6 things about Medicare that every Aussie needs to know
Public healthcare might be free, but it comes with some hidden challenges.
Australia’s healthcare system offers heaps of benefits. For starters, it’s free if you’re an Australian citizen or permanent resident. And if you get into an emergency situation, chances are that your treatment will be covered by Medicare. But what about the rest? There can be a surprising number of hoops to jump through that could make you reconsider the value of additional private health insurance.
1. You could be in for a long wait
You better hope you’re not in a hurry if you're seeking free elective treatment, because waiting times in public hospitals have continued to increase over the last 15 years, reaching an all-time high in 2016-2017. The median waiting time – the time within which half of all patients waiting for elective surgery are treated – is now over 38 days.
The number of patients placed on a public hospital elective waiting list has also increased by 3.2% on average each year. All this waiting around isn’t fun, particularly if you’re in pain. For example, if you need your anterior cruciate ligament (ACL) repaired, you could be really out of luck. Those needing orthopaedic surgery experience extra-long wait times, with 3.8% of patients waiting more than a year. Ouch.
If you rely on the public system, it’s also not first in, first out: it works on a triage basis. This means that the less critical your treatment, the longer you’ll wait.
2. Elective surgery can cost a motza
To add insult to injury, the average out-of-pocket expense for ACL repair in the public system ranges between $374 and $2907. This is one of several common treatments that will cost you a lot of cash.
Have you been waiting to get your tonsils out? Yep, there are out-of-pocket expenses for that too, with a fee of $420.
Private health insurance can help you avoid the price tag, especially if you’re active and prone to injuries.
3. Dentist delay and tooth decay
Uninsured adults are twice as likely as insured adults to delay a dentist appointment or miss one altogether.
That’s because dental treatment is not cheap. If you need two wisdom teeth removed, it could set you back an average of $327. And once you add on the clean, the consultation, X-rays or other fillings, you can say goodbye to another $400.
In addition to preventing tooth decay and gum disease, studies show that poor oral health can even lead to some pretty terrifying cardiovascular diseases.
It's surprisingly easy to get value out of your extras cover, even if you just use it for general dental. If you need optical, physiotherapy or psychology services too, you can get even more value.
4. No freebies on ambulance fees
Oh boy, this one hurts physically and financially. You might be surprised to find out that Medicare does not cover ambo fees, even for emergencies.
If you live in Queensland or Tasmania, you can breathe easy, since governments in those states will cover your ambulance costs. The rest of us could be looking at fees ranging anywhere from $300 to $5,000 dollars or more without private health cover. Most private health funds will cover ambulance fees through hospital or extras cover, and you can also find policies that cover nothing but ambulance fees.
5. Private hospitals are better. Fact.
It's an age-old debate: is a private hospital actually any different to a public one? While the quality of public healthcare in Australia is excellent by global standards, overcrowding and waiting lists could make for an unpleasant experience.
In hospital, any incident that results in harm to a patient is known as an adverse event. This could be your stitches accidentally coming apart, you picking up a new infection, or, um, dying.
In 2015-2016, there were nearly double the number of adverse events in public hospitals as there were in private hospitals. While there are many reasons for this, the fact remains that 6.67% of public hospital patients experienced adverse effects, compared to only 3.8% of private hospital patients.
Health insurance gives you more access to the private system. Having health insurance can also give you more choice, from choosing your hospital to choosing your specialist or your surgeon.
6. Expect the unexpected
You can’t always predict when you’re going to need health care. Whether you break a leg or suffer a stroke, the hard truth is that anything can happen at any time.
We can feel lucky to live in a country where Medicare will cover a lot of our emergency treatment, but what about long-term rehabilitation? If you need ongoing rehab, home modifications or care visits, Medicare will only cover some of the short-term costs.
There are big opportunities to get value
Many people underestimate the power of private health cover, thinking that you only need it if you have a major health condition, if you make over a certain income threshold and maybe for dental if you get extras cover. But it can be much more than that. If you hunt around, you’ll find policies that cover everything from in-vitro fertilisation (IVF) to gastric banding to remedial massage to gym memberships. There’s truly a policy out there for everyone.
So why should I care?
If you are injured or ill in Australia, you will get seen. That’s the beauty of living in a country that looks after its people. But the flipside of such a system is that you may have to put up with a few inconveniences. Luckily there’s a remedy for that: the private component of Australia’s public-private hybrid approach.
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