Health Care System

NLC Annual Conference 9th July 2007 Mary Pozzobon Integrating the International Student into the Australian Health Care System Objective • Identify the medical community and the access • Operation of the medical processing • The OSHC Deed • The hospital process The System – Non Emergency Doctor Diagnostic E.g. X-ray Specialist Pathology Hospital Treatment e.g. Surgery The System – Emergency Emergency Department Public Hospital Doctor Diagnostic E.g. X-ray Pathology Specialist Hospital Treatment e.g. Surgery Australian Health Care System • Public System – Medicare – Access to out of hospital services – Public hospital admission – Waiting list for „non essential‟ – Funded via income tax system, estimated $1,500+ per person in Aust – No ambulance cover Australian Health Care System • Private System – Private Health Funds – Private hospital access – No waiting list – Gap fee reduction – Excess fees payable on hospital admission – Different products at different individual costs payable annually Ancillary Cover • Private System – Private Health Funds – Extra‟s cover for dental, optical, chiropractic, podiatry, psychological, prescription medicines etc – Waiting periods – Limits on services – Different products at different individual costs payable annually – These are available to international students OSHC Condition 8501 What does it really mean! Description International Students must maintain health insurance for you and your family members for the whole time you are studying in Australia Who is involved? • • • • • Dept. of Immigration & Citizenship (DIAC) Dept. of Health & Aging (DHA) Educational Institution An OSHC Provider The Students How does it work? DIAC Sets OSHC as a condition of VISA DHA Sets the rules for operating OSHC Education Institution Advises students on their visa responsibilities OSHC Provider Services students Complies with DHA rules How does it work? INTERNATIONAL STUDENTS ARE RESPONSIBLE Comply with Student visa condition set by DIMA The rules set by DHA The University policy Your OSHC policy OSHC DEED Effective 1 January 2006 OSHC aims to ensure that: (a) the cost of health insurance is affordable and accessible for both medical and hospital treatment (b) the risk of personal financial crisis for overseas students requiring medical treatment is minimised; (c) the risk of bad debt to hospitals, doctors and other health professionals and ultimately the Australian taxpayer is eliminated or minimal; OSHC Deed • • • • Defines who is eligible Defines who is a dependant Determines what benefits are payable (Section 7) Determines benefits not payable (Section 8) – Pre-existing conditions (8.1(d)) • Discusses contributions and refunds (Section 6) • Discusses periods of over (Section 10) • Rules for pre-existing conditions Section 10 As of 1st of January 2006 “Where a student has allowed their OSHC to lapse…they are required to back pay premiums for the lapsed period” “…health funds will not be obliged to pay benefits for medical costs incurred during the period the student did not have OSHC, only for future claims” All students must have valid OSHC Back-Dating Rules – Good News Prior 1 Jan 06 Now Day 1 – No OSHC No Cover Attend Medical service Day 2 – Purchase OSHC Day 3, 4, 5, … – Operation Hospital Claims / Radiology / Pathology / Hospital accommodation No Cover Deemed Preexisting No Cover Covered Must have back-dated from the date your OSHC expired ALL OSHC PROVIDERS are required to enforce back-dating of policies OSHC Deed Reference: http://www.health.gov.au/internet/wcms/publishing.nsf/content /BB6090580215B214CA256F1900166600/$File/Deed%2020 05%20Final_Dec05.pdf Universities • DHA completed an OSHC Deed Review which recommended that Universities improve „renewal rates‟ (late 2005) • DHA & DIMA have met with Universities (31 Aug 06) • All agree to ensure that students comply with condition 8501 • Most Universities nation-wide are enforcing Program Length Cover (PLC) Hospital Access When to Visit a Hospital • Arranged Admission – 1st visit = Medical Practitioner – Medical Practitioners generally request blood tests; x-rays etc – Referral to „Specialist‟ / Surgeon – Review documents – Arrange admission to hospital – may be a waiting period depending on the urgency – Advise OSHC Provider • • Medical Certificate Details regarding the date of hospitalisation When to Visit a Hospital (2) • Emergency Treatment – Immediate medical attention required • • • • • • Unconsciousness Excessive blood loss High fever (for …..hours) + vomiting + diarrhoea Broken Limbs 1 Urgent – life threatening immediate treatment 5 Non life threatening – when a doctor becomes available – Registered nurse assessment upon arrival (Triage) – Observation • • Hospital admission Referral to local doctor Upon Arrival • Patient will be asked to complete a „detailed form‟ • Personal Details • Medical History • Circumstances: – – – How did the „current situation occur‟? How were you feeling? What were you doing when the incident occur? • Allergies • Insurance provider • Signature „that the information is correct‟ Patient Liaison Officer – Ensures correct and complete documentation – Provides information pamphlets on procedures/fees – Billing Department raise fees for all services and aim to recover expenses directly from OSHC provider Patient Liaison (2) – “Release of Information” Form; allows OSHC provider to obtain information regarding the treatment and assess for pre-existing issues. – OSHC Provider may ask for a „Medical Certificate‟ – Written note from the treating doctor regarding medical condition Other Issues • Language barrier – all parties – Interpreter services • Available Hospital Services • Social Workers - counselling – Patient Advocate -complaints • Privacy – Information is confidential, student authorises the release to third parties Other Issues (2) • Discharge Summary – Provides a brief regarding condition and treatment provided – Forward to local doctor – May be required for OSHC claims information • Going Home from Hospital – Home help – Friends / Family assist with recovery – Follow up appointments Notes to Remember • Information you need to supply – Insurance Membership Card – Home address and phone number details – Details of any medicine that you are taking • Arrival of ambulances may extend your waiting time at the hospital • Highest medical need first Out of Hours Help • Nurse on Call – 24 hours / 7 days per week • 24 Hour or Extended Hours Medical Clinics • Find a local doctor that you are comfortable with – – – – Check on-campus options Local to your home Check with OSHC provider Community Services SUMMARY • All overseas visitors to Australia will receive the same high standard of care and attention from hospital staff regardless of social status, age, religion, gender, sexual orientation, cultural or political beliefs Questions