Understanding the Australian Healthcare System

The Australian healthcare system is one of the best healthcare systems in the world. It operates in a hybrid mode, i.e. it consists of both public and private systems. If you are an expat living in Australia, or if you are planning to move to Australia, then you might want to know what the Australian healthcare system has to offer.

In the following sections, this article will go over a brief overview on the entire Australian healthcare system, then moving on to more focused topics.

Overview of the Australian Healthcare System

In Australia, there are many providers of healthcare. They include:

  • primary care services delivered by general practitioners (GPs)
  • medical specialists
  • allied health workers
  • nurses.

The way the Australian healthcare system is designed, for any kind of ailment the first point of contact are the GPs. For more specific and serious health conditions patients are able to seek consultation from medical specialists, however, they first need a GP referral to get a booking.

As stated previously, there are both public and private sectors in the Australian healthcare industry. Through Medicare, Australia’s universal health care scheme, Australian citizens, Australian permanent residents and eligible expats in Australia are able to access the public hospital system either for free or at low-cost.

If one has private health insurance, they are able to choose private healthcare providers along with public healthcare providers. Generally, for private health care (including services both in and out of hospital) cost of the health care is borne by the individual.

What is Medicare?

Medicare has been there since 1984; it is the umbrella term for the government funded Australian healthcare system. Its three major parts are:

  • medical services
  • public hospitals
  • medicines

Medicare covers a range of services:

  • Seeing a doctor or specialist: Medicare will pay the whole cost. If the doctor does not bulk bill, you will have to pay for the consultation then claim part of the cost (called a rebate) back from Medicare.
  • Going to hospital: If you are a public patient receiving care in a public hospital, Medicare will cover all your costs. If you go to the emergency department of a public hospital, Medicare will pay for everything.
  • Prescribed Pharmaceuticals: Medicare covers a range of prescription pharmaceuticals subsidised under the Pharmaceutical Benefits Scheme (PBS).
  • Tests and scans: Medicare covers a range of tests including x-rays and pathology tests.
  • Eye tests: Medicare pays for eye tests conducted by optometrists. If you are under 65 this can be claimed once every three years. Over 65 year-olds can claim it once a year.
  • Mental health services: You can claim a Medicare rebate for up to 10 sessions (increased to 20 during the COVID-19 pandemic) each calendar year with a mental health professional. To do this, you need a mental health care plan and referral from your doctor.
  • Other support: Medicare covers the costs for some long-term conditions, some allied health services such as physiotherapy, and some prescription medicines.

Medicare is funded by the Australian Government through taxation revenue, including a Medicare Levy and Medicare Levy Surcharge. The State, territory and local government also help fund, manage and administer these public hospitals. 

Expats eligible for Medicare in Australian Healthcare System
Due to the Reciprocal Health Care Agreement with Australia, expats from the following countries can apply for Medicare. To register and receive their Medicare (government-run healthcare system) card, they will need:

  • a passport;
  • travel documents;
  • permanent visa.

Expats from these countries covered by Medicare in Australia.

TOEFL Internet Based Test (TOEFL iBT)
TOEFL is an Internet Based Test and has a number of test centers across the world. The duration of the test is 4.5 hours which is longer than IELTS and Pearson. The test results are available after 10 days of the exam date which is similar to the IELTS test.

Q) What score should I achieve and how many points do I receive?
English test results are divided into 5 main categories: Vocational, Functional, Competent, Proficient and Superior. Your minimum requirement differs according to the visa you are applying. However, for the “points test” following is the points allotment:

Belgium Netherlands Slovenia
Finland New Zealand Sweden
Italy Norway United Kingdom
Malta Ireland

Private Health Insurance
It is important to note that some medical and allied health services are not subsidised through Medicare. For instance, Medicare does not usually cover costs for ambulance services, most dental services and optical aids (such as glasses and contact lenses). Typically for these services, private health insurance is a great option for managing these health care costs.

  • hospital cover for some (or all) of the costs of hospital treatment as a private patient
  • general treatment (‘ancillary’ or ‘extras’) cover for some non-medical health services not covered by Medicare — such as dental, physiotherapy and optical services.

Some people with private health insurance have either one of the other both. The Australian Government provides a means-tested rebate to help individuals with the cost of their private health insurance.

More information on Private Health Insurance Rebates can be found here.

Roles of each level of government in Australian Healthcare System
The different layers of government are jointly responsible for the provision and operation of the healthcare system in Australia. Below is a brief list of main roles of each level of government in Australia’s health system.

The Australian Government:

  • develops national health policy
  • funds medical services through Medicare and medicines through the Pharmaceutical Benefits Scheme (PBS)
  • provides funds to states and territories for public hospital services
  • funds population-specific services, including community-controlled Aboriginal and Torres Strait Islander primary health care, health services for veterans, and residential aged care
  • funds health and medical research
  • regulates medicines and medical devices
  • supports access to and regulates private health insurance.

State and territory governments:

  • fund and manage public hospitals
  • regulate and license private hospitals and other health premises, and regulate products with health impacts such as alcohol and tobacco
  • deliver community-based and preventive services (for example, cancer screening and immunisation), ambulance services, and services to address complaints against any of these.

Local governments in some jurisdictions can be involved in:

  • delivery of community and home-based health and support services
  • environmental health services (for example, waste disposal, water fluoridation)
  • public health activities.

Costs of Healthcare in Australia
Medicare is mostly funded through taxes. Taxpayers contribute 2% of their taxable income to fund the system. It must be noted that sometimes not all healthcare costs are covered by Medicare. Regardless of you covered by Medicare, you might have to pay the out-of-pocket expenses.

If the doctor or specialist does not bulk bill, you need to pay for the consultation and claim part of the cost back from Medicare. The amount that you don’t get back from Medicare is known as the gap fee.

If you are wondering about the costs of Ambulance services in Australia, then know that there is a fee for ambulance services in Australia. Medicare does not cover the cost of an ambulance. If you have private health insurance, it may cover some or all of the cost.

Costs of Healthcare in Australia

Telehealth is currently the versatile way of availing healthcare services in Australia. It entails having a consultation with a healthcare provider by phone or video call.

Many GPs, specialists and other healthcare providers now offer a telehealth consultation when a physical examination isn’t necessary. It’s not intended to replace essential visits to the doctor, but rather be a convenient solution when you can’t see a doctor face to face.

If you have seen your regular doctor or medical centre in the last 12 months, they may be able to bulk-bill your telehealth consultation.

How to Find a doctor?

Before you can see your doctor, you would need to book an appointment first. To book an appointment, it is not necessary to be registered with a specific doctor in Australia. In fact, you can see any doctor either as a public or private patient.

The best way to go about it is for you to look up the Australian Doctors Directory. There you get to look up a doctor by their name, if it has been recommended to you by your friends, family or other medical professionals; or look for all the practitioning doctors in your suburb.

Once you have the necessary details, you can call the number to book a consultation. You can also install the HotDoc App and book your next healthcare appointment through the app, without having to call anyone.

If you are a private insurance holder, then you might want to check the healthcare providers affiliated with your insurance provider. That way, you might find the most cost-effective services.

Average Wait Time in Australian Healthcare System

According to the 2020-2021 data, the proportion of people waiting longer than they felt acceptable for a medical specialist appointment was 21.7%, compared to 16.6% of people waiting for a GP appointment.

People living in outer regional, remote or very remote areas were more likely to report  a longer wait time than they felt acceptable for an appointment than those living in major cities:

  • medical specialist appointment (26.6% compared to 21.4% in 2019-20)
  • GP appointment (22.9% compared to 15.2% in 2019-20).
  • public health activities.

People with a long-term health condition were also more likely to report waiting longer than they felt acceptable for an appointment than those without a long-term health condition:

  • medical specialist appointment (23.3% compared to 16.9% in 2019-20)
  • GP appointment (18.7% compared to 13.5% in 2019-20).

Giving Birth in Australia

If you are considering having a baby in Australia, there are a few factors that you’d need to consider. If you are a non-residents from one of the above mentioned countries, you’ll be covered under the Reciprocal Health Care Agreement. This means you will be entitled to free or subsidized essential treatment.

If you plan on having a baby in Australia as a foreigner, it is recommended you take out private insurance. Otherwise, it can be quite expensive to cover the costs yourself.

While at the hospital ready to give birth, it is recommended that you bring the following documents with you.

  • Antenatal card
  • Copies of your birth plan
  • Private health insurance details (if applicable)
  • Medicare card (if applicable)
  • Money for fees (if applicable)

Unlike a few countries, giving birth in Australia doesn’t automatically give the new born the Australian citizenship, unless one of the parents are Australian permanent resident or Australian citizen. For individuals on temporary visas, the newborn is given the same status as its parent(s).

How to get a Permanent Residency in Australia?

Australia offers a variety of visas that will allow you to secure permanent residency in Australia. To check which visa is the most suitable based on your circumstances, we recommend that you book a consultation to discuss that. During the consultation, our team of immigration lawyers will provide you with a feasible pathway to help secure a permanent residency in Australia.

Given the mammoth of experience the team brings in, we provide feasible and practical counselling on your successful pathway to Australia. The team is well adept with knowing what helps increase the chances of success for your application.

If you are unsure whether this visa category applies to you or not or if you are looking to be successfully nominated, then don’t hesitate to contact us or directly email us at hello@pathmigration.com.


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