How Our Healthcare System Works And The Hacks You Should Know

Good health is your most important asset and a strong healthcare system is its best defence. Take a brief tour of the fundamentals of Australian health care and learn a few healthcare hacks to make it work for you.

The World Health Organisation considers access to decent healthcare to be a fundamental human right. In a perfect world, every human being on earth would be given the best possible chance to thrive and live a long life, with a safety net of medical and psychological care to catch us when we fall. There’s a very good reason to aim for this: healthy individuals make for healthy societies. When we’re strong and well, we make our best contributions to the world. When we’re sick, we are mostly concerned with how to get better.

In Australia, public discussions around healthcare tend to land in one of two streams – we gnash our teeth over billowing “unsustainable” costs or we complain about levels of service. The truth is, our health system does reasonable well. It isn’t perfect, but we get a lot of bang for our buck and we rank well on a global scale. Here’s why.

Feelin’ kinda free

Medicare is Australia’s “free” public health system, introduced to the Australian parliament by Prime Minister Gough Whitlam ahead of his dismissal in 1975. Gough was out, but Medicare (then Medibank) made it through, despite vigorous objections from the Liberal-Country Party Coalition. Prior to this, only Queensland, Tasmania and the Church offered free hospital treatment.

The notable thing about our “free” public health system is that it isn’t free – we pay for it through our taxes. It is only free for those who can’t afford to contribute. The Medicare system is funded through general tax revenue and through the Medicare levy, an extra 2% tax for anyone whose income is over a certain threshold.

Because Australian healthcare costs are significant and expanding (we spend over $160 billion a year on healthcare), we also lean on the private healthcare system to ease the burden on the national budget. People on high incomes are expected to have private healthcare. If they don’t, they pay an additional tax called a Medicare Levy Surcharge. As a society, we have decided over time that this is an important way for our tax dollars to be allocated. We all carry each other, and we lift up those who can’t afford to carry themselves.


So what does Medicare deliver? Basically everything we need. Medicare covers primary or every day healthcare, hospital care and medication (through the pharmaceutical benefits scheme). If you get rushed to hospital after an accident or you are diagnosed with a life-threatening illness, you won’t come out of treatment with a huge personal debt. If you get the flu or need a vaccination, you can visit a bulk-billing doctor even if your bank account is empty. If you get pregnant, your baby won’t be delivered along with a huge hospital bill.

There are still out-of-pocket expenses – gap payments for specialists, tests that aren’t covered, medication that isn’t in the scheme – but Medicare covers the lion’s share of our public medical costs.

The perks of private

So why then, with all this free health on offer, does anyone bother with private health insurance?

The short answer is speed and choice. Private patients who need surgery can choose their own surgeon – you don’t get that option in the public system. Private patients get private hospital rooms and they aren’t subject to long waiting lists for treatment. Our public system prioritises patients in terms of need – the most urgent health problems get dealt with first, and your knee reconstruction or bariatric surgery could be a long way down the list. Like any commercial system, user pays in private. The more you pay, the more perks you get.

Excellent perks.

It is worth noting that all truly life-threatening health issues are pushed into the public system, because that’s where the bulk of the money, technology and expertise lives. If you get cancer, for example, you will be treated in the public system, even if you’re referred for treatment by a private specialist. If getting liposuction is your primary concern, private healthcare will happily assist.

Somewhere comfortably in the middle

It’s worth stopping for a second to consider how lucky we are to have a healthcare safety net, even though there is room for improvement. While debate still rages in America about the efficacy of Obamacare, a tenth of the population still has no health insurance and hospital treatment can lead people to bankruptcy.

America remains the wealthiest nation on Earth, but their healthcare system is ranked 50 out 55 countries in terms of efficiency – the results they get for the money they spend are relatively bad. Cuba, which is dirt poor but offers free universal healthcare to all of its citizens, has a better life expectancy than the USA.

We’re certainly better off than America, and most of the world’s emerging economies, but there are a number of countries that score much higher than Australia when it comes to equitable access to healthcare. The UK’s beloved National Health Service (NHS) offers much wider access at even lower costs, without relying so heavily on the private system. Scandinavian countries like Norway and Sweden tax their population at much higher rates, but their universal healthcare systems are much more holistic, including better infant and family support.


Sweden’s parental leave is so good, there’s a trend called ‘Latte Papas’ – dads on parental leave who hang out at cafes with their kids (and the other dads).

Meanwhile, we have some uniquely Australian problems that our healthcare system has failed to address, including tragic health outcomes for Indigenous Australians and access problems for people in the country – two things that should be taken into account while we’re taking stock.

It works if you work it

So how do you make the system work for you? If you’re a public patient in Australia, there are few basic hacks for a better healthcare experience. The first and most important thing to do is use the system properly. Hospitals are designed for emergency care or referred treatment, so don’t go to hospital when you have a cold then complain about the wait to see a doctor. If your GP is unavailable, use the free nurse on call or GP helpline for health advice before you head to emergency.

If you’re having a physical or mental health issue and you can’t afford a private specialist, talk to your GP about a health plan (more on that here). They’ll refer you to specialists and you’ll get a certain amount of treatment covered by Medicare, which could include things like physio, psychology or even seeing a dietician. And get ambulance cover for around $40 a year – you’re not covered by Medicare and ambulance rides ain’t cheap.

If you end up in a public hospital, it helps to understand the system. You are being cared for by a team of doctors ranging from interns who are a year out of medical school, to residents who are two-three years out, to registrars who have at least five years’ experience, to fully qualified consultants. Their availability to answer your questions is inversely proportional to their experience. You can sometimes feel like you’re getting different information from different people. Communication and case management is not always ideal. The best thing you can do is to be positive, be assertive and know your rights. If you need back up, nominate a family member or friend to advocate on your behalf and keep track of the big picture. Know that everyone is doing their best and you are in good hands.

If you’re thinking about getting private health cover, know that you can’t access most benefits for the first 12 months of your policy. Check the details of your policy carefully to make sure you’re covered, especially for something like a planned pregnancy.

Make sure that you make the most of your extras. Most mid-level insurance policies give you an annual budget for various kinds of healthcare such as physiotherapy, dental care, occupational therapy, optical care, alternative medicine and osteopathy. Health insurance is expensive, so use the full suite of rebates on offer to get your money’s worth.


Pilates. Image: Flickr

Private insurance policies sometimes cover preventative healthcare programs such as Pilates. This makes sense from the insurer’s point of view, because they’re hoping to prevent more serious treatment down the line. They may also offer healthy lifestyle rebates, supporting you to lose weight or quit smoking. You should take advantage of these benefits – they’re in your best interest too.

And finally, know that whatever pressure they put you under, private health insurance is not necessarily necessary.

Whether you go public or private, the best possible healthcare hack is to take care of yourself while you’re young. Exercise, eat well and pay attention to your best asset. The Australian healthcare system has got your back, but the less you need it, the happier you’ll be.

Lead image: All Saints, Presto

Simone Ubaldi is a ghostwriter, music journalist, film critic and has co-authored four books, including memoirs of Bon Scott and Mark ‘Chopper’ Read. She stashes a lot of her writing here.