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Medicare is a government national health insurance program in the United States, begun in 1965 under the Social Security Administration (SSA) and now administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the SSA, including people with end stage renal disease and amyotrophic lateral sclerosis.
Medicare is the publicly-funded universal health care insurance scheme in Australia, operated by the nation's social security department, Services Australia. Medicare is the principal way Australian citizens and permanent residents access most health care services in Australia. The scheme either partially or fully cover the cost of most primary health care services in the public and private health care system. All Australian citizens and permanent residents have access to fully covered health care in public hospitals, funded by Medicare, as well as state and federal contributions. International visitors from 11 countries have subsidised access to medically necessary treatment under reciprocal agreements.
In the medical profession, a general practitioner (GP) or family physician is a physician who treats acute and chronic illnesses and provides preventive care and health education to patients of all ages. GPs' duties are not confined to specific fields of medicine, and they have particular skills in treating people with multiple health issues. They are trained to treat patients to levels of complexity that vary between countries. The term "primary care physician" is more usually used in the US.
Resource-based relative value scale (RBRVS) is a schema used to determine how much money medical providers should be paid. It is partially used by Medicare in the United States and by nearly all health maintenance organizations (HMOs).
Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.
General practice is the name given in various nations, such as the United Kingdom, India, Australia, New Zealand and South Africa to the services provided by general practitioners. In some nations, such as the US, similar services may be described as family medicine or primary care. The term Primary Care in the UK may also include services provided by community pharmacy, optometrist, dental surgery and community hearing care providers. The balance of care between primary care and secondary care - which usually refers to hospital based services - varies from place to place, and with time. In many countries there are initiatives to move services out of hospitals into the community, in the expectation that this will save money and be more convenient.
Medical billing is a payment practice within the United States healthcare system. The process involves a healthcare provider obtaining insurance information from a patient and filing, following up on and appealing claims with health insurance companies in order to receive payment for services rendered, such as testing, treatments, and procedures. The same process is used for most insurance companies, whether they are private companies or government sponsored programs. Medical coding reports what the diagnosis and treatment were and prices are applied accordingly. Medical billers are encouraged, but not required by law, to become certified by taking an exam such as the CMRS Exam, RHIA Exam, CPB Exam and others. Certification schools are intended to provide a theoretical grounding for students entering the medical billing field. Some community colleges in the United States offer certificates, or even associate degrees, in the field. Those seeking advancement may be cross-trained in medical coding or transcription or auditing, and may earn a bachelor's or graduate degree in medical information science and technology.
A Medicare card is a plastic card, the same size as a typical credit card, issued to Australian citizens and permanent residents and their families. The card or the Medicare number is required to be provided to enable the cardholder to receive a rebate of medical expenses under Australia's Medicare system, as well as subsidised medications under the Pharmaceutical Benefits Scheme (PBS). The card is usually green in colour, although interim cards are light blue and cards for Reciprocal Health Care Agreement visitors are light yellow. The cards are issued by a government agency called Medicare Australia.
The Australian Medical Association (AMA) is an Australian public company by guarantee formed as a professional association for Australian doctors and medical students. The association is not run by the Australian Government and does not regulate or certify doctors, a responsibility which lies with the Medical Board of Australia and the Australian Health Practitioner Regulation Agency. The association's national headquarters are located in Barton, Australian Capital Territory, in addition to the offices of its branches in each of the states and territories in Australia.
Medical education in Australia includes the educational activities involved in the initial and ongoing training of Medical Practitioners. In Australia, medical education begins in Medical School; upon graduation it is followed by a period of pre-vocational training including Internship and Residency; thereafter, enrolment into a specialist-vocational training program as a Registrar eventually leads to fellowship qualification and recognition as a fully qualified Specialist Medical Practitioner. Medical education in Australia is facilitated by Medical Schools and the Medical Specialty Colleges, and is regulated by the Australian Medical Council (AMC) and Australian Health Practitioner Regulation Agency (AHPRA) of which includes the Medical Board of Australia where medical practitioners are registered nationally.
Health care prices in the United States of America describes market and non-market factors that determine pricing, along with possible causes as to why prices are higher than other countries. Compared to other OECD countries, U.S. healthcare costs are one-third higher or more relative to the size of the economy (GDP). According to the CDC, during 2015 health expenditures per-person were nearly $10,000 on average, with total expenditures of $3.2 trillion or 17.8% GDP. Proximate reasons for the differences with other countries include: higher prices for the same services and greater use of healthcare. Higher administrative costs, higher per-capita income, and less government intervention to drive down prices are deeper causes. While the annual inflation rate in healthcare costs has declined in recent decades; it still remains above the rate of economic growth, resulting in a steady increase in healthcare expenditures relative to GDP from 6% in 1970 to nearly 18% in 2015.
General medical services (GMS) is the range of healthcare that is provided by general practitioners as part of the National Health Service in the United Kingdom. The NHS specifies what GPs, as independent contractors, are expected to do and provides funding for this work through arrangements known as the General Medical Services Contract. Today, the GMS contract is a UK-wide arrangement with minor differences negotiated by each of the four UK health departments. In 2013 60% of practices had a GMS contract as their principle contract. The contract has sub-sections and not all are compulsory. The other forms of contract are the Personal Medical Services or Alternative Provider Medical Services contracts. They are designed to encourage practices to offer services over and above the standard contract. Alternative Provider Medical Services contracts, unlike the other contracts, can be awarded to anyone, not just GPs, don't specify standard essential services, and are time limited. A new contract is issued each year.
Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately.
Concierge medicine, also known as retainer medicine, is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors agree to provide enhanced care, including principally a commitment to limit patient loads to ensure adequate time and availability for each patient.
In the United States, Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately.
Health care in Australia operates under a shared public-private model underpinned by the Medicare system, the national single-payer funding model. State and territory governments operate public health facilities where eligible patients receive care free-of-charge. Primary health services, such as GP clinics, are privately owned in most situations, but attract Medicare rebates. Australian citizens, permanent residents, and some visitors and visa holders are eligible for health services under the Medicare system. Individuals are encouraged through tax surcharges to purchase health insurance to cover services offered in the private sector, and further fund health care.
Bundled payment is the reimbursement of health care providers "on the basis of expected costs for clinically-defined episodes of care." It has been described as "a middle ground" between fee-for-service reimbursement and capitation, given that risk is shared between payer and provider. Bundled payments have been proposed in the health care reform debate in the United States as a strategy for reducing health care costs, especially during the Obama administration (2009–2016). Commercial payers have shown interest in bundled payments in order to reduce costs. In 2012, it was estimated that approximately one-third of the United States healthcare reimbursement used bundled methodology.
Balance billing, sometimes called surprise billing, is a medical bill from a healthcare provider billing a patient for the difference between the total cost of services being charged and the amount the insurance pays. It is an especially common problem in the United States with providers who are out of network, and therefore not subject to the rates or terms of providers who are in-network. Balance billing has a variable prevalence by market and specialty.
Whitecoat Health Service Directory, commonly referred to as Whitecoat, is an online directory of healthcare professionals. It was launched in Australia in 2013 and New Zealand in 2018. The service allows consumers to rate their experience of a healthcare provider and read other users’ recommendations and reviews. By 2016, Whitecoat was the largest website of its kind in Australia. Whitecoat has drawn significant criticism from professional medical bodies.
The Better Access Scheme also known as the "Better Access to Psychiatrists, Psychologists and General Practitioners initiative" is a program of the Australian Government that provides subsidised mental health care to Australian residents. Under the scheme, General Practitioners (GPs), Paediatricians and Psychiatrists with a Medicare provider number are able to refer patients to eligible allied health practitioners for treatment of mental health conditions under Medicare. The scheme is a key component of health care in Australia and aims to improve the treatment and management of mental illness within the Australian community. The introduction of the Better Access scheme has provided over 30 million individual treatment services for Australians with mental health disorders since its inception.
References
- ↑ "Medicare Bulk Billing"
- ↑ "Billing and claiming options"
- ↑ Mikala Theocharous (2023-01-28). "Bulk-billing GP crisis hits all-time high, affecting over 50 per cent of Australians". Nine News . Retrieved 2023-02-02.
- ↑ Anthony Galloway (2023-01-29). "Falling rate of bulk-billing sparks urgent call for overhaul of Medicare". Sydney Morning Herald . Retrieved 2023-02-02.
- ↑ The Age, 19 June 2014: Medical copayment deserves to fail in the senate
- ↑ Sydney Morning Herald, 3 March 2015: Abbott government scraps GP co-payment
- ↑ "Bulk Billing Doctors". Thursday, 23 May 2019