Health Funds & Chronic Disease Management Programs

Medicare covers services for chronic disease sufferers but only for a certain amount of services. Find out how private health funds may offer more.

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by Gary Andrews

Last update 15 Apr 2021


People who live with chronic diseases may be faced with multiple doctor and hospital visits and treatments throughout the course of their diseases.

While a chronic disease is defined as lasting for at least six months, many if not most chronic disease sufferers deal with their illnesses for many years, perhaps their whole lives.

They usually need to map out a plan for disease management so that the disease stays in check and does not explode into something bigger than it has to be.

When managed properly, chronic diseases can often be kept "in the background" and do not have to severely impact the patient's life.

Proper health management allows the patient to get regular, accurate medical care for his illness so it can be well-monitored, and doctors can pick up on any nuances and treat them before they develop into full-scale problems.

Participating in a chronic disease management program can literally be a life saver.


What are Chronic Diseases?

Chronic diseases are ones that are ongoing or recurring.

They are not curable in most cases and generally can only be managed in order to keep them at bay.

Examples include asthma, dementia, diabetes and heart disease.

When managed properly, none of these affect the normal functioning of the patient.

When mismanaged or not managed at all, they can have severe and even life-threatening repercussions for the patient.

What is the Chronic Disease Management Program?

The Australian Medicare system recognizes the need for a chronic disease management program and as such offers reimbursements for patients who require management programs.

The program is based on an inter-disciplinary approach spearheaded by a general practitioner who coordinates a team and develops a solution to manage the patient's care.

Patients with chronic diseases make up a large segment of the overall Medicare expenses in Australia because these patients need high surveillance and monitoring to stay healthy.

How Does Private Health Insurance Play Into the Program?

Although Medicare does provide a strong amount of services for the chronic disease sufferer, this is only within the public system and for a certain amount of services.

The program is quite organised, but it may not provide all of the services or the level of health management that a patient requires or requests.

Private health funds can offer much more.

They can integrate your care with the Medicare program so that you get your reimbursements and still get the extras offered through the private health fund.

A person who deals with a chronic disease unfortunately knows that he will need to see doctors and has a higher potential for hospital treatment, so he is well aware beforehand if the benefits of registering with a private health fund.

It may afford him access to different choices of doctors and hospitals, and swifter or more frequent treatments if needed.

Most health funds have their own chronic disease programs and can create a custom plan to help each patient map out the best health care options to manage his illness.

Each fund offers its own array of customizable packages.

When you compare health funds, find out if there are waiting periods for health cover and for pre-existing conditions, as these can last as long as twelve months.


This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.