Why do I have to pay a gap when being treated in hospital?
Want to avoid paying out-of-pocket costs? Here's how.
Conducted at the University of Melbourne and published in the Medical Journal of Australia (MJA), this research analysed the gap of out-of-pocket costs of an initial outpatient consultation for 11 non-surgical specialist fields across the country.
The out-of-pocket expense is the additional cost that a doctor or specialist charges, above what Medicare pays for. This extra cost is dictated by the doctor based on what they believe their service is worth.
The researchers conclude that because there’s a lack of information publicly available measuring the patient’s recovery against standardised outcomes, it’s difficult to account for the fee variations based on the quality of care that the specialist offers. This lack of available information also results in patients being unaware of the large variation in out-of-pocket payments between doctors.
This conclusion is echoed in the research paper’s corresponding editorial, which suggests that information for patients could be improved by a website where medical specialists report their fees - enabling patients to make financially and clinically empowered decisions when it comes to choosing their doctor.
The findings of this latest research are similar to the outcomes of previous analysis of nib’s 2014-15 claims data, reported on in February 2016.
This data showed that there’s a large variation in fees paid to medical specialists across a broad range of procedures.
This data showed that there’s a large variation in fees paid to medical specialists across a broad range of procedures and the top-end prices that were charged by some specialists were two or three times the fee recommended by the Australian Medical Association (an organisation which lobbies for doctors).
Mark Fitzgibbon, nib Chief Executive Officer, said that there’s a need for increased transparency around cost and medical efficacy so that patients can make more informed decisions about their healthcare.
“That’s where tools such as our online comparison website Whitecoat come in handy, providing customers with access to such information to ensure they are armed with the knowledge to make the choice that’s best for them,” he said.
"Whitecoat provides customers with access to such information to ensure they are armed with the knowledge to make the choice that’s best for them,” he said.
Whitecoat allows patients to search and compare healthcare providers online and has about 210,000 providers and 250,000 patient reviews. The platform is soon being expanded to include the average inpatient fees charged by a surgeon or anaesthetist, MediGap participation rate and patient outcomes and feedback.
nib also provides customers with a no gap medical scheme, which means there will be no out-of-pockets for the hospital procedure if the specialist charges at the MediGap rate.
Here at nib, we’re continually looking for ways to improve the health sector and we work closely with industry and Government to drive further reforms that improve affordability and information transparency for our customers.
We believe that understanding your health cover should be simple, so check out our new articles How well do you know your cover?, access your policy details using Online Services, or call us on 13 16 42.
*For an initial outpatient appointment that isn’t bulk-billed (based on 2015 data).