Our medical consultants are members of bodies such as International Society of Air Medical Services (Australasia) or the International Society of Travel Medicine and cover activities ranging from emergency rescue operations to interpretation services. This personnel base is supported by an extensive range of portable medical evacuation equipment and allow for an international mobile response giving Mondial Assistance a strategic advantage when responding to emergency situations.”
IAG collectively manages over 351,000 travel assistance cases a year, with nearly 18,000 travellers being evacuated
AXA Assistance Australia also boasts complete coverage for travellers who find themselves in need of help – no matter how remote a part of the Outback they find themselves. The company states: “Corporate strength, combined with our global network of Alarm Centres, professional medical providers and correspondents, enable us to respond efficiently and sensitively, to any emergency medical or travel situation around the globe. In every case, we provide immediate solutions in a caring, responsible and cost- effective manner, whatever the profile of your customer; from international expatriates in the need for permanent protection, to high-maintenance business travellers, requiring on-the-spot answers.” It adds: “Pre-arranged special rates, priority access to local facilities and PPO discount capabilities guarantee we always deliver the best service at the best price.”
ACE Assistance also operates in Australia, offering insured travellers emergency medical evacuation, medically supervised repatriation, legal assistance and compassionate visits if the policyholder is travelling along and is hospitalised for more than a week. It also provides for payment of approved medical services or a redirection of hospital accounts straight to ACE Insurance.
ING Australia has its own in-house emergency assistance team, Omega, which offers help to both outbound Australian tourists. QBE Australia also offers Omega assistance to outbound travellers, as do several other Australian travel insurers. Cover More, a well-known Australian insurer, offers emergency medical assistance through its sister company, Customer Care Pty Ltd, which it claims is ‘one of the region’s leading assistance providers with our own medical and technical people based in Australia’. It is a member of Insurance Australia Group (IAG), which provides assistance services for over 127 million policyholders each year. IAG collectively manages over 351,000 travel assistance cases a year, with nearly 18,000 travellers being evacuated.
Outbound Australians
Medicare covers only services rendered in Australia. Australians visiting countries with which Australia has reciprocal healthcare agreements are generally covered by the host country’s public healthcare system while they are in the host country. Australians planning such visits, though, should contact Medicare to check the details of what is covered by the agreement in each country before arriving there. Healthcare provided while in transit to or from these countries is not covered by the agreements and nor is the cost of repatriation in cases of serious illness or death.
The bottom line for travellers to Australia and for Australians travelling overseas is the vital importance of taking out comprehensive travel insurance
In visits to other countries, the full costs of healthcare will be generally charged to the traveller and no assistance will be available from the Australian Government. All Australians travelling overseas are advised to purchase comprehensive health insurance, regardless of whether or not they are travelling to countries with which Australia has a reciprocal healthcare agreement.
The bottom line for travellers to Australia and for Australians travelling overseas is the vital importance of taking out comprehensive travel insurance, including medical insurance, for the duration of their trip. The costs of medical assistance in many countries can be astronomic including, where necessary, repatriation to the traveller’s home country.
Overall, Australia is a safe place to visit. However travellers should be particularly aware of the vastness of the country and, if driving, will invariably encounter road conditions unlike those in their home country. In addition, Australia the opportunity for a range of adventure activities which all include inherent risk of accident. As the old adage says, “if you can’t afford travel insurance you should not be travelling.”