eSurgery

Australia has one of the better public health system in the world in terms of what it offers patients who are sick.
Central to this is Medicare.

What is Medicare?
“Medicare ensures that all Australians have access to free or low-cost medical, optometrical and hospital care while being free to choose private health services and in special circumstances allied health services”. You can read more about this including eligibility from the Medicare website. Basically Medicare sets up a list of fees for various medical items. Eg Consult with GP, consult with specialist, excision of skin lesion, blood tests. Each item has a specific item number. (You can find that online if you search for the Medicare Benefits Schedule)

What is Bulk-billing?
Medicare pays only 85% of the Medicare Benefit Schedule for most outpatient services and 75% for inpatient services done privately. This Schedule is determined by the Australian government and has not kept pace with inflation over the years. Clinics that bulk bill would get their patients to sign the Medicare slip and claim the fee directly from Medicare. Hence patients would not need to pay anything out of pocket.

What is a Gap?
Most doctors would charge fee higher than the 85% of the Medicare Benefit Schedule – the difference in the fees is the gap.

Why is a Referral needed to see a Specialist?
Specialists can only claim their specialist consulting fees only if the patients have a referral. The standard referral from a general practitioner(GP) is valid for 12 months unless otherwise stated. A referral from another specialist is only valid for 3 months.

Why is it important to have a family doctor?
There is a lot more preventative medicine practiced here in Australia. Having a GP would ensure that you are that you have adequate screening for common medical conditions and that you have had the appropriate vaccinations. Also it is a lot easier to see a GP when one is really ill if one already is a patient of a particular clinic.
For routine consults, there can be a waiting time to see a popular GP – eg It can take 1-3 weeks to get an appointment to see some of the GPs I know(of course if one is really ill, the GP will try to fit you in or the clinic will try to fit you in to see another GP at the same practice)

Why are there waiting times here in Australia?
That is the culture here… eg there can be even a few weeks wait to book dinner here in some popular restaurants
Also not as many doctors work long into the night or as many weekends like say the GPs in Malaysia – there is a good work life balance here in Australia. Hence you can be assured that the doctor you see is fresh and not fatigued!

If the public system is free , why should I get private insurance?
There is a waiting list in the public system. While the public system is all right for cancers and other life threatening illness – for other medical conditions, the public system is too overburdened to meet the demands in time.
There is an online website where you can actually check the waiting times for surgery for common medical conditions eg hernia repair
Lets say a 35year old patient has bleeding in the toilet bowl from haemorrhoids. The patient first sees his GP. The GP first treats this with haemorrhoid ointment and advise a high fibre diet. The patient then returns for review with ongoing intermittent bleeding after 2 weeks. The GP then refers the patient to a surgeon at the public hospital. The patient would usually have to wait for a few weeks and sometimes months to get an appointment at the surgical outpatient clinic. Once the patient is seen in the outpatient clinic, if the haemorrhoids require banding or the bleeding needs to be investigated further to rule out bowel cancer with a colonoscopy, the patient is then put on a surgical waiting list. This can be either Category 2(up to 90 days) or Category 3(up to 365 days). Hence it will be a few more months before one has the procedure.
If one goes privately or tells the GP that one has private insurance and wishes to see a surgeon privately, then the GP would refer directly to see the surgeon(usually around 1-2 week wait) and then from there the patient will be booked in to have the procedure in 1-2 weeks.

Also after a certain age, the cost of private health insurance increases for each year later that one takes it up.
So if one were to need a knee or hip replacement one day – one has either pay much more to take up the private insurance later in life or wait 1-2 years in the public health system.

Furthermore, if one’s income is above a certain level, one has to pay an additional 1.5% Medicare Levy Surcharge(additional tax) if one does not have private insurance.
“Currently, you have to pay the surcharge if you are:
a single person with an annual taxable income for MLS purposes greater than $80,000 in the 2011-12 financial year; or
a family or couple with a combined taxable income for MLS purposes greater than $160,000 in the 2011-12 financial year. The family income threshold increases by $1,500 for each dependent child after the first;
and do not have an approved hospital cover with a registered health fund.”