Medicare a national health insurance scheme in Australia offering subsidies to cover medical and health service costs. The scheme was introduced in February 1984 following the Health Legislation Amendment Act 1983 and other related legislations (Biggs, 2004) . Medicare was introduced to offer simple, fair and affordable healthcare for all Australian citizens which can be termed today as achieving universal health coverage through health insurance systems. Social inclusion in healthcare was the core mandate of the policy, by bridging inequalities in accessing healthcare services (Biggs, 2016) . Medicare relies on the theories of social rights. Healthcare in Australia and most countries in the rest of the world have access to medical services that have a human right in their constitutions and statutory documents (Garland, 2015) . There are however several inequalities linked to accessing healthcare services and the cost of healthcare remains to be the main challenge. Medicare's main intent was to fill this gap and address the accessibility of services as a social right of Australian citizens. Medicare is mainly funded by levies on citizens’ taxable income at 2%. This, however, does not fully fund the entire scheme, it is also funded by general taxes collected by government and donations.
Medicare pays specified benefits for health/medical services for which claims are submitted. Medicare benefits can only be accrued when one receives medical services from private practitioners and can only be received in a public health facility when a client chooses to be treated as a private patient. Most medical practitioners in Australia operate in the private sector. The services eligible for the Medicare services are published in the medical benefits schedule, any services outside the schedule may not attract any benefits (AGDH, 2019) . Services, however, must also be clinically relevant in order to receive Medicare benefits. Clinically relevant services are those that are generally accepted by relevant professions as necessary for the successful treatment of a condition. Services such as medical examinations for insurance purposes, mass immunization, services funded by state health services and third party insurance covered services are excluded from the benefit (AGDH, 2019) . This, however, does not mean that new services cannot be updated into the medical service benefits schedule.
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When new medical services are proposed, they are vetted by the Medical Service advisory committee which is a special independent committee that advises the minister of health and if passed may be listed in the schedule. Payments to practitioners are made through bulk billing where the practitioner is directly paid by the department of human services for all services provided to the client. In bulk billing, the patient does not pay for any service and may be regarded as free. Bulk billing, however, is not mandatory hence the practitioners may choose otherwise leading to the second mode of payment. The practitioner may open a patient account and charge the patient directly after which the patient claims the amount paid from the department of medical human services. In this form of payment, the practitioner is at liberty to charge the patient extra costs meaning Medicare partially covers the medical bills (Biggs, 2016) . Most medical practitioners prefer the second mode of payment despite Medicare providing incentives for bulk billing in the case of certain patients such as children and persons with disabilities (Khoo, Hasan & Eagar, 2018) .
Medicare is accessible to all Australian citizens, New Zealand citizens legally in Australia, any person who has obtained a permanent VISA, applied for a permanent VISA, having a work permit, having permanent residence, and Norfolk Island residents (AGDHS, 2019) . Individuals from other countries may also have limited access to Medicare in case their countries reach an agreement with the Australian federal government. Medicare is however inaccessible to prisoners and individuals having third party insurance covers that cover for the same services listed by Medicare. Practitioners are eligible if they meet requirements under the Health Insurance Act 1973, and are recognized specialists, consultant physicians, and general practitioners. Non-medical practitioners must be members of registered associations recognized by the federal government. All the practitioners must obtain a provider number specific to Medicare from the department of human services (AGDH, 2019) .
Medicare is one of the best government health insurance schemes in the world and even in developed countries. However, there are numerous challenges and gaps that exist within the system hence making it unable to achieve its desired agenda which is equality in healthcare service provision. The federal government has taken various measures over the years through various governments however some of these gaps and challenges remain to be imminent.
Regional challenges continue to be a problem. Rural areas and certain remote islands remain to be faced with accessibility to healthcare problems. These areas are faced with a shortage of healthcare facilities and specified professional healthcare providers (Dixit & Sambasivan, 2018) . Residents of such areas are unable to acquire certain surgical services and if they do they do not get such services in time (Calder, 2019) . Most of the healthcare providers in Australia operate in the private sector and most of the private health facilities are located in urban and metropolitan areas where there is a high demand for healthcare services. These individuals are unable to access Medicare-funded facilities or accredited practitioners (Biggs, 2017) . The residents of remote areas are therefore cannot enjoy the diversity of healthcare providers that are available for the rest of the Australian citizens. Having a limited choice of practitioners will mean the limited choice of services, the residents are unable to decide beyond what is provided by the government. In the principles of social inclusion and social justice, limited choice is a major obstacle. Being that the citizens are unable to choose while others from the urban areas can is a sign of inequality in access to medical services. In the current setup of Medicare, these citizens do not also enjoy the premiums they pay since Medicare does not cover most services in public health facilities.
Medicare is still faced with high out of pocket payments. Most practitioners still prefer billing the clients rather than direct billing despite the federal government providing incentives for practitioners who use bulk billing after offering services (Kerr & Hendrie, 2018) . Client billing gives practitioners to include extra costs or increase the costs of healthcare services beyond the Medicare benefits specification. These costs can go as higher as 4 times more hence making healthcare affordable to the financially stable or the rich. Patients, in this case, are forced to pay high out of pocket fees for health service (Dixit & Sambasivan, 2018) . This happens mostly with specialized treatment services and certain surgical procedures. In respect of social inclusivity and social justice, the healthcare system is not fair to the poor and the financially unfortunate. The poor look more marginalized as before when it comes to acquiring specialized treatment, the system still strongly supports the financially capable of getting the best health services while the poor because of inadequate finances remain without such privileges.
The rise of chronic disease prevalence in Australia has also present a major challenge in the Australian health system. Chronic conditions require continuous treatment and other palliative care and the cost is often high due to the high prices of medication and procedures required to extend the life of the patient. Medicare in its current capacity is unable to cater to all the expenses related to these diseases (Philip, 2015) . The increasing cases of chronic diseases are not only a problem in Australia but also the emergent issue for all healthcare systems globally. Most private healthcare insurance companies do not cover individuals with chronic diseases and if they do, they pay high premiums that the ordinary poor citizens cannot afford (Philip, 2015) . This presents a gap in the accessibility of health services among the poor Australian citizens. Individuals who are affected by chronic infections such as certain types of cancers that require hefty amounts are left hopeless without help from public health insurance.
Medicare is also facing a problem in dealing with the rising demand for home-based care for the large aging population. The aged in Australia have been gradually increasing over the years. Home-based services for the aged are quite expensive as compare to normal health services (McPake & Mahal, 2017) . The Australian healthcare budget is currently at about 10% of the Gross Domestic Product which is contributed mostly by the working population. The increased number of aged individuals will strain the existing finances set up for the ordinary health services making the other services less available for the other citizens (Biggs, 2017) . Focusing on the other services without home-based care for the elderly is may also present an equality problem in the system since the aged spent their younger ages developing h same economy and paying the same premiums (Robinson et al., 2015) . This calls for Medicare to design a sustainable model for dealing with the problem of the elderly in healthcare in order to create a balance with the rest of the health services (Philip, 2015) .
Mental health is another upcoming global health challenge and Medicare and Australia are no exempted. Currently, Medicare policy is not clear on how to handle mental health patients and related services (Liu & Eibner, 2019) . While considering inclusion in government policies, individuals with mental illnesses also deserve inclusion in the systems (Biggs, 2017) . Any individual is at risk of falling into mental illness, would it mean therefore that when this happens, they are no longer able to access mental health-related services?
The challenges identified in Medicare require resolution in order to have a more inclusive and fair healthcare system in Australia. The system should try to redistribute healthcare providers to marginalized areas at least at one central point around these areas and provide subsidies and incentives to such providers as a means of motivation (Godding, 2014) . This will solve the problem of healthcare practitioner's regional imbalance and unequal distribution of quality services within the country. In terms of out of pocket payments. Medicare should advocate for more direct billing by practitioners and through doing the same, should also boost the benefits and increase the incentives so that more citizens are able to access services at lower costs (Callander, Fox & Lindsay, 2019 . As of now, there is a big gap between the poor and the rich in terms of access to healthcare services. The department of human services should also look at the problems of chronic illnesses and mental illnesses. Medicare benefits on chronic services should be expanded and those on metal illnesses should be well defined to avoid exclusion barriers from the scheme benefits. The growing demand for services to the elderly should also be expanded in order to accommodate the growing populations of the elderly.
In summary, Medicare has promoted universal health coverage in Australia but not to the conclusion. The current setup of Medicare has failed to address some key issues which are barriers towards achieving universal health coverage. In addition access to quality healthcare services as a constitutional right is not achievable when a group of citizens are unable to access certain services due to barriers. Medicare should, therefore, be strengthened and restructured if need be in order to satisfy social justice and achieve social inclusion.
References
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