<Li> patients may be entitled to further benefits once they have crossed a so - called safety net threshold, based on total health expenditure for the year . </Li> <P> Government expenditure on health care is about 67% of the total, below the OECD average of 72% . </P> <P> The remainder of health costs (called out of pocket costs or the copayment) are paid by the patient, unless the provider of the service chooses to use bulk billing, charging only the scheduled fee, leaving the patient with no out of pocket costs . Where a particular service is not covered, such as dentistry, optometry, and ambulance transport, patients must pay the full amount, unless they hold a Health Care card, which may entitle them to subsidised access . Services not covered by Medicare may be covered, in whole or in part, by health insurance . </P> <P> An additional levy of 1% is imposed on high - income earners without health insurance . Individuals can take out health insurance to cover out - of - pocket costs, with either a plan that covers just selected services, to a full coverage plan . In practice, a person with health insurance may still be left with out - of - pocket payments, as services in private hospitals often cost more than the insurance payment . </P>

When did the australian healthcare system start and why