In this section...
December 2000
The National Health Act 1953 and Health Insurance Act 1973 allow health funds to pay a benefit in excess of the Medicare Benefits Schedule (MBS) fee for medical services where conditions are met through contracts or other agreements. This allows health funds to provide 'no gap' or 'known gap' in-hospital medical services to insured patients.
The Private Health Insurance Administration Council (PHIAC) has commenced collection of improved data from private health insurers designed specifically to measure the medical gap starting from the September 2000 quarter.
The December 2000 quarter figures in this report are from this new PHIAC collection and are the most accurate available. They are not directly comparable with reports prior to the September 2000 report. Historical trend figures given in this report, prior to September 2000 are derived indicative estimates only.
From the March 2001 quarter a breakdown of services performed under known gap agreements or schemes, and those performed outside the agreement or scheme framework will also be available.
No gap services
The proportion of in-hospital medical services for which there was no gap has continued to increase. Note that each private episode of care may include a number of medical services provided by a number of doctors.
In the December quarter, 2,148,588 in-hospital medical services (representing 65% of the total) were provided to patients with no out-of-pocket costs. This is an increase of 5 percentage points from the September quarter 2000 figure of 60%.
Figure 1: Proportion of in-hospital medical services with no gap, Australia
The percent of services with no gap varies from 55% in New South Wales to 77% in Western Australia.
The largest increase in the December quarter was in the Northern Territory, with a 37 percentage point increase over the September estimate. This increase should be viewed with caution, as the reporting of these statistics is relatively new. The proportion of in-hospital services with no gap and the change over the September quarter is shown in the following table.
Figure 2: In-hospital services with no gaps December 2000, and change since September 2000
|
|
NSW/ACT |
Vic |
Qld |
SA |
WA |
Tas |
NT |
Australia |
|
Proportion of services with no medical gap - December 2000 |
55% |
71% |
62% |
75% |
77% |
64% |
60% |
65% |
|
Proportion of services with no medical gap - September 2000 |
50% |
69% |
58% |
69% |
71% |
51% |
23% |
60% |
|
Percentage point change from September 2000* |
5% |
3% |
5% |
7% |
6% |
4% |
37% |
5% |
Figure 3: Proportion of in-hospital medical services with no gap, by State - December 2000
Gap payments
The average gap payment for all insured in-hospital medical services was $18.18 in the December quarter 2000, including services where no gap payment was made. This figure is a decrease over the September quarter figure of $21.49
New figures collected by PHIAC now make it possible to calculate the average gap for services where a gap was paid. This was $51.56 in the December quarter compared to $54.20 in the September quarter.
Figure 4: Summary of in-hospital medical services with no gaps
December 2000
State |
Proportion of services with no medical gap |
Average payment made by patients across all services * |
Average payment by patients where a gap was paid |
|
NSW/ACT |
55% |
$ 23.01 |
$ 51.41 |
|
Vic |
71% |
$ 15.52 |
$ 53.15 |
|
Qld |
62% |
$ 19.44 |
$ 51.65 |
|
SA |
75% |
$ 7.41 |
$ 29.70 |
|
WA |
77% |
$ 15.52 |
$ 66.13 |
|
Tas |
64% |
$ 24.71 |
$ 68.23 |
|
NT |
60% |
$ 27.19 |
$ 68.24 |
|
Australia |
65% |
$ 18.18 |
$ 51.56 |
* Includes services where there was no gap
September 2000
State |
Proportion of services with no medical gap |
Average payment made by patients across all services * |
Average payment by patients where a gap was paid |
|
NSW/ACT |
50% |
$ 26.13 |
$ 52.77 |
|
Vic |
69% |
$ 15.19 |
$ 49.72 |
|
Qld |
58% |
$ 28.91 |
$ 68.86 |
|
SA |
69% |
$ 8.30 |
$ 26.84 |
|
WA |
71% |
$ 18.41 |
$ 63.34 |
|
Tas |
51% |
$ 41.30 |
$ 84.59 |
|
NT |
23% |
$ 9.99 |
$ 12.98 |
|
Australia |
60% |
$ 21.49 |
$ 54.20 |
* Includes services where there was no gap