Australians paying more for hospital fees despite fewer visits

Peter Terlato 18 May 2016

Gap payments are highest in the ACT.

The nationwide proportion of in-hospital medical services with no gap payments has dropped 3.5% over the last year.

According to the latest data from the Australian Prudential Regulation Authority (APRA), the proportion of services with no gap decreased from 88.4% in March 2015 to 85.9% in March 2016.

A medical gap is the out of pocket cost you pay for medical charges over what Medicare and your private health insurance cover.

Despite there being less gap-free services, average gap payments increased slightly.

The average gap payment across all services rose from $18.59 in March 2015 to $19.23 in March 2016.

StateServices with no gapAverage gap
across all services
Average gap
when gap was paid
NSW87.10%$25.96$200.79
VIC85.50%$12.43$85.43
QLD85.40%$19.36$132.20
SA87.50%$6.38$51.16
WA82.90%$19.81$115.71
TAS90.90%$10.80$118.43
ACT78.00%$60.83$276.09
NT80.90%$34.72$181.54
National85.90%$19.23$136.26

Average gap payments across all services was highest for those in the Australian Capital Territory, with patients approximately $60 out of pocket, more than 200% higher than the national figure.

Patients in the Northern Territory forked out an average of $34.72, followed by New South Wales at $25.96.

For non-GP services Medicare covers 85% of the Medicare Benefits Schedule (MBS) fee, the baseline price for medical services, as a rebate.

If you have private hospital cover and are admitted to hospital for a procedure, your doctor can choose to bill more than the Federal Government scheduled fee. This can result in out of pocket expenses not covered by Medicare or health insurers.

Picture: Shutterstock

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