Bridging the gap

DESPITE a massive advertising blitz by the Federal Government there is still widespread confusion regarding legislative changes to help close the health fund gap.

According to Consumers Health Forum of Australia executive director Matthew Blackmore, forum members remain annoyed about the gap.

“They feel justifiably annoyed,” he told Business News.

But he said the legislative changes the Government introduced in August last year made the gap more transparent.

The gap exists when doctors charge for services above a level set by the Government. The Government pays for 75 per cent of a set fee for medical services provided in hospital, with the remainder paid by the health funds.

The changes mean funds also will cover the patient above the regulated set fee schedule if an agreement or scheme is in place.

The new legislation introduced a new method additional to individual agreements with doctors, through which health funds can cover the gap for doctors’ services received in hospital under “gap cover schemes”. These schemes must be approved by the Minister for Health and Aged Care.

Although the legislation does not get rid of the gap fully, it now is referred to as a “known gap”. Patients now must be told, up front if possible, when there will be out-of-pocket expenses.

Mr Blackmore said most health funds now advertised which doctors had entered into an agreement with them.

“I think that is part of the reason why doctors have signed up with health funds … because of the competitive advantage,” he said.

HBF public affairs manager John LeCras said about 70 per cent of doctors were now covered by the health fund through the scheme, where the fund guaranteed to cover all costs.

He said HBF had noticed a substantial increase in public interest in private health cover since the gap cover schemes and the 30 per cent government rebate were introduced.

Figures from the Private Health Insurance Administration Council show Western Australians have taken to private health at a greater rate than those in other States.

In the March quarter, 48 per cent of the WA population had taken out private health cover, compared with the national average of 45 per cent.

In the year to March, an additional 226,000 Western Australians and 2.5 million Australians took out private health cover.

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