Australians paying more for hospital fees despite fewer visits

Peter Terlato 18 May 2016 NEWS

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.

State Services with no gap Average gap
across all services
Average gap
when gap was paid
NSW 87.10% $25.96 $200.79
VIC 85.50% $12.43 $85.43
QLD 85.40% $19.36 $132.20
SA 87.50% $6.38 $51.16
WA 82.90% $19.81 $115.71
TAS 90.90% $10.80 $118.43
ACT 78.00% $60.83 $276.09
NT 80.90% $34.72 $181.54
National 85.90% $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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