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Supervisor : Dr.TabriziHadi Gholipour : Provider

HEALTH INFORMATION MANAGEMENT

Tabriz University Of Medical Sciences_Paramedical faculty(Feb 2010)

Health Insurance In The Developed Countries

Australia

Medicare AustraliaAn Australian government agency

Medicare Australia

Medicare Australia is an Australian government agency and plays an integral role in the Australian health sector. Its objective is to assist in improving health outcomes in Australia.

These health programs include:

Australia's universal health insurance program, Medicare

Australian Childhood Immunisation Register

Australian Organ Donor Register Family Assistance Office & etc…

MedicareAustralia’s universal health care system

Medicare is Australia’s universal health care system introduced in 1984 to provide suitable Australian residents with affordable, accessible and high-quality health care.

Medicare was established based on the understanding that all Australians should contribute to the cost of health care according to their ability to pay.

Medicare ensures that all Australians have access to free or low-cost medical, optometrical and hospital care while being free to choose private health services and in special health services.

Medicare provides access to:

free treatment as a public (Medicare) patient in a public hospital.

free or discounted treatment by medical practitioners including general practitioners, specialists, participating optometrists or dentists (for specified services only).

Who is eligible?

People who reside in Australia ( excluding Norfolk Island)are eligible if they:

hold Australian citizenship have been issued with a permanent visa hold New Zealand citizenship

What does Medicare cover?

The benefits you receive from Medicare are based on a Schedule of fees set by the Australian Government. Doctors may choose to charge more than the Schedule fee.

Out-of-hospital services

Medicare provides benefits for:

consultation fees for doctors, including specialists

tests and examinations by doctors needed to treat illnesses, including X-rays and pathology tests

eye tests performed by optometrists most surgical and other therapeutic

procedures performed by doctors

some surgical procedures performed by approved dentists

specified items under the Cleft Lip and Cleft Palate

You can choose the doctor who treats you for out-of-hospital services.

Medicare pay 85% of this fees.

In-hospital services

Public Patient:

If you choose to be admitted as a public (Medicare) patient in a public hospital, you will receive treatment by doctors and specialists nominated by the hospital. You will not be charged(pay) for care and treatment, or after-care by the treating doctor.

:Private Patient

If you are a private patient in a public or private hospital, you will have a choice of doctor to treat you. Medicare will pay 75 per cent of the Medicare Schedule fee for services and procedures provided by the treating doctor. If you have private health insurance some or all of the outstanding balance can be covered.

You will be charged for hospital accommodation and items such as theatre fees and medicines. These costs can also be covered by private health insurance.

What's not covered by Medicare?

Medicare does not cover such things as:

private patient hospital costs (for example, theatre fees or accommodation)

dental examinations and treatment ambulance services home nursing physiotherapy, occupational therapy, speech

therapy, eye therapy, or psychology acupuncture (unless part of a doctor's

consultation)

glasses and contact lenses hearing aids and other appliances the cost of prostheses (except External Breast

Prostheses) medicines medical and hospital costs out of country medical costs for which someone else is

responsible medical services which are not clinically necessary surgery solely for cosmetic(beauty) reasons examinations for life insurance, superannuation or

membership of a friendly society eye therapy

Claims and Cover

The benefits you receive from Medicare are based on a Schedule of fees set by the Australian Government. There are a number of ways to claim from Medicare, which option you use probably will depend on how your doctor organizes their payment.

HOW DO I CLAIM FROM MEDICARE?

Bulk billing Medicare offices Your doctor’s practice By mail (GPO Box 9822 in your capital city) Telephone (1300 360 460) Medicare Australia Access Points Medicare two-way forms Medicare Easyclaim

Bulk billing :

In this way your doctor sends a billing to Medicare directly and accepts complete Medicare’s fee.

Medicare Easyclaim:

Medicare Easyclaim is a quick, easy, secure and convenient way for you to claim your rebate at the doctor’s.

Medicare Easyclaim means for youIf you normally pay to see your doctor, Medicare Easyclaim

lets you claim your rebate on the spot, using the EFTPOS terminal in your doctor’s practice. Your rebate is paid directly into your cheque or savings account almost immediately.

Medicare Easyclaim is gradually being rolled out to participating medical practices. Just look for the Medicare Easyclaim sign or ask the practice.

Medicare two-way

Medicare two-way is an Australian Government initiative designed to make lodging health claims easier for people with private health insurance. Under Medicare two-way you can lodge all your in-hospital claims with your participating private health fund or with Medicare.

There are over 35 funds participating in Medicare two-way

Australian Health Management Group (AHM) The Doctors' Health Fund Limited (AMA) Navy Health Limited (NHB) Police Health (POL) Railway & Transport Health Fund Ltd (RTH)

How will Medicare pay my benefit 

Electronic Funds Transfer (EFT) Cash Cheque

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Medicare enrolment application

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Medicare claimappendix

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