Guide for patients on how the health care system funds medical care australian medical association electricity nw

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• For hospital costs, private health insurers and hospitals enter into contracts that usually mean that you won’t have out-of-pocket costs when you have treatment.·For medical services, private health insurers set the amount of benefit they will pay. gas oil ratio for leaf blower If the medical practitioner agrees to charge a fee that is equal to that benefit you will not have an out-of-pocket cost.

The fee charge by a medical practitioner covers not only their own personal income, but also his or her practice costs – the wages for practice staff (nurses, receptionists, administrators), and other costs for running a medical practice such as equipment, medical supplies, cleaning, rent, electricity, computers, continuing professional development, accreditation and insurance.

Since Medicare began 40 years ago, Government indexation of Medicare Schedule Fees have not kept pace with real increases in practice costs. This is why today patients will find there is a difference between the amounts of the fee their doctor charges and their Medicare rebate. These are commonly called ‘out-of-pocket costs’, because the patient must make up the difference out of their own pocket.

Medicare rebates are not payable for any medical service that is not listed on the MBS, or when the service is not considered to be ‘clinically relevant’, that is the service is not generally accepted in the medical profession as being necessary for the appropriate treatment of the patient. In both cases, the payment arrangements are a private matter between the treating medical practitioner and the patient. Medicare Safety Nets

The Australian Government has agreements with the State and Territory Governments to fund public hospital services. All eligible Australians are able to access hospital treatment as a public patient in a public hospital. electricity distribution costs The government funding agreements require public patients to be provide with treatment that is free of charge. Australians who elect to be public patients are not able to choose the hospital that they are admitted to or the medical practitioners who will treat them. gas mask drawing Private patients

The costs of hospital treatment includes accommodation, operating theatres, prostheses, medical services, allied health services and pharmaceuticals. It is a common misunderstanding that private health insurance covers the entire cost of hospital treatment.Similar to the MBS arrangements, private health insurance will not always cover the full costs of hospital treatment provided to private patients. There are primarily two reasons for this:

There is an enormous range of private health insurance products. The general rule is that the cheaper the premium the less the product will cover. For example, products will exclude cover for specific medical treatments, such as obstetrics, cardiac procedures, neurosurgery and hip and knee replacements. Some products will only cover treatment provided in public hospitals. The premiums for these products are lower than the products that cover all medical services listed on the MBS and in any type of hospital.

Private health insurers are required to produce Standard Information Statements for each of their products, which clearly sets out what the product does not cover. wd gaster theory Private health insurers send these statements to their policy holders each year. gas density formula The statements are also available from www.privatehealth.gov.au and the private health insurers’ websites.

For hospital costs, private health insurers and hospitals enter into contracts that mean that the private health insurer pays an amount to the hospital that is higher than the minimum benefit amount. In these situations, the patient would usually not have an out-of-pocket cost for hospital costs. If there is no contract between the patient’s private health insurer and the hospital, the hospital is able to set their own charges and the patient may incur an out-of- pocket cost.

This is why having top cover doesn’t guarantee that you will not have any out-of-pocket expenses if you need hospital treatment.Only a few private health insurers will pay a benefit with a ‘known gap’. This is where the private health insurer will permit the medical practitioner to charge a fee that is a specific amount above their medical benefit level.