A Greater Australia: Population, policies and governance - CEDA

Section 3.4• Private medical services, which receive no direct government funding but allAustralians are supported by the Commonwealth funded public insurer MedicareAustralia, which refunds patients a defined amount for each medical servicecovered;• Doctors who are not restricted in what they can charge, and patients pay out-ofpocketgap charges;– If doctors choose to bill at the level of the Medicare rebate, they can directly billMedicare Australia;– Private insurers are forbidden to insure gap payments for out of hospital services,but can insure up to a prescribed limit for in hospital services;• Private hospital services, which are funded privately, although Medicare and privatehealth insurance payments at least partially cover doctors’ costs, with private healthinsurers able to insure for hospital costs;• Other health services – in particular allied health (most notably dental services) –these are privately funded with many of the services able to be covered by privatehealth insurance; and• The Pharmaceutical Benefits Scheme funded by the Commonwealth under whichprescription drugs are available with a fixed co-payment (which depends on whetherthe patient is a concession card holder).3. The challenges of chronicity and multi-morbidity,and chronic care models3.1 Chronicity and multi-morbidityChronic conditions have a multiple impact on individuals, health systems and societiesas a whole. They represent a restraint on the quality of life, functional status andproductivity of people who suffer from them 12 . Further, they are the main burden ofdisease and mortality in most countries across the world and they compromise thesustainability of health systems.It has been estimated that before 2030 chronic diseases will account for 70 per centof the global disease burden and will be responsible for 80 per cent of deaths across13 14the world.The prevalence of a range of chronic conditions in the US from 1987 to 2002 includingcancer, mental disorders, pulmonary disorders, as well as diabetes, will increase. 15 Thenumber of individuals with multiple chronic conditions will increase dramatically in thecoming years 16 . A similar evolution is observed in most common chronic conditions,such as diabetes mellitus and the recognised pandemic of obesity. 17 The World HealthOrganisation estimates that the number of patients with diabetes worldwide will doublefrom 2005 to 2030, including in the US, Europe, Canada and Australia.With an ageing population, Australia follows the international trend of an increase inpatients with chronic conditions. Comparisons with other countries, 1987–2006, canbe found in the Australian Institute of Health and Welfare’s, Australia’s Health 2010. 18Around 75 per cent of Australians currently suffer chronic illnesses 19 , representing87.5 per cent 20 of healthcare expenditure. For example, the prevalence of diabetes inAustralia by one estimate will have increased by 207 per cent by 2033 21 . Table 1 showsthe prevalence of the main chronic conditions other than diabetes in Australia.A Greater Australia: Population, Policies and Governance164