Significant healthcare and community service costs
When determining if you meet the visa health requirement, a
Medical Officer of the Commonwealth (MOC) will consider whether you have a condition that may be a significant cost to the Australian community. Significant cost is interpreted as a cost that is ‘higher than the average health and community services cost for an Australian’.
The Significant Cost Threshold (SCT) is the underpinning policy to ‘contain public expenditure on health care and community services’ as outlined in the
Migration Regulations 1994.
How the ‘average’ cost of an Australian is calculated
The ‘average cost for an Australian’ is calculated as the average spending for health and welfare services an Australian would require over a 5 year period.
To determine the average spending for health and welfare services, we use two published Australian Institute of Health and Welfare (AIHW) reports on Health spending (AIHW Health Expenditure) and Welfare spending (AIHW Welfare Expenditure). A projection is then applied to the AIHW data to bring the figure from historical data into the current year, and this is used to set the SCT value. The SCT is reviewed biennially.
The SCT value includes the following cost items from health and welfare services:
Hospital
Health care given in a hospital setting
| Aged Care
Residential Care, Home Care and Community Services
|
Primary Health Care
Health care delivered in the community including by a General Practitioner
| Disability Services
Disability support services, funded by the National Disability Insurance Scheme (NDIS), Employment Support, Youth Support, Social Services and Protection Support
|
Unreferred / referred Medical Services
Medical specialists and pathology / laboratory testing
| Specialised Education Support
Early Intervention support for children with disability
|
Research and Public Health
Public health research and communication programs for health awareness in the Australian community
| Cash Welfare Payments
Carers Payments, Disability Support Pension, Child disability Assistance Payment etc
|
Pharmaceuticals
Prescribed drug treatments and therapies under the Pharmaceutical Benefits Scheme
|
|
The current value of the SCT is $86,000.
How the SCT is used to determine if a visa applicant meets the health requirement
Having a condition does not automatically mean that you will exceed the SCT. The health and community costs will depend on what kind of condition you have, how severe it is and your intended period of stay in Australia.
The way in which a MOC assesses the estimated cost of your condition will differ depending on whether your application is for a temporary visa or for a provisional / permanent visa.
For temporary visa applicants: Your estimated health and/or community costs for your condition will be assessed for your period of stay in Australia.
For provisional or permanent visa applicants: Your estimated health costs for your condition will be generally assessed for a period of 5 years (or 3 years if you are aged 75 years or older). However, if you have a permanent or ongoing condition with a reasonably predictable course, the MOC will assess your health costs over your remaining life expectancy up to a maximum of 10 years.
Regardless of whether the MOC has assessed your costs for a temporary visa or a provisional / permanent visa – the SCT value is applied against those estimated costs to determine if you meet or do not meet the health requirement. For further information see MOC assessment.
If your estimated costs are assessed by the MOC to be above the SCT value of $86,000, you will exceed the SCT and therefore not meet the health requirement.
Assessment Outcome
We will not grant you a visa if you do not meet the health requirement because your condition is likely to be a significant cost, unless a health waiver is available for the visa subclass that you have applied for and a decision has been made to exercise a waiver of those costs. A health waiver enables the decision maker to consider your personal circumstances to mitigate any costs so that the costs can be waived.
The Department can consider exercising a health waiver for some visas where we are satisfied that granting the visa would be unlikely to:
- result in significant cost to the Australian community, or
- prejudice the access of Australian citizens or permanent residents to health care or community services in short supply
Safeguarding access to health care and services
When the MOC is making an assessment as to whether you meet the health requirement, they will also consider whether your condition is likely to prevent Australian citizens or permanent residents accessing health care or community services in short supply. We call this 'prejudicing access' to these services.
We take advice from the Australian Department of Health and Aged Care on health care and community services that are considered short in supply. Currently these are determined to be:
- organ transplants
- dialysis
We will not grant you a visa if you do not meet the health requirement because your condition is likely to prejudice access to health and community services in short supply, unless a health waiver is available for the visa subclass that you have applied for and a decision has been made to exercise the waiver.
