The Australian Health Care System:
Australia has both public and private health care.
Public Health: Australia has a universal health care system, in which all Australian residents have access to treatment through Medicare. The drawback to treatment through the public health system is that patients will typically be placed on a waiting list (which can entail very long waits) and in the public system you cannot chose your doctors.
Private Health: The Private health system offers the advantage of choosing your surgeon (e.g. Mr Freedman) and access to a choice of treating hospital, date, and implants. The disadvantage is the financial costs associated with the surgery.
Cost of Surgery:
There are several costs to surgery. Most patients think that the bills they are paying are for the doctors. In reality there are multiple providers who bill:
- Surgeon’s Fees (see below).
- Anesthetist’s Fees. Your anesthetist will contact you prior to surgery to outline any out of pocket fees.
- Assistants Fee (the doctor who assists the surgeon during your operation) – Mostly paid for by medicare/health fund. The assistant may charge a small out of pocket fee.
- Hospital bed and Theatre costs – Paid for by you private health insurance, with patient needing to only pay any excess associated with your policy.
- Implants and Prosthesis – Generally this is covered by your insurance company, but it is important to check with them prior to the surgery.
- Pathology and Radiology – Blood tests and X-rays taken during your inpatient stay. Usually paid by the health fund by depending on your policy there may be some costs.
Orthopaedic surgeries in Australia are classified by Medicare item numbers. These numbers have an associated rebate from the government. Unfortunately, these rebates have not changed much since the 1983 and have not kept up with inflation, let alone the costs of running a high quality practice and ever increasing cost of medical indemnity insurance.
The difference between the true costs and the government rebates has given rise to an out-of-pocket expense called the GAP. Most surgeons in will charge AMA (Australian Medical Association) rates for the services. This is almost three times the Medicare rebate. Some of the discrepancy is covered by your private health fund but there will usually still be a GAP amount.
Mr Freedman endeavours to keep surgery costs manageable for patients so that health decisions are not influenced by financial considerations. Our fees are generally midway between the health fund rebate and the AMA recommended fee.
In general, there are no gap charges for patients who have claims recognised by the Transport Accident Commission (TAC), WorkCover/WorkSafe or The Department of Veterans Affairs (DVA). Surgery invoices will be submitted directly to the third party insurer.
Self-funding patients will need to account for medical (doctors) fees and will also require a quote from the hospital and the prosthesis companies. The surgeon’s and anaesthetist’s fees partly rebated by Medicare. Some out of pocket fee may apply. Self-funding surgery is not inexpensive, but we endeavour to keep fees reasonable and find that many patients chose and manage to pursue self-funded surgery.