Australians paying more for hospital fees despite fewer visits

Peter Terlato 18 May 2016

Waiting Room

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

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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