Australian Medicare

Anne E. Wright

n 2019, when my partner and I downsized for our retirement, we settled in Australia, my partner’s native homeland. The Australian national health care system was an important factor in our decision after having witnessed the compassionate and supportive care my partner’s brother and sister received while undergoing treatment for cancer in Australia, versus my own arduous and disheartening cancer journey in the United States. In the five years we’ve been here, we’ve had to utilize just about every facet of Australian Medicare and have so far found it to be superior to the American system.

Medicare is premium-free for Australian citizens and permanent residents. Visits to general practitioners (GPs) that “bulk bill” - meaning the doctor is compensated directly from Medicare - are also free of charge for patients. MRIs, CT scans, EEGs, blood tests, etc. are usually also free of charge if a doctor deems them necessary. Net out-of-pocket costs for specialist consultations generally run about $100 after a Medicare reimbursement is deposited directly into the patient’s account (usually within hours of the appointment).

Remarkably, hospitalizations, for the most part, are also free of charge within the Medicare system. We never received a single bill for my partner’s weeklong hospitalization two years ago. Not only that, before he was discharged, I was contacted by a hospital representative to ascertain the accessibility of our home. Based on that conversation, the hospital requested an in-home safety evaluation by an Occupational Therapist (OT). The OT recommended multiple grab bars, safety railings, an easy-access sliding door entry to the bathroom, and easy-turn water taps. All were installed at no cost to us by a government program called Short-Term Restorative Care. We were thrilled and astounded. From the government’s standpoint, it is more cost-effective to pay several thousand dollars on home safety equipment than to spend potentially tens of thousands of dollars for a hospitalization resulting from a serious fall. But still, it was a huge relief for us.

My next-door neighbor recently had knee replacement surgery. Her surgery, hospitalization, and follow-up physical therapy were all essentially free. Her one out-of-pocket cost was the specialist’s approximately $100 consultation fee. That being said, there is a drawback with a national healthcare system when it comes to surgeries for joint replacements which in Australia are considered elective in that they are non-urgent. Cancer and other life-saving surgeries are performed without delay but wait times for elective surgeries have blown out since COVID, sometimes in excess of six months. Private insurance, for those who can afford it, can reduce wait times, cover the cost of private hospitals, private rooms, extra physical therapy, and the like. The cost of private premiums varies from insurer to insurer and depends upon the specific extras the patient selects.

Seniors are particularly well looked after under the Australian system. There are dedicated aged care programs, prescription medications are capped at the equivalent of $5 U.S. dollars, higher Medicare rebates for specialist consults, and ambulance services are free of charge (in Queensland, ambulance services are free for everyone). When a pensioner’s out-of-pocket expenditure for specialists reaches a certain level (currently about $500 U.S. dollars) in a calendar year, Medicare reimbursements to the patient increase. The same is true for out-of-pocket costs for prescriptions. Once a patient spends a certain amount on medications in a given year, a program called Safety Net kicks in, and prescriptions are free for the rest of the year. Similar provisions are available to non-pension-age patients, but the out-of-pocket expenditure requirements are much higher before Safety Net benefits are granted.

One of the best benefits of universal Medicare is that no one is tied to an employer for their health care. In Australia, you can move from job to job and state to state freely without ever having to worry about losing your health care. And since the government has always been one’s healthcare provider, pre-existing conditions are not an issue.

We’ve personally found that because doctors in Australia determine the appropriate health care plan for each patient rather than for-profit insurance companies like in the United States, patient outcomes are better. The care here is proactive and preventative. If a doctor wants a scan to confirm or exclude say a tumor, they order one. It’s far easier and less expensive to remove a small tumor than waiting until it spreads. Since there is no battling an insurance company for coverage, procedures, and treatments are done in a timely manner. If a patient is in the emergency room and requires hospital admission, they don’t have to wait for insurance pre-authorizationor have the added stress of wondering if the hospital they are in even accepts their insurance. If they need the treatment they get it.

No healthcare system is perfect. Here in Australia, there are the aforementioned wait times for elective surgeries, there is a need for more urgent care facilities to fill the gap between general practices and busy hospital emergency departments, and rural communities often lack easy access to comprehensive medical services. Overall though, Medicare is a system that strives to achieve the best possible outcome for patients.

Anne E. Wright, a former journalist, received her BA from Tufts University