The system is established by people, and it is inevitably imperfect. Just like people, advantages and disadvantages coexist.
The Australian system is not cold either. On the contrary, it is hot, with human temperature. It is precisely because of the temperature and human touch that Australia's medical insurance system can be said to be "perfect".
Medicare is Australia's federal medical insurance system, which can pay most of the medical expenses and provide high-quality medical services and guarantees for Australian citizens and Australian permanent residents. You can only choose medical insurance as your only medical insurance, or you can combine medical insurance with private medical insurance. In this way, some items that are not reimbursed by medical insurance will be compensated by private insurance, which will make your life and health more secure!
What kind of medical insurance does medical insurance provide?
The protection scope of Australian federal medical system mainly includes: inpatient medical treatment, outpatient medical treatment and drug welfare.
1. Hospital (hospital)
The most basic hospital medical services are summarized as follows:
Public patients)+Medicare: According to the National Medical Insurance Benefit Plan (MBS) formulated by the Australian government, public patients can enjoy free accommodation, treatment, nursing and continuous treatment after discharge from public hospitals. Medical insurance will pay 100% for public hospitals. But! As a patient at public expense, you have no right to choose a doctor. The hospital must appoint medical staff to see you. You can't choose when to be hospitalized or have surgery. You must share a room with other patients. (except in case of emergency)
Public patients++medical insurance++private insurance: You can choose public hospitals as public patients. Of course, at the same time, you must accept the shortcomings that Bian Xiao just talked about ... but! You have private insurance, so you can choose a more advanced and convenient private hospital.
Private patients: As private patients, part of medical service expenses in public or private hospitals can be reimbursed by medical insurance according to 75% of MBS standard. Other expenses, such as ward fees and nursing fees, need to be paid by individuals or private medical insurance companies.
2. Outpatient Medicaid
The meaning of medical treatment here refers to seeing a doctor in a medical institution other than a hospital, such as clinics, medical centers and laboratory inspection centers for general practitioners and specialists.
If you have medical insurance, it doesn't cost you a penny to see a general practitioner (GP family general practitioner) in the clinic, and 85% can be reimbursed for seeing a specialist MBS. As long as there is a puffed bill hanging at the door of the clinic you go to, you don't have to spend a penny!
3. Pharmaceutical Benefits Pharmaceutical
According to the Australian Government's Drug Benefit Plan (PBS), medical insurance provides prescription drug subsidies to patients. The government has a clear list of subsidized prescription drugs, and individuals only need to pay the co-payment for each prescription drug. Different prescription drugs charge different fees, and the standard of 20 15 is that the out-of-pocket payment of each drug does not exceed $37.70 at most. About RMB 170, which is the subsidy given to you by the government. Do friends in China spend 1800 yuan every time they go to the hospital? Is it itchy to see here? However, in convex and concave areas, not all drugs are included in the welfare plan, and some drugs still need to be paid at their own expense. The government will adjust the self-payment standard every year, so please pay more attention. (Details stamp → http://www.pbs.gov.au/pbs/home)
In Australia, those poor people who are seriously ill will not lose all their money when they buy medicines every day, because the government has established a drug safety net (PBS Safety Net) to help people control their expenses when buying medicines, so as not to cause economic difficulties. The key line of 20 15 is 1453.9 USD. After the drug expenditure of individuals or families exceeds this critical line, they can get a PBS security network card from the pharmacy. When you need to buy prescription drugs again, you only need to pay no more than 6. 10 for each drug. The government adjusts the critical line of the drug safety net every year. Bian Xiao thinks that the system in western countries is really perfect and worth learning from, so that not so many poor people will go bankrupt once they get sick. ...
In addition to the drug safety net program, Australia also has a medical insurance safety net. The national medical insurance safety net mainly includes: medical expenses of general practitioners and specialists, medical imaging examinations (ultrasound, CT, X-ray, MRI, etc. ), as well as other medical laboratory expenses. The national medical insurance safety net does not include the cost of treatment in hospital and the cost of batch billing.
As long as you register in medical insurance and join the national medical insurance safety net, you can get this kind of safety guarantee. When the medical expenses reach the critical line of the safety net, Medicare will inform you that you can apply for more expenses from Medicare when you continue to use Medicare medical services this year.
For example, if you have a chronic disease and need to see a doctor frequently, are you worried about the burden of accumulated medical expenses? This safety net can help you reduce medical expenses when you visit a medical institution outside the hospital. When the medical expenses of an individual or family reach a critical value, the expenses for seeing a doctor in a clinic or medical center outside the hospital can be reduced or exempted in the future. From 20 16 65438+ 10 month 1, when the difference between out-of-pocket expenses (that is, medical expenses actually paid to doctors (at most 150% of MBS standard) and medical insurance reimbursable expenses exceeds a certain amount, medical insurance can still be paid. According to the family situation, the difference standard is $400, $700 or $65,438+$0,000.