Taking care of your health is important, so when you need care, understanding how to make informed choices is essential. If you need to go to hospital, navigating the different components of Australia's Healthcare System can be challenging and confusing, when you just need to focus on your health.
So, let's break it down and take a look at the parts of the system, and how it all works together.
The healthcare system at a glance
Australia’s healthcare system is one of the most comprehensive in the world. It offers a range of services from general and preventative health, through to treating more complex conditions that may need a specialist or hospital care.
The system has two major parts: the public health system, and the private health system. When you need care, you might access it through one of the two systems, or a mix of both.
Let’s explore what they look like:
The public system is made up of a number of components, including public hospitals, community-based services, and affiliated health organisations largely owned and governed by state and territory governments. Australian citizens, permanent residents, and people from countries covered by Reciprocal Health Care Agreements (refer to ‘Healthcare for international visitors’ for more information) access care within the public health system for free or at a lower cost through Medicare (funded by tax).
The private system includes health service providers that are owned and managed privately, such as private hospitals, specialist medical and allied health, and pharmacies.
While the public system is funded by local, state and federal governments, the private system is funded by a combination of:
- Private health insurers (covering people with hospital policies)
- Patients (covering their own expenses)
- Medicare (towards part of the cost of medical professionals)
- Sources like WorkCover and TAC (for people covered by statutory schemes)
- Other government and private funding
In the lead up to and during a hospital visit, health professionals, including doctors and specialists, can provide treatment through either the public or the private system.
Healthcare for international visitors
If you’re an international visitor to Australia, travelling for work, study, or tourism, you generally won’t have access to Medicare. This is why it’s often a requirement of your visa that you purchase private health insurance, such as Overseas Student Health Cover or Overseas Visitors Cover. These policies allow you to access services through both the public and private Australian healthcare systems without relying on Medicare (waiting periods, yearly limits, fund and policy rules apply).
If you’re from a country with a Reciprocal Health Care Agreement (RHCA) this means you are eligible for Medicare, but it will only cover you for medically necessary treatment. Any other treatment is your responsibility. The Australian government strongly recommends all international visitors have private health insurance before they travel. RHCAs don’t cover expenses not covered by Medicare, like ambulance and private hospital costs. Check Services Australia for full RHCA eligibility criteria.
Who delivers healthcare
Medical professionals
General practitioners (GPs) are often your starting point when it comes to health and care. During your first consultation, they will assess any problems you may present with, and try to treat your immediate health concerns.
If needed, they can also organise relevant tests to inform a diagnosis, and can refer you to a specialist, hospital or alternate care.
For example, if you’ve got a heart condition, they may refer you to a cardiologist. Find out more about what you can expect when visiting a specialist.
Your GP may also refer you to what’s known as an allied health professional. These are trained professionals who can help manage physical and mental health, such as physiotherapists and psychologists.
Public and private hospitals
If you need to go to hospital in Australia for an operation or treatment, there are different types of hospitals.
Public hospitals
Public hospitals provide high quality medical care at low or even no cost to people with access to Medicare. They are usually where you go if you have an emergency.
If you need non-urgent treatment, and choose to be a public patient, you may need to wait longer until a space becomes available, you won't be able to choose your doctor (you'll be looked after by the doctor on-call for your health issue or condition), and you may be in a shared room with other people while you recover.
Public hospitals are funded by the government, but also get funded by health insurance when patients choose to use their private cover in a public hospital.
If you’re an international visitor with private health insurance, you might also be treated at a public hospital, with your insurance policy helping to cover the cost.
Private hospitals
Private hospitals are owned and operated by private organisations but licensed and regulated by the government. Typically, you'll get:
- Choice as a private patient regarding aspects of your care, like choosing your doctor
- Reduced waiting time for elective or planned surgeries (compared to public hospitals)
- The choice of a private room (if available and medically appropriate).
Find out more about going to hospital.
Who pays for healthcare
Depending on how you use the healthcare system, funding comes from the government, as well as private health insurers, and sometimes through payments by patients.
Medicare
Medicare is the government’s scheme to give Australian citizens, permanent residents, and people from countries covered by Reciprocal Healthcare Agreements (refer to ‘Healthcare for international visitors’ for more information) access to healthcare (funded through taxes). It covers:
- Treatment as a public patient in a public hospital
- 75% of the fee on a government list called the Medicare Benefits Schedule (MBS) for doctors’ services in hospital if you’re a private patient
- All of the cost (what’s known as ‘bulk billing’) or some of the cost of going to a GP or specialist
- Some (but not all) tests and examinations your doctor orders for you
- Reduced cost on some prescription medications, if they are on a government list called the Pharmaceutical Benefits Scheme (PBS).
The Medicare Benefits Schedule (MBS) is a list of services subsidised by the government. Each has a fee that the government says is appropriate to charge for that service, though some practitioners may charge more than the MBS’s recommended amount. This can lead to out-of-pocket expenses for the patient.
Private health insurance
Private health insurance is an optional cover many Australians take out to give them more choice when it comes to their healthcare, as you can choose a level of cover to suit your needs. International visitors and students will often be required to purchase and maintain private health insurance before being eligible for an Australian visa.
Private health insurance covers things like:
- Hospital treatment: Once you are admitted to hospital, private hospital cover may help pay for the costs of treatment and your stay.
- General treatment: Also called ‘Extras’ or 'Ancillary', this depends on your policy but can include dental, optical, physiotherapy treatment, and more.
- Ambulance: You could get cover for emergency and sometimes non-emergency transport and/or treatment. In some states, an ambulance may already be covered, or cover can be purchased by a subscription directly from the provider.
Healthcare can be expensive. Learn more about options for funding your treatment.
If you’re an Australian Bupa member, you can learn more about how health insurance works in Bupa’s Important Information Guide (PDF, 2MB). And if you need more help understanding the Australian healthcare system, simply get in touch – you can call, message, or visit us in-store.
Next: What to do when you feel sick