What is Medicare and how does the medical system work in Australia?

As a clinic which caters to many new Australian patients (particularly Japanese), we would like to take some time to explain how the medical system in Australia works. It is also not uncommon for Australians themselves to not understand how our own system works! We hope you find the information here of assistance in reducing uncertainty when dealing with the health system either at our clinic or elsewhere. If there is any information you think we should add to this section please feel free to contact us and let us know.

Understanding Healthcare in Australia

1. Getting a Medicare card

All Australian citizens are issued a Medicare number. From birth, until a young adult becomes independent they are usually included on their parents’ Medicare card.

A young person can apply for their own Medicare card once they turn 15. This can be useful if a young person has concerns about their parents knowing they are accessing a health service (there are a variety of reasons why this concern arises for young people). The record of any attendance transacted through this Medicare card will only show up on this Medicare card (and not on the parents’ account). This is very important as reducing barriers to accessing healthcare is important in improving the health outcomes of young people.

2. Calculating your medical fee

The calculation of the medical fee sometimes creates confusion for patients who don’t understand why they may not be eligible for a certain ‘service’ such as a chronic disease management plan or mental health care plan.

When you see a health professional, a Medicare ‘code’ is applied to the consultation which varies depending on the nature of the service provided. This code is selected from the Medicare Benefits Schedule (MBS) item list by the health professional.

The amount of money (rebate) the patient may receive for the consultation may vary, depending on the code applied. We apply these codes very seriously, and follow stringent criteria set by Medicare for the application of these codes. There are very serious consequences for health professionals that abuse the Medicare system and use the wrong code.

3. Bulk billing

Some clinics in Australia will “bulk bill” a patient. This is where the health professional chooses to accept only the MBS rebate amount as payment for their service. Most businesses can only make this a viable business model by having a very high turnover of patients (the more patients per hour, the more money they make).

This can lead to doctors seeing more than ten patients per hour – that is, doctors spending a maximum of six minutes per patient. Taking into account the time required to call the patient from the waiting room, to walk to the consultation room and to write notes post-consultation, not much time is left for the actual consultation.

We understand that this model of care can be unpleasant for the patient, and can also be dangerous.

At Albert Road General Practice we have no interest in providing five-minute consultations. We prefer to take our time with each patient to ensure they are heard and cared for appropriately. In order to provide this high quality of care, like all other “private billing” practices, we charge a fee above the Medicare rebate. The difference between the total fee amount and the Medicare rebate amount is known as the ‘gap’, which is your out-of-pocket cost that is charged at the end of your consultation.

Ready to start the journey towards better health?