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Definition

An indicator of a person's eligibility for Medicare services as specified under the Commonwealth Health Insurance Act 1973, as represented by a code.

Components

Data Element (this item)

Representation

This representation is based on the value domain for this data element, more information is available at " Medicare eligibility status code N ".
Data Type Number
Format N
Maximum character length 1
Values
Value Meaning Start Date End Date
Permissible Values 1 Eligible
2 Not eligible
Supplementary Values 9 Not stated/unknown

Comments

Guide for use:

An eligible person includes a person who resides in Australia and is one of the following:

  • an Australian citizen
  • a permanent resident
  • a New Zealand citizen
  • a temporary resident who has applied for permanent residency and who has either an authority to work in Australia or an immediate family member who is an Australian citizen or permanent resident
  • a person, or class of persons, who has been declared eligible for Medicare for the purposes of the Health Insurance Act 1973.

Other persons, as temporary residents, who are fully eligible for Medicare include:

  • a person who is a head or member of a diplomatic mission or consular post or is a member of such a person's family, where there is a Reciprocal Health Care Agreement (RHCA) in place between Australia and the country they represent (currently United Kingdom, Republic of Ireland, the Netherlands, Malta, Italy, Sweden and Finland) - with the exception of New Zealand diplomats.

Other persons, as visitors or temporary residents, who are eligible for Medicare, in certain circumstances, include:

  • persons who are visiting Australia and are eligible persons because there is a RHCA in place between Australia and their usual country of residence (currently United Kingdom, Republic of Ireland, the Netherlands, Malta (eligibility limited to 6 months), Italy (eligibility limited to 6 months), Sweden, Finland and New Zealand - it should be noted that the RHCA with New Zealand and the Republic of Ireland limits the access to medical services for their residents to that of public patients in public hospitals) - with the exception of New Zealand diplomats.

With respect to hospital services, persons covered by an RHCA (except RHCA diplomats as they have full Medicare eligibility) are eligible only as public patients in a public hospital and are ineligible persons if they are admitted as a private patient in either a public or a private hospital;

It should also be noted that some patients can be both an 'eligible person' and either personally or a third party liable for the payment of charges for hospital services received; for example:

  • prisoners
  • patients with Defence Force personnel entitlements
  • compensable patients
  • Department of Veterans' Affairs beneficiaries
  • Nursing Home Type Patients.

Newborn babies take the eligibility status of the mother.

Context:

Admitted patient care:

To facilitate analyses of hospital utilisation and policy relating to health care financing.

Comments:

Commencing with Version 9.0 of the National Health Data Dictionary, three separate metadata items are recorded in the Dictionary:

  • Elected accommodation status
  • Medicare eligibility status
  • Compensable status.

This is because each metadata item relates to a separate concept and requires separate information to be reported. These three items replace the previous metadata items Patient accommodation eligibility status and Compensable status.

References

Related content

Relation Count
Use within a Question 0
As a numerator in an Indicator 0
As a denominator in an Indicator 0
As a disaggregation in an Indicator 0