Welcome to Netrider ... Connecting Riders!

Interested in talking motorbikes with a terrific community of riders?
Signup (it's quick and free) to join the discussions and access the full suite of tools and information that Netrider has to offer.

Public Health / Private Insurance, WTF does it all mean?

Discussion in 'The Pub' started by far_canel, Mar 12, 2009.

  1. My morning start up at work is to read a few news websites, and i pick a handful and read, sometimes comment and what not. Following up on the comments on this article I'm still completely confused as to how this country's health system works.

    All i know is there is public and private health. All i know is i pay medibank private some money, and in my wallet is a green card that says medicare, and the other card reads medibank.

    If i go to the doc's, i wave those cards around and end up paying something called a gap. If i need elective surgery (2 x shoulder re-con's, metal removed from leg, and back thingo) i have to pay all these other bills that my private health insurance doesn't cover (why pay it then? seems to make a good dint in my bank balance every fortnight).

    If i come off the bike hard i go to a public hospital...

    But seriously, wtf is all this stuff... I have absolutely have no idea and its sending me up the wall when issues like this appear. What is the difference between all the health care systems??!!?!?!??? Why in many of these news article comments are people talking about us sliding towards an American 3rd world health care system? Why does everyone keep mentioning / blaming the governments for the health system?

    If someone has the time can you please explain it all to me in straight forward terms etc?? I've never had any idea of this stuff and would like to know as i predict (and already have) spent a bit of time in hospitals and under the knife. (the way i always see it, you don't pay health insurance, you wait in line, you pay health insurance, you walk straight in and get served no bills to pay)

    thanks in advance...
  2. I am in exactly the same boat as you mate. I have private health insurance that just keeps on increasing in cost every 6 months, yet when I have needed surgery twice, I have still paid out several extra thousand dollars. I am just stumped sometimes.

    Any arguments for or against just one unified health care system?
  3. same reason i don't have private.....from what i can tell, i am better off paying the excess for tax and staying on the public, but would love to hear some views as to why to go private, cos so far i can't see any :)
  4. The private health insurance industry make their money by charging a platinum plated price for a turd of a product. Having read the small print of a few policies, I wouldn't pay for any of them with washers.

    Also note that, when adjusted for the fact that the private system cherry picks the easy stuff and chucks the difficult and chronic cases back onto the public system, health outcomes from private are no better. Indeed, I can relate a number of stories of folk (directly known to me, not a friend of a friend's brother's mate) discharged too early to clear a profitable bed, then suffering complications which required treatment in a public emergency department.

    As I see it, private offers maybe two advantages. (1) For elective surgery you may wait less time (not the case in my own experience but possible) and have some choice as to dates so as to fit in with work/family etc commitments. (2) You can, to an extent, choose your specialist (a dubious advantage at best, as the average bod is not able to make an adequately informed decision on this in many cases).

    Beyond that, frankly, I can't see that you get much. Extras like dental and optical cover might help some people but, again based on extensive small print reading, what you can claim is often quite limited.

    Having had, within my immediate family, rather more direct experience of WA's public hospital system than I would like, I cannot see, personally, any advantage whatsoever that would justify the premiums I would have to pay, particularly now that at least one family member is, basically, uninsurable. In fact, a few years ago, a run of serious medical bad luck would have seen the gap payments break us financially and leave us destitute or, at least, permanently indebted. Not a great outcome to have paid a premium to achieve.

    Like Stewy, I'm happy to pay the surcharge, rather than enrich the private insurers. Maybe if their product was better I may be less adamant about it.
  5. I have been in a private hospital and experienced public ones, so far the only difference I have noticed is the private one had alcohol on the menu which I can't have because I was on pain killers.

    Treatment was fine, food was ok, pain killers worked.

    Didn't pay a cent because work cover rocks

    My wife gave birth in a public hospital. Again treatment was good, even had a midwife that stayed 2 hours after her shift with us to try to be there to deliver the baby and see it. She wasn't there at the time of birth and came to see us the next day in her lunch break.
    Food was good and there was a heap of support.

    Other than the public hospital having a few more bogans and it had 4 bed to a room unlike the publics 2 to a room. There wasn't really any difference.
    Also the public one was in logan so a large number of bogans is expected.

    As for emergency dept, things have taken ages in the public one. Don't have experience with that in the private.

    Private hospitals will get elective (non critical) surgery done faster then public.
  6. It depends on how tuff you are.

    Me, I'm a friggin pansy. Got out of bed one day, was pissing blood. Actually it looked more like tar at the time it was that dark. Off to the GP. Might be a kidney stone he says. Will book you in for CT scan and see what we can find. Come back in 3 days for the scan.

    Woke up in the middle of the next night, and OMFG! It hurts. I can't describe it, but I couldn't walk, I couldn't drive, and it was 3am. Wife drives me to the public hospital. We walk in, explain possible kidney stone, get taken to a room, and within 5 minutes of arrival, jacked full of morphine.

    Feel better now? Yes? OK, go home. We will make an appointment for you with the urologist, and send it to you in the mail.

    2 more morphine visits and a week later, I ask

    "Where is this damn urologist appointment?"

    "Oh it can take up to 6 months to get in, just keep coming back here for morphine"

    "Are you fcuking stupid? Don't be joking man"

    "Sorry, we only have one and we share him with another hospital"

    "I'm sorry to hear that good sir, I will be leaving this establishment now, thank you for informing me of this so quickly"

    So I march back to the GP - "I have private health, refer me to a urologist please." He sends me that afternoon to a guy in north adelaide, I get a second CT scan that afternoon, and go in for treatment at Calvary hospital the next afternoon. ESWL treatment is done under a general, and I'm home by 10pm that night.

    My gap "excess" was $250, but that was all. All scans and xrays were free, as if you ask, most specialists have preferred radiographers that in exchange for the referral will often offer large discounts or even just charge at the schedule with no gap. But you almost always have to ask the specialist, "Hey mate, I'm a little strapped for cash, do you have a radiographer that wont charge me a gap." I haven't found one yet that refused.

    We have had the same thing with wisdom teeth for the wife, and I have had lumps removed from the soles of both feet. Every time, service has been instant, and the wait time has been less than 7 days to get treatment.

    We received a statement from the insurer, showing the benefit received for the year, and for 2007-2008 they had paid out over $27000 in treatment for me and my wife, who also uses the optometry stuff, at a cost of only $477 in excess, plus the $1850 premium.

    In essence, The speed and efficiency of the private system, will keep getting my premiums, because who wants to wait around in agony, for the Australian public system to get off its ass. I'm happy to pay a few thousand dollars a year, to know that I will get help in a heartbeat, when I need it.

    If you find you are having to still pay gaps and stuff, or certain things aren't covered, call your provider and check your level of cover. A lot of things come under extras cover, the main cover is only really aimed at getting you a bed in a hospital. If you can give them specific examples, they can tell you whether its an extra, or just not covered at all.

    It's like the gap you pay to the anesthetist, it's not because his services aren't covered, but because he usually charges above the scheduled price. Most insurers will cover the schedule, but not the gap. But again, ask nicely, and he may just charge you schedule only.

    I'm not trying to sell anyone insurance, just sharing my personal experience.
  7. Do you really think you got 27,000 bucks worth of treatment?

    This is where the bullshit and inflated prices come in. Not as bad as the USA but I resent the way private health cover works: getting stuck with "gap payments" and the like to cover inflated prices.

    The only reason private health cover hasn't completely collapsed is because people were forced to get it via tax penalties.
    Me: I just paid the penalties because I spend a total of almost zero on healthcare each year and would rather my money go to public facilities rather than private health companies that provide no benefit to me.

    I think they just need to piss off private healthcare as a system and boost the public healthcare by a corresponding amount. I don't care if I share a room with people, but I do want to get treated promptly. Which you do for anything urgent and don't have to pay anything.
    This idea that you stay sick unless you are rich is a dangerous concept to be entertaining in society, which is basically what private health care is all about (if you pay, you get fixed, if you don't then you live with it for as long as it takes to maybe get around to fixing you).

    The real solution there isn't private health, the solution is to have more efficient or staffed public health system. Buy back the private hospitals from the catholic nuts (who promptly shut down things like IVF and abortion services.. thereby reducing the availability of those things on religious reasons) and voila: you increase the public health system's capacity.

    Healthcare isn't a business it's about society's wellbeing.

    That said: if someone can tell me which private health cover actually covers you for things properly then I might consider getting it. Last time I looked it appeared useless unless you have glasses or kids that need braces. For a single guy in good health it appeared like it was not going to cover for anything and you'd be using the public system for everything.
  8. Private health insurance in this country is almost the biggest rort there is.

  9. Thanks all for your comments and information.

    So, following my text based block diagram, we have:

    Private system

    Get sick/injury (non-life threatening) -> see local GP -> get referred to specialist -> insurance pays for specialist at a fixed rate, you pay the remainder (Gap) that they change over the standard rate.
    Happens relatively quickly (?).

    Public system

    Get sick/injury (non-life threatening) -> see local GP -> get referred to specialist -> wait until they are free and see them -> paid for by government.
    Happens in any time.

    Life threatening injury

    Ambo takes you to the most suitable hospital (most likely Alfred if in melbourne for road trauma) -> once stabilised you can elect private or public treatment ->
    public: wait around until fixed up, if life threatening, most likely fairly quickly.
    private: go to a private hospital and get fixed up and possibly pay a gap or ten.

    Please correct the above if wrong!!

    Now, what is medicare??? What does that do? What is bulk billing? Thanks again for your help...
  10. I have private health cover (mid level with ancilleries) and I wouldn't call my experience with private vs public not worth it.

    I had an angiogram last year the actual angiogram was in a public hospital but the recovery afterwards was seperated into 2 streams of people. Those with private health cover and those without. When I realised this I asked a couple of questions and was requested to 'keep quiet about it' because the public patients didn't know we were getting what amounted to a higher level of care.

    Those people without private cover had to lie down and stay basically still for several hours so that the hole where the 'probe and line' went into ones body (near the groin area ouch) would scab over and not bleed seriously. This was accomplished by using pressure on the site of the insertion into the femoral artery (what amounts to a pressure bandage). Then after quite some hours they were sent away and told to stay within 10 minutes of the hospital and were not to spend the night by themselves. For me that would have meant getting a motel room nearish to the hospital since our house was 45 minutes from the hospital.

    OTOH my private cover included a 'collagen plug' that filled in the hole where the angiogram was done which meant I was up and mobile in less than an hour, then I was transported by ambulance to the private hospital and admitted where I was given a single bed in a private room overnight which meant I didn't need to have anyone wasting time supervising me. The 'plug' not only reduces post procedure complications it actually reduces discomfort as well and is absorbed by the body by itself in 2 to 3 weeks.

    Also there was an included consulation with a doctor and a dietician the next morning at the hospital before I was released and I was given quite a bit of information about my options. That information would have to have been tracked down by the public patients themselves.

    There was no 'gap' to pay as the private hospital I was transferred to is a 'no gap' hospital with my insurer.

    *edit* I should add that there was an excess of $100 on the insurance claim though.

    *edit 2* I also get to claim a rebate on my glasses and on the orthotics and braces for the kids. In addition the yearly dental checks are covered and a number of dental procedures (like fillings and extractions) are covered.
  11. This is a really good thread.

    Loz also has some good anecdotal stories as he's had two bad offs, one on private cover, one on medicare.

    VTRAffair, I suffer from Kidney stones too. The worst kind of pain I've ever been in, I can hardly describe it. Every year it's back to the hospital and jacked up with Morphine.
  12. This is a good thread! im 23 reasonably healthy and other than bad vision, too much blood in my alcohol stream is my only real problem.

    Should I get Health Insurance?? Would it help with optomitrist fees (I need new glasses and maybe contacts soon - I need special hard contacts $800+ for a pair). What about perscriptions, and the dentist etc? Does it help with that stuff?
  13. Years ago I looked at getting private health insurance. I had to get some wisdom teeth out. The plan was to pay into is for twelve months, claim, but then stay in.

    the sums just didn't make sense. I had to pay a whole heap of money. I had to pay a gap and I had to pay more for the surgery.

    I wasn't even close to good value. It was even doubtful the surgery was covered.

    since then the cost has almost doubled in real terms.

    I can't for the life of me understand why anyone would have private health insurance.

    It gets better. A mate of mine recently had is second kid. he went through the public system. for the first he went private. the reason being the midwife system the public system has is far superior to the private system of seeing a specialist ever second week.
  14. medicare is similar to health insurance, but provided by the government, it ensures that, unlike in America, if you get sick you aren't left to die if you dont have money to pay for treatment

    bulk billing is where the doctor charges what medicare is willing to pay for the service. so it is free to you
  15. medicare is similar to health insurance, but provided by the government, it ensures that, unlike in America, if you get sick you aren't left to die if you dont have money to pay for treatment

    bulk billing is where the doctor charges what medicare is willing to pay for the service. so it is free to you
  16. Overall, probably not. You'll just be subsidising some fat old bugger's hip replacement :wink: .

    Seriously though, it might help with the dentistry and the optical stuff. Just be really, really careful to read the small print, because I've seen some policies sold as all singing, all dancing, covers everything, but, when you really look, you find that there's an absurdly low lifetinme limit on what they'll pay. I've seen maxima of a couple of grand ever for dental, say, which won't go far if you eat lots of sugar or play contact sports much.

    Just be aware of exactly what you're buying and have a realistic idea of what the premiums will cost you vs either relying on the public system or (for your contacts maybe) putting your premium money in a high interest savings account and paying out as and when yourself.
  17. Had a wisdom tooth out four years ago. Entirely self financed it cost me about $300. Even having all four done, at that rate it would come to rather less than a year's premium.
  18. 2 sets of braces for 2 kids at roughly $6000 per set of braces of which we can claim 50%.

    That means we've got $6000 back in the last 3 years.

    It has cost us about the same as we've got back *just* from the braces, I estimate that we are about $2000 in from at the moment.

    But that isn't really what it's about, it's about not sitting in a waiting area in casualty for 8 hours when you're classified as non-urgent and not being booted out of hospital in the absolute minimum time they can get away with and not having to stay in a shared hospital room with 3 snoring, farting Kitzo/Smee clones :LOL:
  19. had a wisdom tooth out this year, would have cost $1300 self funded... and thats if it was only a day in hospital. if something went wrong it was about $200 a day
  20. we've only been in the country for 3 years and because the system is so different to the good old NHS we did quite a bit of research. I have to say though that I am still very confused....

    Because we have a young family we picked the highest level of hospital cover and extras that we could, from a fund that offered what looked best for the kids; good dental, orthodontics etc.

    So, first off we had to pay our premiums for 12 months before we were even covered for anything

    After the qualifying period we made some minor claims and still had out of pocket expenses

    This past year, i have been progressively reducing the amount of cover we have, and especially increasing the excess we pay. I'd say look very closely at this aspect of things - we now pay $150 excess for hospital admissions BUT it is capped at $250 per year. I'm saving $100 per month by increasing the excess with a worst case outlay of $250. And on top of this excess doesn't apply to the kids!

    Finally, we just got a referral for Amelia to see an ENT specialist, and she's now booked in for the operation withn 7 days.

    so, in summary I'd say there are a whole load of mixed messages around. If you've got a family, the insurance is worth it for the peace of mind, but shop around VERY carefully to get the best policy for you.

    if you've no family and/or are single then I'd say definately don't bother. What's the worst that can happen? If you get hurt on the road TAC (in Vic) will cover it. If you have any other emergency you'll get good and prompt treatment at a public hospital. If it's non-emergency you'll still get good treatment at a public hospital but might have to wait for it. For anything else go to the pharmacy and get some panadol

    Since the government have lifted the threshold for medicare levy surcharge, many people won't even be penalised now for NOT having insurance.

    And the other big wind up is lifetime health cover. They are trying to bribe you to take out insurance by raising the premiums if you wait untl you are older. but do the sums. the money you save by not paying the premiums from a younger age more than outweigh the higher premiums when you do take cover out.

    anyway - just my ramblings. I'm not even going to start on medicare......