In this section...
June 2001
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) commenced collection of improved data from private health insurers designed specifically to measure the medical gap starting from the September 2000 quarter.
The June 2001 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.
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 June quarter 2001, 2,364,036 in-hospital medical services (representing 71% of the total) were provided to patients with no out-of-pocket costs. This is an increase of 2 percentage points from the March quarter 2001 figure of 69%.
Figure 1: Proportion of in-hospital medical services with no gap, Australia
The percent of services with no gap varies from 56% in the Northern Territory to 85% in South Australia.
The largest increase in the June 2001 quarter was in Tasmania, with a 5 percentage point increase over the March figure. Other States had increases of between 2 to 4 percentage points, except for the Northern Territory, which had a decreases of 2 percentage points.
The proportion of in-hospital services with no gap and the changes since the September quarter is shown in the following table.
Figure 2: In-hospital services with no gaps September 2000 to June 2001, and changes* since September 2000
NSW/ACT |
Vic |
Qld |
SA |
WA |
Tas |
NT |
Australia |
|
|
Proportion of services with no medical gap - June 2001 |
66% |
74% |
66% |
85% |
79% |
71% |
56% |
71% |
|
Proportion of services with no medical gap - March 2001 |
64% |
70% |
63% |
83% |
77% |
66% |
58% |
69% |
|
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 |
2% |
4% |
3% |
2% |
2% |
5% |
-2% |
2% |
|
Percentage point change from |
9% |
-1%* |
1% |
8% |
0% |
2% |
-2% |
4% |
|
Percentage point change from |
5% |
3% |
5% |
7% |
6% |
4% |
37% |
5% |
*Changes should be viewed with caution, as the reporting of these statistics is relatively new. Health funds made changes to reporting systems to provide better information on medical services and the method of compilation provided data in some cases that is not consistent with data collected in previous quarters.
Figure 3: Proportion of in-hospital medical services with no gap, by State June 2000 to June 2001
Gap payments
The average gap payment for all insured in-hospital medical services was $19.48 in the June 2001 quarter, including services where there was no gap. This figure is a decrease over the March 2001 figure of $20.29. This decrease should be viewed with caution as it could be influenced by seasonal factors or by the data collection method, which is relatively new.
The average gap for services where a gap was paid by the patient was $67.31 in the June 2001 quarter compared to $64.28 in the March 2001 quarter. This increase should also be viewed with caution as it could be influenced by seasonal factors or by the data collection method. It was also expected that the average gap, over services where a gap was paid, would increase. Doctors who charge smaller gaps are likely to be among the first to sign up to no gap schemes or arrangements.
Figure 4: Summary of in-hospital medical services with no gaps
June 2001
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 |
66% |
$ 28.70 |
$ 85.02 |
|
Vic |
74% |
$ 14.39 |
$ 54.59 |
|
Qld |
66% |
$ 20.40 |
$ 60.58 |
|
SA |
85% |
$ 4.32 |
$ 29.59 |
|
WA |
79% |
$ 12.59 |
$ 58.83 |
|
Tas |
71% |
$ 22.08 |
$ 75.41 |
|
NT |
56% |
$ 33.67 |
$ 76.96 |
|
Australia |
71% |
$ 19.48 |
$ 67.31 |
*Includes services where there was no gap
March 2001
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 |
64% |
$ 29.27 |
$ 81.63 |
|
Vic |
70% |
$ 14.50 |
$ 48.19 |
|
Qld |
63% |
$ 22.08 |
$ 60.15 |
|
SA |
83% |
$ 7.49 |
$ 43.58 |
|
WA |
77% |
$ 13.10 |
$ 57.80 |
|
Tas |
66% |
$ 24.39 |
$ 70.92 |
|
NT |
58% |
$ 31.30 |
$ 74.47 |
|
Australia |
69% |
$ 20.29 |
$ 64.28 |
*Includes services where there was no gap
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