The Healthcare System in Norfolk Island: Medicare, Hospital, Emergencies, Evacuation, Medication and Health Risks

The Australian Department of Infrastructure is responsible for the island’s main health and aged care services. It funds and works with the Norfolk Island Health and Residential Aged Care Service (NIHRACS), funds and manages the health component of the intergovernmental agreement between the Commonwealth and Queensland, and funds an ambulance service (St John Ambulance) and cross-border health services from Queensland and New South Wales. NIHRACS is a multi-purpose service that delivers primary care, community care and aged care, with an acute care capacity; the Australian government funds the majority of it.

The service offers an emergency department open 24 hours a day, inpatient care and support services, a general practice clinic, a dental clinic, allied health care, residential aged care and home care in partnership with a local provider. The sources consulted describe only this public service for routine care, specialist care going through the mainland.

Services Australia states that you can enrol in Medicare if you live in Australia and are an Australian or New Zealand citizen, a permanent resident, an applicant for permanent residence or a temporary visa holder covered by a ministerial order; citizens and permanent residents of Norfolk Island, the Cocos (Keeling) Islands, Christmas Island and Lord Howe Island may also enrol. A person visiting Australia from a country linked by a reciprocal health care agreement may also be entitled to it: the list includes Belgium, Finland, Italy, Malta, the Netherlands, New Zealand, Norway, Ireland, Slovenia, Sweden and the United Kingdom, and France is not on it.

Home Affairs specifies that, in most cases, visitors are not eligible for Medicare and are responsible for all costs incurred during their stay, in public and private hospitals alike; a person who is not eligible is considered a private patient and pays the costs not covered by their insurance. Home Affairs strongly recommends that ineligible visitors take out private health insurance, and several visas require, through condition 8501, adequate insurance to be maintained during the stay. Holders of a visa covered by a ministerial order should enquire with Services Australia. Enrolment is done online through myGov or by form, once in Australia, with a passport or an ImmiCard and the visa details.

The NIHRACS general practice clinic operates Monday to Friday, 8:30 am to 5 pm, and is closed at weekends. The service invites patients to book an appointment to ensure quick access and appropriate triage; walk-in consultations are accepted, with a possible wait as priority goes to patients who have booked. Each patient presents with a valid Medicare card, and the service specifies that the clinic is billed to Medicare with no out-of-pocket cost for cardholders. A standard consultation lasts fifteen minutes; some procedures, such as medical certificates, smear tests, skin checks or minor procedures, require a longer appointment. A new patient fills in a registration form.

For a French national without a Medicare card, no consultation tariff was read on the pages consulted: the fee should be requested from the clinic before the consultation and paid invoices kept, useful for reimbursement by an insurer or, for urgent and unforeseen care only, by Assurance Maladie (French health insurance) on return. NIHRACS also runs a dental clinic, with separate appointment booking. See healthcare reimbursement in Norfolk Island.

NIHRACS describes its situation frankly: the island is comparable to small rural Australian towns, with a small hospital and a general practice clinic that handle all emergencies and manage inpatients. Pathology and radiology services are limited, with some tests sent to the mainland; there is no operating theatre, and patients with a surgical emergency or who are seriously ill are evacuated to the mainland. The number of ventilators is limited, and any patient requiring ventilation is evacuated, unless mainland facilities are saturated. The wait for a plane can reach 16 hours.

In an emergency, call 000 or go to the hospital immediately. The Department of Infrastructure specifies that evacuation is to the most appropriate mainland facility and that its cost is covered by the Australian government; NIHRACS writes that this cover applies to people who have a Medicare card, and strongly advises travel insurance for visitors who do not. An ambulance service (St John Ambulance) exists on the island. See also repatriation and assistance.

For care the island cannot offer, a Queensland hospital service, Metro North Health, provides residents with tertiary specialist care, funded by the Australian government, through a dedicated Norfolk Island support programme, with a coordinating nurse for patients with complex needs. The island’s health service also offers a telehealth system and visiting services.

NIHRACS runs a patient travel assistance scheme (NIPTAAS) that subsidises, for residents, travel to the mainland: medical evacuation, non-urgent transfer to a hospital and access to specialist services. The service specifies that it is a subsidy and not a full reimbursement, and that it may not apply to services available by telehealth. For a non-resident, travel and accommodation costs fall under travel insurance or the international contract.

The Pharmaceutical Benefits Scheme and the National Diabetes Services Scheme apply on the island for people holding a Medicare card or the corresponding card. A community pharmacy operates on the island; the health service recommends bringing all the medication needed for the length of the stay, as it may not have every product in stock. It is therefore useful to carry prescriptions and to keep treatments in their original packaging, and to check the biosecurity rules on arrival (see the Department of Infrastructure’s travellers page).

For maternity, the Department states that new mothers who have given birth on the mainland are asked by the health service to obtain a referral letter from their doctor before leaving the island and to present the hospital discharge documents for the formalities relating to the newborn. As the island has no operating theatre, pregnancy follow-up should be prepared with the health service well before the due date.

France Diplomatie reminds travellers, for Australia, that vaccinations in the French schedule must be up to date (notably diphtheria, tetanus, polio, whooping cough and measles), and describes additional vaccines depending on the regions and length of stay (yellow fever for travellers coming from endemic areas, chikungunya, dengue, Japanese encephalitis). Its pages do not describe Norfolk Island: a doctor or an international vaccination centre should be consulted before departure.

As for precautions, France Diplomatie stresses for Australia sun exposure, caution at sea (currents, marine fauna) and the imperative of an assistance contract covering all medical costs and medical repatriation, as the costs can under no circumstances be covered by the embassy. A seriously ill person may be refused entry in the absence of sufficient funds. Expavy compares international health cover with medical evacuation; the Norfolk Island page brings together the procedures.