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Person—eligibility status, Medicare code N

Identifying and definitional attributes

Metadata item type:Help on this termData Element
Short name:Help on this termMedicare eligibility status
METeOR identifier:Help on this term270093
Registration status:Help on this termHealth, Superseded 29/11/2006
Definition:Help on this termAn indicator of a person's eligibility for Medicare services as specified under the Commonwealth Health Insurance Act 1973, as represented by a code.
Context:Help on this term

Admitted patient care:

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

Data Element Concept:Person—eligibility status

Value domain attributes

Representational attributes

Representation class:Help on this termCode
Data type:Help on this termNumber
Format:Help on this termN
Maximum character length:Help on this term1
Permissible values:Help on this term
2Not eligible
Supplementary values:Help on this term
9Not stated/unknown

Data element attributes

Collection and usage attributes

Guide for use:Help on this term

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.

Comments:Help on this term

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.

Relational attributes

Related metadata references:Help on this term

Supersedes Medicare eligibility status, version 1, DE, NHDD, NHIMG, Superseded 01/03/2005.pdf (18.2 KB)

Has been superseded by Person—eligibility status, Medicare code N Health, Superseded 04/07/2007

Implementation in Data Set Specifications:Help on this term
All attributes +

Admitted patient care NMDS Health, Superseded 07/12/2005

DSS specific attributes +

Admitted patient care NMDS 2006-07 Health, Superseded 23/10/2006

DSS specific attributes +
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