The Healthcare System on Christmas Island: Medicare, Health Centre, Emergencies, Evacuation to Perth and Vaccinations

Australia has a universal public health system, Medicare, funded by a levy on salaries, and private insurance that coexists with it (CLEISS, the French centre for European and international social security liaison). On Christmas Island, the care provider described by the Department of Infrastructure is public: the Australian government funds and operates the Indian Ocean Territories Health Service (IOTHS), which offers primary care, pathology, radiology, a pharmacy, short-stay hospital care, public health, maternal and child health programmes, services for older people and people with disabilities, urgent care, patient travel assistance, emergency medical evacuation, dental care, a social service, telehealth and access to visiting specialists.

These services are supplemented by a service agreement with the Western Australian Department of Health, which provides specialist medical advice, hospital care in Western Australia, additional tests and breast cancer screening. The Department of Infrastructure administers the whole on behalf of the Australian government; federal services such as the Pharmaceutical Benefits Scheme are provided as on the mainland.

According to Home Affairs and Services Australia, those who can enrol in Medicare are Australian citizens, permanent residents, New Zealand citizens in regular residence, holders of a resident return visa, certain applicants for permanent residence, temporary visa holders covered by a ministerial order, and citizens or permanent residents of Norfolk Island, the Cocos (Keeling) Islands, Christmas Island and Lord Howe Island. Visitors are as a general rule not eligible and bear all their costs, in public hospitals as in private ones.

Reciprocal agreements open care covered by Medicare to visitors from eleven countries or territories: Belgium, Finland, Ireland, Italy, Malta, Norway, New Zealand, the Netherlands, the United Kingdom, Slovenia and Sweden (Services Australia). France is not on this list and France Diplomatie reminds us that there is no bilateral agreement between France and Australia in the field of social cover. The carte Vitale and the EHIC therefore have no effect on the island.

First contact goes through the Christmas Island Health Centre, at 33 Phosphate Hill Road. The Department describes a small health centre, with a few general inpatient beds and two emergency beds, where general practitioners and nurses provide primary and acute care. The emergency department and inpatient care run day and night; general practice consultations and dental care take place on weekdays, with a late slot one day a week for consultations. The exact hours are published by the IOTHS (telephone from abroad: +61 8 9164 8333).

On fees, the Department indicates that no charge is made for consultations covered by the Medicare scale for a citizen or permanent resident. A person not eligible for a Medicare card is billed according to the Australian Medical Association scale; consultations for a visa, diving or occupational medicine certificate are billed under the same scale, and dental care under the Department of Veterans’ Affairs dental scale. Home Affairs adds that someone not eligible is a private patient who pays their costs at the time of care. See the page healthcare reimbursement on Christmas Island.

The Department of Infrastructure reminds us that, as in many remote places on the mainland, specialties are not always available. Specialists visit for orthopaedics, obstetrics and gynaecology, paediatrics, ear, nose and throat, ophthalmology, radiology and women’s health; the list published by the IOTHS also cites internal medicine, cardiology, gastroenterology, psychiatry, physiotherapy, podiatry and dietetics. Residents and visitors may have to travel to Perth for services or emergencies that exceed local resources.

The IOTHS lists among its services emergency medical evacuation and a patient travel assistance scheme. The official pages read do not detail who pays for a visitor’s evacuation: the island’s national park website asks all visitors to hold travel insurance covering unforeseen health needs and emergency evacuation, and France Diplomatie deems essential a contract covering all medical costs and medical repatriation, which the embassy in no case bears. See the page repatriation and assistance.

In an emergency, France Diplomatie says to dial 000, the single number for the whole of Australia. The island’s health service answers on 08 9164 8333 from within Australia. The Australian Federal Police provides local policing on the island and coordinates emergency operations; its helpline is 131 444 (France Diplomatie).

The Department recommends a personal locator beacon for any outing away from residential areas, as some areas have no mobile reception: the Federal Police lends them free of charge. The national park notes that roads are sometimes reserved for four-wheel-drive vehicles and that plenty of water should be carried.

The Department indicates that the Australian Pharmaceutical Benefits Scheme is provided to the island as on the mainland and that the IOTHS runs a pharmacy. For a stay, the Department recommends bringing personal medicines for the whole length of the trip, as special products may be in limited stock and take up to a week to arrive; essential medicines go in hand luggage. General pharmacy and supplies are available from the island’s pharmacist.

It is prudent to carry the prescriber’s prescription for chronic treatments and to check the quarantine rules with the Australian Department of Agriculture, Fisheries and Forestry (number 1800 900 090) before departure.

The Department of Infrastructure specifies that no special vaccination or medication is required to go to the island. France Diplomatie reminds travellers for Australia that the vaccines recommended in France are essential abroad and mentions, depending on regions and trips, yellow fever (compulsory for travellers from endemic areas), chikungunya, dengue and Japanese encephalitis. It also reports cases of thrombosis in people sensitive to immobilisation during the Europe-Australia flight. Its pages contain no recommendation specific to Christmas Island: consult a doctor or an international vaccination centre before departure.

The most concrete risks on site are those of nature: sea with no patrolled beach, dangerous cliffs and rocky platforms, swell during the rainy season, heat and humidity (21 to 32 °C, 80 to 90% humidity). The national park recommends a hat, sunscreen, sturdy shoes and water, and not feeding wildlife. The Department also advises reef shoes to limit injuries from stonefish and coral. See the page living on Christmas Island.

• Insurance: assistance contract or insurance covering all medical costs, medical evacuation and medical repatriation (France Diplomatie; national park website). For a visa subject to condition 8501, adequate insurance must be maintained throughout the stay (Home Affairs).
• Medicines: personal treatments for the whole stay, essentials in hand luggage (Department of Infrastructure).
• Vaccinations: update the vaccines recommended in France; a doctor’s advice for the others (France Diplomatie).
• Safety on site: personal locator beacon for outings away from inhabited areas, plenty of water, sturdy shoes, swimming only at Flying Fish Cove in calm seas.
• Contacts: emergency number 000, the island health service switchboard, contact details of the insurer or assistance provider reachable at any hour.

To compare cover options for a stay abroad, see the page expat health insurance.