Curious as an OzBargainer what do you do to avoid gaps?
Getting hard for me to find one now since my local GP is charging a gap of $20. I found one that still bulk bills but took me a while to switch. Bad reviews on google but so far ok based on my last few appointments.
How about you?
my GP charges me $70 and I get ~43 back on medicare. So I guess the gap is around $37
my GP charges me $70 and I get ~43 back on medicare
Same for my GP but your guess is a bit off
I guess that's why they're MrThing and not MrMaths. FFS.
$90, and $43 back
Wow $53 gap alot. Ive never seen a GP go over a $40 gap.
mine is at least this… I think it may have been more like $90 now last visit so $47 gap
I think Australians have no idea how spoiled they are to have a medical system that provides fairly priced GP services and free public hospital services.
Compared to…. America? Africa? South America? China? In that case, I agree.
Even the UK tbh. The NHS is wonderful but their right wing keep stripping it year after year and there's very little private to offload it. We've got a good mix of public and private here with enough standard setting by the public system to keep the private costs to the consumer down. America is the reverse, private monopolies and virtually nonexistent public.
The NHS is nowhere near as good as it is made out to be. Very good for emergency, but that's about it.
Yes. My point is, ours suck and we are not "spoilt", though sucks less than a selected others.
It's not spoiled. Whitlam's Medibank vision, which became reality in his first term of govt, was that all Aust citizens would be entitled to access free medical care. Private insurance was available for those who wished to choose their surgeon or specialist, but all GP consultations were free. This was a right, not a privilege. It is only through the wilful neglect of successive govts of both stripes that this right has been undermined to the point now where it has been pretty well lost. And why the wilful neglect? Because govts didn't want to allot budget to maintaining the standard of medical care we all took for granted. Their priorities have changed without formal acknowledgement or announcement to the electorate. And people like you have not only swallowed the new normal without protest, but consider we are "spoiled."
What's spoiled is the tremendous medical system we had. A curse on both the major parties for their role in destroying what we took as a given.
And people like you have not only swallowed the new normal without protest, but consider we are "spoiled."
Mate I'm saying that we are NOT spoiled… I'm providing a counterargument to the OP.
I'm forced to pay $1800
No one has forced you. It is your choice
i was forced to be born. i did not have a choice
If I don't take out the policy I pay a lot more in tax, for nothing in return. Do you consider that a good choice?
That selfish prick attitude is exactly why this country has gotten this bad
@[Deactivated]: So it's selfish for me to choose to take out a $1800 a year private health policy instead of paying $5,500 a year in penalty tax
Meanwhile people who happily get Medicare for free and pay nothing into the system are presumably not selfish in your book.
What a shit take.
@justworld: $1800 is including extras i believe?
So really the amount that you are "forced" to pay is less than $1800
Exactly, we pay about $3500/year for family private health insurance but it's completely useless. Especially when you read through it and find out that they always go through medicare first, they only cover what medicare won't and even then it's extremely limited, what a scam. I never pay for a gap but I only see the doctor about once a year just to get a refill on a basic prescription. 99% of my visit (as well as my parents) to all doctors (specialists included) have been completely useless in my experience, they have yet to come up with a solution that webMD couldn't have.
My GP stopped bulk billing a while back. I switched to another GP in the same clinic who still bulk bills and she is just as good. It's a bit strange to have some GPs bulk bill and some don't in the same clinic.
I have been having private health insurance for the last 30+ years. I had my RARP (Robot Assisted Radical Prostatectomy) 3 years ago for $9500, with $414.50 rebate from private health. A friend from overseas did the same RARP this year and it cost him $6000 for the surgery. Both surgeries were done at Epworth but with different surgeons, it puzzles me why someone with private health insurance had to pay so much more out of pocket than a foreigner.
Why are you paying so much, get a cheaper plan?
According to this
https://www.choice.com.au/money/insurance/health/articles/ch…
The cheapest bare-bones plan in Victoria is $1214 per year - my plan is about $600 more expensive than that but I get the extra cost back because the yearly optical and dental extras are worth around $400 and then there's better coverage for everything else, just in case I need it.
Every health insurance policy starts off with a $1200 sunk cost, unfortunately.
I feel like paying a 50% premium on the cheapest possible option negates your statement than you neither 'need nor want' your policy.
Eg Medibank Basic Everyday Starter is $1250 and gives you a pair fo $249 glasses from specsavers and a free dental check up on top of 60% back on a rubdown or back crack.
Also if you get good at gaming their points platform you can get some new airpods or a watch every year
@6079 Smith: The price you've quoted for Medibank Basic includes the rebate, which doesn't apply to everyone. Without the rebate it's $1,700 per year. And is similar to the plan that I've got.
Ive started churning and burning, generally can get 18 weeks free doing this plus gift cards
If you don't want the cover then simply cancel the policy.
Well you can't because you get charged it in tax instead and a 10 year loading can apply if you don't have it
You're still not forced to have private health. You can choose to pay that money to an entity that isn't trying to rort the system.
I think Australians have no idea how spoiled they are to have a medical system that provides fairly priced GP services and free public hospital services.
That utterly disappointing attitude of "we are receiving sooo much" brings high medical charges, brings co$tly everything.
Virtually all countries with high paying taxes will offer medical and other social services (including education) without charges.
Tax collection should be to pay for services to the community and NOT politicians perks.
You are not forced to pay for voluntary private health premiums. They just offer various financial incentives/penalties for not having this if you meet certain scenarios.
"I mean nobody is forcing you to pay for health insurance, you've just made a decision to buy it because it might be financially beneficial for you (in which case you do want it). "
Charging a 1.5% taxable income penalty is effectively forcing someone. Unless you really want to be a pedant and say that I could just choose to not have PHI and pay a lot more tax.
Correct. The Medicare levy tax surcharge, 90k and above, hasn’t moved so inflation (cpi wage growth) catches more and more tax payers in it. So effectively you’re just transferring the money from government coffers to private shareholders if you get basic level PHI, which gives you nothing anyway.
@Vomo: Call me naive, but when that's your choice, I'd rather give it to the government than shareholders so perhaps it might contribute to a better health system and helping others.
It's not a tax penalty. It's charging those who have the means to contribute more to the system. No one is forced into private health cover.
@Orion au: $90,000 doesnt mean you have the means to contribute more. A $90,000 salary is a struggle to service a loan for a modest apartment.
@worrierwan: Yes, whilst I agree that house prices and the cost of living has gotten out of hand so that the scenario you introduce is true, you still have more to contribute than someone on 60k who doesn't hit the threshold.
Perhaps the real problem now is that the threshold is too low given where we are at.
I have been looking at PHI this year as this was the first year as a family we went over the income threshold. For us the saving in tax would be about the same cost as getting PHI so not really beneficial for us unless we claim a lot back.
@onetwothreefour: If it's about net even then beneficial as you could avoid additional lifetime health loading.
Something to consider when running the sums
@futureminime: But also lifetime isn't lifetime, it's 10 years. There's practically no circumstance where you're better off taking out health insurance to avoid lifetime loading.
@Bren20: You are correct, mostly. Not many cases when it's a determining factor on its own, but should be added to the Estimated Value of the Buy case when assessing if private health insurance is cost effective for a situation. That's why I said if it's about net even.
Consecutive 10 years when the increase of 2% per year, ignoring increases in premiums above inflation/time value of money by paying the 20% over 10 years, is a 20% extra cost vs 100% saved by not getting it.
Side note is "If you cancel your private patient hospital cover after paying for the LHC loading for 10 continuous years, you may become liable to pay the LHC loading again if you take out another private patient hospital cover later."
Probably unlikely to affect that many people, as long as you're aware.
The cases where it can be worthwhile is when you believe you will be using the hospital cover, or will be wanting to take out a high level of hospital cover in the near future. E.g. the 100% of the low premium may be cheaper than the +20% of the higher premium.
May be useful if you're planning a family, or getting older/have health conditions and want to smash out the LHL while you may have some minor issues but the chance of major issues is lower so you can get higher cover later without the loading.
So yeah, very few cases.
So if you get private health insurance it means you pay less tax? On what income brackets is it worth it?
Maybe you could create a poll so you have a good idea of the spread. In all honesty I don’t know what gap I’m paying however I have a brilliant GP and I can afford the money. When it comes to my health I’m willing to pay that bit extra.
Standard consultation, Pay $96.42, Rebate $42.85, Out of pocket $53.57. I’m in a regional area, no bulk billing available.
This.
My local practice used to bulk bill everyone. Then it introduced gap payments for most patients. Not me, I've got a concession card. Now they're not accepting new patients at all. So I'd like to switch GPs to see if I could find someone more competent - she's a nice person but she isn't solving any of my medical problems - and who I didn't have to book 3-4 weeks ahead to see, but I couldn't get in elsewhere if I tried.
I have to say, I warned people years ago this would happen. They said we've got a shortage of doctors, so lets open the immigration doors wide open to any who want to come here. They said immigration will solve the problem. I said that isn't what happens with immigration. What will happen is that Australian kids will see that they have to compete against people from poorer countries who are willing to work for lower wages, and they'll choose another occupation. And that's exactly the situation we've ended up with with GPs. These days only 15% of Australian medical students choose to be GPs. That's why we've got a shortage of GPs.
But, hey, no problem. Recent research compared the performance of GPs, with GPs with AI assistance, with AIs without any supervising GP. Having an AI to help them diagnose helped a bit. But the AI won easily. Bring on AI GPs.
https://www.theguardian.com/commentisfree/2024/nov/30/if-ai-…
These days only 15% of Australian medical students choose to be GPs.
It is hardly a free and open market! Doctors generally have high pay, high job security and high status. So there are at least 20 applicants for every medical school place. Those select few who get through the admissions process tend to be highly competitive and ambitious. Dux of their school. So of course they want to get into the top specialities.
Right now we two streams: Medical/Surgical and Dental. If a third degree type was added, for GP, it too would be inundated with quality applicants. Including those not from recent immigrant families.
AI diagnosis is great, but good luck getting the AMA to cooperate. AI needs lots of data, and the vested interests are very protective of their data. Also, the privacy problem, real or perceived.
The AMWAC advise the federal government how many places to allocate to university for medical students, this number is for the commonwealth funded places and is distinct from international full fee places. So foreign students aren't taking places away from local medical students, as is commonly believed. The govt is just deliberately doing a shitty job at funding these type of courses, which leads to only the best 1% of local students competing for those places (GPs don't actually need to be the best brains of society), while anyone with enough money can apply for the larger number of international places.
The govt wants more students to study more STEM and vocational courses, like education and agriculture. Perhaps this strategy might help in the long term, it's hard to say.
Pretty much every practice employs some form of AI now anyway. With consent they'll record the conversation and put it into text that's then added into your patient file. Some of them integrate directly into the practice management software too.
Basically saving the GP from having to spend extra time typing and summarising your notes. It's good and bad. Some lazy GPs end up adding a massive wall of text into the patient file, while others filter out the irrelevant data and make it more user friendly for other clinicians to read and decipher.
same could be said for any other job
same could be said for any other job
Exactly.
I like your train of thought. They are indeed connected and kids these days prefer to exit early at school and do trades.
The AI helps to cut the beaurocracy in the system, just my observation.
Yep let an AI diagnose, summarise, gp reviews, cheap.
Value your GP. 12+ years of study to be a specialist doctor. Tens of thousands of dollars to be member of specialist colleges, sit exams, study Masters degrees, upskill in mental health/skin condition/other pathologies…
Last week an electrician quoted me “$240 per hour” to get some LED lights replaced. Plumber call-out fee is $120 plus labour/materials. Locksmith charges $250-$300 to pick a lock (what skill is required there..)
We live in a world where tradies live in fancier houses than degree-educated professionals. Tradies get to claim their whole car/ute as a business expense. Lots of dodgy cash-in-hand charges that don’t get declared to the ATO..
Yet people find it bizarre to pay a $40 gap for their health.. and are always looking for bulk-billing (no charge) so they can save their $40 for cigarettes/alcohol/vaping/fancy brunch..
The term “general practitioner” is a misnomer as most people think they are a “general doctor”. In fact a GP is a specialist in family medicine. In other countries they are called Family Physicians. They need to have broad knowledge of “everything” (for example, cardiology, respiratory, orthopaedics, dermatology, gastroenterology, endocrine, etc.) in order to mange influenza, asthma, COPD, bronchitis, diabetes, strokes, psoriasis, eczema, atrial fibrillation, inflammatory bowel disease, etc.) without mentioning pregnancy, anxiety, mental health, paediatrics, immunisation, preventative healthcare such as bowel cancer screening/mammogram.. then sexual health, geriatrics, palliative care, etc.
Crazy!
What I hate is seeing people driving into Bulk Billing Clinics in their Beamers and on thier $1000+ iPhones with 4 kids, having some smokes and expect the provision of thier health care to be completely free. Well it's free at the point of service but not free for the wider community, someone is picking up the tab.
Why any GP for any respect for thier profession would operate a fully bulk billing clinic is beyond me. I am suspecting those clinics operate as medicare swiping terminals as opposed to seriously providing health care services.
Now I get there are times where the wider community should be picking up the tab, ie young and old vulnerable people who are literally on thier last dime etc etc, but I'd say (without any data to back this up) for 90 % of households (yes I meant households not individuals) , they are able to meet the gap payments required for the occasional GP consultation, its all about budgeting, prioritisation, financial responsibility.
When you give something for free then it's not valued or appreciated, There needs to be a shared responsibility model with the individual and the state, so the individual shares some of the financial load to keep the system economically sustainable.
The Consultation gap payments should be on a sliding scale based on your ATO earnings, and it needs to pass the iPhone and Beamer test.
''can you please bulkbill me dr I'm having trouble putting food on the table after paying for the european holiday I just booked and those botox injs are so expensive''
young and old vulnerable people who are literally on thier last dime
Agree for young people (<25) because that pays dividends later on, but why would you subsidize people who had their entire life to save for retirement, but failed at it? Especially when they're on the pension already, little sympathy for poor money management and poor planning.
I pay a gap of maybe $35-45 or so.
I'm happy to do so for similar reasons mentioned by others.
I'm also a big believer in some kind of co-pay for everything as people don't value free things well (i.e. people tend to overuse free things) - but that might just be my economist hat coming out.
Agree, people definitely think twice if there is a co-payment.
My GP co-payment is about 37 for a 10min and I think 60 for 20min.
The bigger issue is that it now takes 3+ weeks to get an appointment, almost 4 weeks, 2 years ago it was 2 weeks, and before COVID it was about a week.
I've pretty much told her to marry me because that's the only way to keep up to date on my health 🤨
I feel better solution will be first 5 attendances in a year should be gap and next 5 with $30 gap payment and next $5 with $60 gap payment and so on. This way people who seldom falls sick still can get treatment and people who rot the system can wisely think about how often they want to visit for simple ailments.
GP's in Canberra are routinely charging over $100 for a standard appointment now.
Yeah it's ridiculous. I'm blown away by all these ppl still getting bulk billed, or gaps under $50
What's the use of medicare then?
Well we still get the medicare rebate, we just get to pay a bigger gap
Albo's ACT
What does this even mean?
A decade of Liberal neglect got us to this position.
Albo has been completely uninspiring and has not done anything to improve it.
The Greens are the only ones pushing for Medicare. They will add dental to it.
Agree re Lib neglect, but the ALP has also just sat on their arses and watched it happen - and Albo is as weak as piss, so no expectation of any action from this govt. Gough would be spinning in his grave.
Bullshit re the Boomers voting against Shorten's proposals. Plenty did, plenty didn't. Many of us, certainly including me, are appalled at the state of things today in all sorts of areas we're being blamed for by a poisonous mostly GenX managed media. I've always voted progressive, and same with everyone I know. PLEASE don't fall for the anti-Boomer spin peddled by the press. All stereotyping is simplistic, a gateway to bigotry and frankly, dumb.
@rossnroller: Bill's reforms were what the country needed. He just needed to earn the punters trust first imo and split some into a second term.
@gakko: Agree. Think people got scared that he was going to be leading a mega-spending govt a la Whitlam. But while Whitlam had a sweeping vision for a future Australia that he wasn't going to be cautious about and did what it took - and changed the country much for the better, don't think anyone would put Shorten in the same class as Gough.
Also, as soon as Shorten began his anachronistic banging on about "the big end of town" he lost a lot of potential votes and ended up snatching defeat from the jaws of victory! He needed to take the electorate along with his policies rather than alienate and divide, and didn't have the clarity or cut-through of a master like Keating or the gravitas and vision of Whitlam. Result? Morrison!
A decade of Liberal neglect got us to this position.
it was ALP under Gilard that got rid of the indexation of medicare not the LNP but dont let the fact get in the way of the agenda - Abbott for all the left hate him was the only one who said and was ha been vindicated in saying the system wass unsustainable and was slautred for suggesting a 7 dollar payment in which the government would of added indexation to medicare but the ALP and Greens opposed it
As for the Greens they will say anything so rubs suport them, knowing full well they will never have the responsibility to get it across the line - both parties actually have looked into bulk billed medicare funded dental it is the Dental society itself that doesnt want it because it would mean they cant charge shit tones of money for basic proceedures
unless the Dentist themselves get behind it then it wont work - everyone needs to be on board
the current ALP backbench want medicare dental, Allied health and mental health but it would likely have to be at the cost of the NDIS and the 'Greens' and socialist wouldnt allow the NDIS to be scrapped or drawn back 80-90 percent - the front bench dont want to bring anything else in due to the aim budget repair and fear of future fuelling inflation
the pie is only so big we already spend 10 percent of our GDP on healthcare
i personally would support mental health and Allied health being put under medicare before dental as it would offload a lot of pressure on the hospital systems
lol gotta love (or hate) the Greens. Medicare is struggling to survive, so lets make more services free.
@SlickMick: Easily done by cutting loopholes for the rich. The Liberals and Albo are too gutless to touch this.
Shorten proposed to but the baby boomers, the rich and the dumb collectively stopped him.
@arcticmonkey: Wow you have some Green supporters here. Thankfully ozbargain isn't representative of the country as a whole.
Bulk billed
Care to share more details? Situation, area, history with GP?
Another aspect you should consider about why there's less bulk billing practices is the cost. Doctors are on all sorts of different agreements where many take home 70% of the billings. With the rest left to pay the wages for the practice manager, administration staff, nurses, the supplies for the doctors/nurses, administration related costs, infrastructure like power, IT, rates, water, rent, insurance, accreditation and every other cost associated with the business.
Now if the practice has trouble employing doctors they'll need a locum doctor and it's near impossible to make profit when you have one of those. A locum can easily make $250 an hour and depending on the circumstances (rural practices especially) that price can be even higher. You'll find that a lot of regional hospitals employ locum doctors and that's a whole different can of worms.
It certainly doesn't help when Medicare are always changing the rules about what item numbers can be used with what. It's not uncommon for a practice to be using different item numbers together (particularly in chronic disease management), getting it approved and paid out by Medicare only to discover later it was an "administration error" and now they need to pay it back. Do they chase payment up with the patients or accept the loss?
Obviously pay rates vary between practice and location before someone tries to tell me I'm wrong (I'm generalising), but it does help explain why there's less bulk billing practices and why a lot of GPs would like to see the Medicare rebates increased.
yeah I've seen some fuzzy goings on with item numbers so wonder how many 'higher earning' item numbers get used when the more exact item number may not have paid so much …
@Hangryuman: It's so easy to make mistakes when one person at Medicare says "what you're doing is fine" and then when you send off the batching it gets rejected. I know there is one person in Medicare who is notorious for rejecting a lot of payments. They know the ins and outs of every item number.
Staff discount basically.
The GPs I go to have always bulk billed. I cant imagine having to pay a gap everytime i go to the Doctor. Although i dont go that often i guess.
You are very fortunate on both counts. Gap of ~$70 in Canberra
That sucks and is unfair to people after the amount of taxes we pay and medicare levies. Doesnt make sense really. I have some family and a lot of friends who are GPs, they are all killing it, so surely it cant be that the industry is in dire need of increases? What is it? Insurance and liability fees? Or government just wasting all our taxes on other things. Wasnt the whole thing about medicare and our taxes / levies and also about australia being that GPs were bulk billed / free medical cover etc.
Didnt we always shun the US system and parade that ours was better. (Not saying it is in all regards, i do know some people who say the User pays system is better)
@LFO @lonewolf you are mistaken that the government funds GPs directly. the medicare rebate is your rebate. When you see a doctor you pay a fee like any other service like accounting or getting a haircut. bulkbilling means the GP sets their fee at the level of the Medicare rebate. the fact you pay a gap merely means the rebate has not kept up with inflation/market cost over the years. If I told you your salary would be reduced by 40% in the next 10 years would you be happy with that or should we call you greedy when you have objections?
@Harrash: Not to mention most doctors are contractors and not regular employees of the practice like the nurses and administration staff.
Interestingly there's managers in Services Australia who are talking of wanting to change that in the future. Good luck 🤣
If I told you your salary would be reduced by 40% in the next 10 years would you be happy with that or should we call you greedy when you have objections?
Not too valid comparison.
Does it mean on year 0 (zero), when starting, your salary will/would be 40% higher ??
How about further studies/training to become a specialist and then charge whatever in a private, competitive, demanding clinic?
We are talking about a GP, a General Practitioner here. Lets get real.
Asking for more money is just pure greed.
EDIT: just looking at “someone else's” (might not be representative to all) Medicare Claims, meaning the money Medicare PAID to a GP: $41.20 or $42.85 or $51.00 ("after hours": meaning Saturday)
So, not bad for the proverbial 6 minutes consultation.
I invite you to look through your own Medicare records and details to see how much they (Medicare) paid for basic GP services.
I reiterate: extracting even more IS PURE GREED.
How about further studies/training to become a specialist and then charge whatever in a private, competitive, demanding clinic?
We are talking about a GP, a General Practitioner here. Lets get real.
GPs are specialists in their own right. They have specialist medical registration. They still have to undergo a minimum of 4 years post-graduate training to get those qualifications. Surgeons or Physicians are not higher-qualified than GPs. As a general rule, they have the same level of qualifications in their specialties as a GP does in his/hers.
When Medicare was introduced, it was never designed to be a bulk-billing system. It was designed as a government-sponsored type of health insurance that would cover approx 70-80% of medical appointments. The rebate belongs to the patient, and , as others have said, has had indexing either paused or set much lower than inflation. If it had kept up with inflation it would be over $100 per standard consult, which is 6-20 minutes. At the moment it is around $43 for that time. The rebate is around $83 for 20-40 minutes.
You say basic GP services. What exactly do you think that entails? Just writing a prescription or doing a request for a blood test? Because that's not what most basic GP appointments are for.
Why is asking for rebates to go up at the rate of inflation greed? How much study did you have to do for your career? How much HECS debt did you have on graduation? What are your annual insurance & registration costs & how much unpaid CPD do you have to do a year? These are all things that need to be considered when making statements that asking for higher rebates or gap fees is greed.
@Raybert: Are we saying GPs dont make money? I know 2 types of people who get into Medicine. one is for the care factor and they want to help people, and the other type get into it for the money and the status. Should i tell the second type, dont bother because GPs dont make money? Regardless of the fact that every GP I personally know is either High Middle income or in the rich category? I have never seen a GP "struggling" to make ends meet.
@lonewolf: so the tl:dr is it all comes down to you being envious of a highly valued and trained professional's perceived high salary. got it
My family doctor has always bulk billed though there is a wait each time of around 30-45 mins to see a doctor since the clinic is popular. Sometimes I go to one of the big clinics that charges an $80 gap but it's instant, no wait.
I think Australians have no idea how spoiled they are to have a medical system that provides fairly priced GP services and free public hospital services.
Meanwhile, I'm forced to pay $1800 a year in private health premiums for coverage that I neither need nor want.