Australia Yearbook - 2001

Chapter 9—Health 357
In any year, if the sum of the ‘gap’ payments
(being payments above the benefit level and up
to the level of the Schedule fee) for non-hospital
services for an individual or registered family
exceeds a specified amount ($285 for 2000), all
further benefits for the remainder of that year
are paid at 100% of the Schedule fee.
For private medical services provided in hospital,
Medicare benefits are payable at a different rate,
as described in the preceding section.
Private insurers are prohibited from insuring all
or part of non-hospital services which attract
Medicare benefits. They may insure part of the
fee for in-hospital medical services, as described
in the preceding section.
Pharmaceutical Benefits Scheme
(PBS)
The Commonwealth Government provides
Medicare eligible persons with affordable access
to a wide range of necessary and cost effective
prescription medicines through the PBS. The
following details relate to charges and safety net
levels applying at 1 January 2000.
Medicare eligible-patients who do not hold a
Health Care Card, Pensioner Concession Card
or Commonwealth Seniors Health Card, are
required to pay the first $20.60 for each
prescription item. Concessional patients who
hold a concession card must pay $3.30 per
prescription item.
Individuals and families are protected from large
overall expenses for PBS listed medicines by
safety nets. For general patients
(non-cardholders), once the eligible expenditure
of a person and/or their immediate family
exceeds $631.20 within a calendar year, the
additional payment the patient has to make
per item (co-payment) decreases from $20.60
to the concessional co-payment rate of $3.30.
For concessional and pensioner patients
(cardholders), once their total eligible
expenditure exceeds $171.60 within a calendar
year, any further prescriptions are free for the
remainder of that year. All pensioners continue
to have their pensions supplemented by a
pharmaceutical allowance of $2.80 per week
payable fortnightly, or $145.60 per year, to help
defray their out-of-pocket pharmaceutical
expenses. The allowance is not paid to other
concessional beneficiaries.
Patients may pay more than the relevant
co-payment where there is more than one brand
of the same drug or alternative product that
produces similar results. The Government
subsidises on the basis of the lowest priced drug
and any difference in price due to brand or
product preferences must be met by the patient.
The premium is not eligible to be counted
towards the patient’s safety net.
In 1999–2000 the PBS dealt with over 138 million
benefit prescriptions, representing a cost to the
Government of $2,795.6m and a total cost,
including co-payments, of $3,187.2m.
The number of PBS prescriptions per capita in
1999–2000 was 7.2, compared with 6.8 in
1998–99. The number of benefit prescriptions
increased by 7.1% over the previous year, and
the cost to government of these prescriptions
grew by 14% at current prices.
The rate of growth in prescription numbers and
their cost continues to reflect the ongoing trend
towards the prescription of newer and more
costly medicines. The average dispensed price
(in current dollars) for PBS medicine in
1999–2000 was $27.82, compared with $26.36 in
1998–99. Average PBS dispensed price as a
percentage of Average Weekly Earnings remained
effectively constant at 3.6% in 1999–2000,
compared to 3.7% in 1998–99.