The Australian Health Care Post

Austraian health care

medicare cardI’ve wanted to write a post on health care for so long, but it’s always seemed like such a dicey topic that I’ve continually shied away from it. If you know me at all, it will come as no surprise that came to this country predisposed to be in favor of universal health care, but of course nothing is ever so simple as good/bad/black/white, so I don’t want to just sing the praises of  a system with which I have limited knowledge or belittle the experience of people who have a legitimate gripe against the public system.

But, as the health care system here is so drastically different than the one in the U.S., how can I write an expat blog for four years and never mention it? I’m no expert, believe me, but the least I can do is tell you about my experience.

A Little Background

Growing up, I was covered under my parent’s health insurance. My Dad worked for a university, so I assume it was pretty good. My graduation from college and moving away from home coincided closely with my Dad deciding to leave his job, and thus ended my coverage under their insurance, and began my decade of mostly no health coverage.

In my first job, I made an entry level wage. An entry level theatre wage. Let’s just say that it was low. Taking on my company’s insurance plan would have cost me almost as much as I was paying in rent, and considering that I needed to buy, like, groceries, I never really even considered it an option. Leaving that job, I moved back in with my parents for a year and worked at Wal Mart. Say what you will about Wal Mart, but that was the one year of my 20s that I had health insurance. Not just health insurance, but dental insurance, too! Insurance was inexpensive as a Wal Mart employee, and I could afford it. Then, I left for grad school, and was once again uninsured. A friend of mine signed up for Medicaid, and encouraged me to do the same, which in hindsight, I really should have, but I didn’t because … I don’t know why. I just thought I shouldn’t.

I graduated and got a job that paid a little better, and I took up the company’s health insurance. I had it for a year, but I was really struggling financially between rent and my newly acquired student loan bills, even though I’d taken on a 2nd part time job, so I opted out and applied for private coverage. Luckily, I was a healthy person in my late 20s with zero history of health issues, smoking, etc., so I qualified after a health exam and interview. I don’t think it was a great plan, but would have covered me if anything really went wrong. Thankfully, it didn’t, so I never had to test that.

I rarely went to the doctor – maybe half a dozen times in that decade – and when I did, it was usually to a walk-in clinic. The one crazy experience I had was once when I got a scrape on my eye. I was in a lot of pain, and it was after hours, so I made the tough decision to go to the ER. After sitting there for three hours, I finally saw a PA for less than 5 minutes who told me to see a specialist. A week or two later, I got a bill in the mail for $500, which was a lot of money to me, at the time (I did pay it, for the record).

The Australian System

Moving to Australia on a fiancee visa, I became eligible for health care as soon as Partner-in-Crime and I got married. Now, the Australian system is not actually what you would call “socialized medicine.” It’s more complicated than that. It works on two levels – public and private.

The public system is called Medicare, and all citizens and permanent residents are eligible. Under Medicare, you are covered for pretty much all medical that you would need (no dental). Your GP may “bulk bill”  – which means you won’t see a bill – or charge you, and you can claim some or all of it back with Medicare. If you’re hospitalized or need to see a specialist, you’ll be sent to a public hospital and not really have any choice in doctors. For specialists and procedures in the public system, you can be subjected to sometimes significant wait lists. Medicare is funded primarily by a 1.5% tax levy.

Australians may also opt to purchase private heath cover. Private cover gives you access to private hospitals, which will have shorter waits (and may be a bit more glam), and to choose your own specialists. Depending on your cover, it may also help cover extras like chiropractic, vision, health clubs, etc. If you are in an upper tax bracket, there is a 1% tax penalty for not taking out private cover. According to this article, 47% of Australians have private health cover.

My Experience

Up to this point, we’ve opted not to carry private cover. I’d guess we’re a bit unusual on the North Shore where we live, but, hey, we’re used to being a little different. It’s a decision we’ve been comfortable with.

I was lucky to find a GP who I really like and who bulk bills. I’ve never had to wait more than a day for an appointment (usually when you call, they can fit you in later that day, often within the hour). Sometimes there’s a fair wait in her waiting room, and sometimes I’m right in. She never rushes me, answers all my questions, and is sweet to Hushpuppy.

From our GP, we’ve gotten referrals to specialists and a pediatrician when needed. We have visited them all at the local public hospital. Most of these doctors have rooms for private patients and then see public patients at one or more hospitals on a regular schedule. For instance, Hushpuppy has a specialist who is the top of the line in his field. We see him at the hospital, so it charges right to Medicare. Others who see him privately may have less of a wait, but will be charged and will likely be out of pocket. He’s always incredibly busy when we go, and we sometimes are there for a couple of hours, but like our GP, he answers all of our questions and takes the time to be thorough.

The loveliest moment in my Medicare experience was when we had to see a pediatrician for Hushpuppy. She agreed to get a prescription from an allergist for us because of Hushpuppy’s dairy intolerance. She knew we needed it fairly soon, and because her office was on the other side of the city, she actually brought the prescription to my house on her way to picking up her children from school. How’s that for service?

The Australian Health Care Post

With our beautiful midwife, Leonie.

Pregnancy and Delivery: I went through my whole pregnancy as a public patient, and I have nothing but positives to say about the care I received. We only did one thing outside the public system – an ultrasound. We could have done it publicly, but our midwife suggested that the private place was better, and left it up to us. We claimed about a third of the cost back from Medicare, and were happy to pay the rest, as we trusted her opinion. My midwife was beyond wonderful, and when I ended up in the hospital for an emergency C-section, the care I had there was excellent (though, the food was a bit terrible). The doctor who performed the surgery was from the private hospital next door. The only thing I wish we had private cover for would have been to have a private recovery room. But, with private obstetrics you are out of pocket several thousand dollars, even after insurance, and as we never saw an obstetrician until one was performing surgery on me (our choice to go through a midwife program), I think our money was better spent on other things for Hushpuppy, even if it would have been nice to have been alone in my room.

The bureaucracy of Medicare intimidated me, at first. I went in assuming it would be inefficient and slow to get anything done. The first time I went into a Medicare office to sign up, I was ready to wait hours. Instead, I was called to the desk within five minutes, assisted by a friendly clerk, and was out the door in five more minutes. i had my Medicare card in the mail just a couple of days later. The other day, I had to go in to an office to make a claim. No lie, I was in and out in two minutes, and the clerk had an “Inspirational Quotes – Take One” basked on his desk.

As for the actual care, in the public system, I think it helps to be pushy – or have a partner who is not afraid to be pushy, like mine. Sometimes we’ve been told that someone can’t fit us in for ages, but when you push harder (nicely, of course), they magically find a place for you. Not always, but it happens.

I did recently have an experience that soured me a little bit to the public system. I’ve recently been diagnosed with an eye condition (me and eyes, right?), and at this point, the jury is still out on what needs to be done about it. I was referred by my optometrist to a private eye doctor who I saw a couple times and paid for out of pocket. He wanted to book me in right away for an eye surgery that will stop the progression of my condition. This particular surgery is actually not covered by private insurance, so even if we had it, our options are pay several thousand out of pocket or go into the public system, which means a long wait list. We were willing to put down the money (it’s my eyes, so obviously), but I thought that it was prudent to at least explore the public option, first. So, I was referred to a hospital in the city, which is not the one we usually go to, but in looking up the doctor, she seemed top tier, so I felt good about it. We arrived early for the appointment, which was pointless, as I ended up waiting four hours to see the doctor. When I finally got in (to see one of the assistant doctors, not the one I was referred to), I was told that my condition actually had not worsened, as the private doctor told me. The henchman conferred with the top-notch doctor, who acted like I was not even in the room, and when we asked her questions, she was dismissive and short with us. I was told to come back in two months for a further scan, but that if it was eventually determined I needed the surgery, I’d be put on a 12 month waiting list. So while the information I got out of that appointment was ultimately good, I came away thinking she might have given me different advice – or at least been a little bit friendly – had I been seeing her as a private patient. It was the first time I felt “second class” as a public patient.

I think one of the reasons we’ve mostly had a good experience with Medicare is that we’re lucky to live in an area with exceptional public hospitals. And, no doubt, the number of people with private insurance in this area must keep the waits down in the public system. If we lived elsewhere, particularly in a rural area, I don’t know if we’d be as happy with our health care, and we might have to consider taking private cover.

The Cost

The other day, I pulled up our family’s Medicare record on the government website. I was just curious to see how much we’d racked up in bills. Hushpuppy, in particular, has had her fair share of medical expenses – her dairy intolerance, hip dysplasia for which she wore a specially fitted harness and sees the specialist, two trips to the ER, plus just regular doctor’s visits that any baby would have for wellness checks, colds, and so forth. I was amazed to see that the pricing on everything was reasonable. As an American, that’s a bit of a shock. GP visit – $35. Hip harness – $61. In the States, we’re used to seeing completely inflated prices that no one can account for and hardly anyone actually pays. It was just plain weird to see real prices. And, all total, for her intensive year and a half in the health care system? $1300. That’s it. See, that just makes sense to me.

There are plenty of critics of the way that health care is delivered in Australia – mainly to do with it being too costly to the government or that wait lists are too long and detrimental to patients who need care. I can only share my family’s experience over the past four years which has been, on balance ,overwhelmingly positive. The thing I like most about the system, coming from my background of rarely being able to afford coverage and running a nearly decade long risk, is that everyone is covered. Everyone pays in, and everyone can access quality health care. If you want something more and have the means to pay, that’s available. It may not be a perfect system, but it seems equitable, and that’s something I’m wildly in favor of.

2 thoughts on “The Australian Health Care Post

  1. Katy

    Thanks for this post Cristin. It’s very interesting to read your perspective. The Australian system is by no means perfect but it is much better, in my opinion, than the situation here in the UK. Healthcare here is “free” or 100% covered by taxes. In practice this means preventative healthcare does not seem to be a priority. If there is an emergency the whole system kicks into gear but otherwise it is slow and inflexible. Example – You can only visit one NHS (National Health Service) GP practice and it must be near your home. Not ideal for people who are working. An English guy I knew in Australia freaked out because he was referred to get a CAT scan by his doctor the following day. He thought he had some life threatening illness because there is usually several weeks wait for one of those in the UK. Increasingly there are more private options but they are very expensive compared with Australia

    1. Cristin Post author

      Interesting! That’s pretty much the exact opposite of the system in the U.S. – seems like both extremes are fraught with problems. Maybe Australia has hit on something with the middle ground (of course, it has issues, as well, but we’ve been pleased).

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