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CHAPTER 6
Activity solutions
6.1 Dental reform
1
Are dental services for the general population covered by Medicare?
No. The following population groups now have access to dental services:
•
Children aged 2–17 whose parents meet the means test will have an entitlement
for basic dental services through Grow Up Smiling.
•
Low-income adults will have access to funding to assist them with receiving
dental services through the National Partnership Agreement for Adult Public
Dental Services.
2
Explain how the Dental Reform package announced by the Australian
Government promotes the physical, social and mental health of Australians.
Student responses will vary. The following is an example of a response:
The package is improving the physical health of Australia’s as oral health will be
improved such as maintenance of healthy teeth and gums through regular dental checkups, repairing dental caries and any necessary extractions. Mental health will be
improved as people will have peace of mind knowing that they can access the dental
services they need. Parents will be able to ensure their children have regular dental
check-ups and feel that they can provide this for their children without the added stress
of cost and financial burden. Social health will be improved as many people feel selfconscious with poor dental hygiene. Poor oral health can result in people not wanting to
smile or socialise with others, so with regular access to dental services, individual oral
health will improve and so will feelings of confidence and their desire to build and
maintain relationships with others. Good oral health can encourage community
participation and encourage people to participate. People may also have increased
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financial capacity with not having to cover the costs of dental services, enabling great
social activities.
3
Identify the population groups that the Dental Reform package is targeting.
Children aged 2–17, low socioeconomic adults and rural and remote population groups.
4
Analyse how the initiatives announced in the Dental Reform package reflect the
values of the healthcare system.
Students could analyse any of the following values to explain how this reform reflects
the healthcare system: safe, effective, efficient, continuous, accessible, responsible or
sustainable. Example could include:
Accessible – The Dental Reform package is available particularly to those who have a
need for these services, using means testing to ensure that those who have not been able
to afford dental healthcare in the past have access. A focus of the package is also the
development of infrastructure in areas where location is a barrier to access, ensuring the
value of accessibility is met by all.
6.2 Understanding Medicare
1
Visit the Medicare website.
2
Complete the following tables to determine the safety net amounts this year.
Gap
Threshold
Benefit to patient
$421.70
100% of schedule fee for outof-pocket hospital services
Concession and FTBA
$610.70
80% out-of-pocket costs or
the EMSN benefit cap for the
out of hospital services
Extended Medicare safety
net (general)
$1221.90
80% out-of-pocket costs or
the EMSN benefit cap for the
out of hospital services
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PBS safety net threshold
PBS safety net patient
contribution
General patient
$1390.60
$5.90
Concession patients
$354.00
Free
6.3 Private health insurance
1
Hospital cover:
a
What is the cost for singles hospital cover that is appropriate for your age?
The cost for singles for hospital cover appropriate for my age is from $76 per
month.
b
Identify the services that this policy covers.
The services this policy covers include:
•
Private room in agreement hospitals and public hospitals where available
•
Shared room in a private hospital
•
Shared room in a public hospital
•
Intensive/coronary care
•
Theatre fees
•
Pregnancy and birth-related services
•
Gynaecological treatment in hospital
•
Same-day surgery
•
Hip or knee replacement (limited services)
•
Cataract surgery (limited services)
•
Psychiatric (limited services)
•
Rehabilitation (limited services)
•
Surgical prosthesis
•
Medical gap cover
•
Private home nursing
•
Emergency ambulance transport
•
Weight-loss benefits
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c
•
Doctor health checks
•
Quit smoking courses
•
Coronary artery disease program
•
Member support program
•
Diabetes Australia membership
•
Bone health program
•
Healthy heart program
•
Life For Life program
•
Cervical cancer vaccinations
•
Step into life
•
Health coaching
Identify some of the waiting lists that may apply.
Some waiting lists that may apply before claims can be made from the insurance
company are:
•
Basic benefits apply for lap banding in the first 24 months if previously
uninsured
•
Obstetrics co-payment of $75 per night capped at $450 applies
•
Unless you are transferring from another health cover where you have
already served your waiting period, the following will apply; all pre-existing
conditions except for psychiatric, palliative care and rehabilitation – 12
months
d
•
Psychiatric, palliative care and rehabilitation – two months
•
Obstetrics, childbirth – 12 months
Is there an excess for the policy?
The excess for the policy is $500 per calendar year.
2
Extras cover:
a
What is the cost of extras cover for singles that is appropriate for your age?
Cover for basic extras for an 18-year-old single is $27.20 per month.
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b
Identify any waiting lists that apply.
Waiting lists that apply for basic extras cover:
•
6 months for wisdom teeth extraction
•
12 month waiting period applies for any pre-existing conditions from the
date of commencing cover unless transferring from another fund
c
Identify the percentage of the cost of each service that is covered. Are there
limits?
Limits imposed on each service include:
•
Dental maximum $500 per year, increasing by $100 per year to a maximum
of $1000 per year
•
Optical 100% of cost up to $150 in the first year then $200 each year
•
Physiotherapy, myotherapy, chiropractor, osteopath are $25 per consultation
up to a maximum of $350 per year combined including chiropractic X-ray
•
Acupuncture/naturopathy are $25 per consultation up to a total of $350 per
year combined
3
Now that you are aware of the services that are covered by Medicare and private
health insurance and those that are not, do you feel that private health insurance is
a worthwhile investment in your own health?
Student answers will vary according to opinion. Points to consider are individual health
status and the fact that costs of health insurance increases with age if you join later in
life.
4
Will the government incentives influence your decision to take out or remain in a
private health insurance fund in the future?
Student answers will vary.
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