In this section...
March 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 March 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 March quarter 2001, 2,153,633 in-hospital medical services (representing 69% of the total) were provided to patients with no out-of-pocket costs. This is an increase of 4 percentage points from the December quarter 2000 figure of 65%.
Figure 1: Proportion of in-hospital medical services with no gap, Australia
The percent of services with no gap varies from 58% in the Northern Territory to 83% in South Australia.
The largest increase in the March 2001 quarter was in New South Wales, with a 9 percentage point increase over the December figure. Victoria and the Northern Territory had decreases of 1% and 2% respectively. Changes over the quarter, 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.
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 March 2001, and changes since September 2000
NSW/ACT |
Vic |
Qld |
SA |
WA |
Tas |
NT |
Australia |
|
|
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 December 2000 to March 2001 |
9% |
-1% |
1% |
8% |
0% |
2% |
-2% |
4% |
|
Percentage point change from September 2000 to December 2000 |
5% |
3% |
5% |
7% |
6% |
4% |
37% |
5% |
Figure 3: Proportion of in-hospital medical services with no gap, by State
June 2000 to March 2001
Gap payments
The average gap payment for all insured in-hospital medical services was $20.29 in the March 2001 quarter, including services where there was no gap. This figure is an increase over the December 2000 figure of $18.18. This increase should be viewed with caution as it could be influenced by seasonal factors or by the data collection method, which is relatively new.
New figures collected by PHIAC now make it possible to calculate the average gap for services where a gap was paid by the patient. This was $64.28 in the March 2001 quarter compared to $51.56 in the December 2000. 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
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