Media releases

November 10, 2000

Narrowing the gap

MINIMISING out-of-pocket expenses for hospital and day-surgery will be right at the top of the Medibank Private agenda for the next twelve months.

Acutely aware that medical gap payments for hospital and day surgery procedures remains one of the most vexing issues facing private health insurance holders, Australia's largest health insurance fund, is pulling out all stops to address the problem.

In November last year, the organisation introduced its "GapCover" scheme designed to eliminate and reduce "gap" expenses and in September launched a further version of the scheme, following government legislative changes.

In little less than 12 months since the launch of the initial scheme, some 39 per cent of all medical claims (or almost 190,000 claims) lodged with Medibank Private are now made under "no" and "known gap" arrangements.

Coupled with the number of scheduled fee claims (those which are billed according to the Medicare Benefits Schedule Fee) a massive 67 per cent of medical claims now lodged with the fund, carry no out-of-pocket expenses.

What is even more gratifying is that some 1,711 doctors are now using the Medibank Private GapCover scheme - from surgeons and physicians to obstetricians and anaesthetists.

A medical gap is the amount doctors charge over and above the Medicare Benefit Schedule Fee and because doctors are at liberty to charge what they consider an appropriate fee, it may differ from doctor to doctor and from procedure to procedure.

"Gapcover", on the other hand, is an arrangement or understanding between doctors and health funds about how doctors could bill their patients and whether or not they will bill their patients according to these no or known gap arrangements.

Medibank Private managing director, Mark Burrowes, says the participation results by doctors has been very encouraging given that the funds GapCover scheme have been in place for less than a year.

"We see the participation rate by the medical fraternity as a thumbs-up for the scheme. Clearly they not only see the benefits for themselves in terms a more simplified billing system but they recognise the big positives for their patients."

While participation by doctors in Medibank Privates gap scheme since November has increased nationwide; there has been a notable surge in WA, Queensland, NSW and Tasmania. In WA there has been a 900 per cent increase, Queensland (700 per cent), and NSW and Tasmania (600 per cent.)

Says Mr Burrowes: "By contrast the increase has been much smaller in Victoria and SA where billing health insurance funds has been commonplace for some time now. Almost 1,000 doctors across both states now bill under Medibank Private's GapCover scheme."

Mr Burrowes believes that billing by doctors under a no-gap arrangement will accelerate as doctors further appreciate the importance of eliminating gap expenses for their patients.

Minimising out of pocket expenses does come at a cost to Medibank Private. "We pay in excess of $40 million annually to help foot the cost of eliminating gap expenses but at no additional cost to members this year in terms of premium increases," he says.

The ACCC has given the thumbs up to no and known gap arrangements by health funds and in a media release put out today complimented Medibank Private for maintaining a list of medical practitioners participating in these arrangements.

According to the ACCC "such lists provide valuable information for fund members" and the extent of membership exposure to "out of pocket expenses".

ACCC chairman, Professor Allan Fels, also went on to say that all medical practitioners should also disclose to patients any financial interest they may have in products or services they provide or recommend.

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