RE: Re: Support group in Australia

February 24, 2002

Sue,

Imagine a system where you (or your employer) pay hundreds of dollars every

month so that the insurer covers your potential medical costs--after a

sizeable deductible; dictates what it covers (similar to your public

system's restrictions), then negotiates its rates with the medical

profession. What we get is, if you have insurance (we're self-employed, so

it's privately purchased), and for instance you go for labs, the bill comes

for $130 lets say, then the insurance statement comes and says it's

negotiated rate with the lab is $29 so pay only that. Or, since my husband's

an acupuncturist/herbalist--the insurance companies negotiate with the

acupuncturists as a group (usually an association's membership), and have a

set per-visit fee that's unrealistically low and then the insured pays a

" copay " of maybe $10, and the practitioner has to eat the rest of his costs,

or raise his rates for everyone else to cover the difference. So the actual

health care provider doesn't get enough to pay for his time, the person with

insurance pays through the nose--and the insurer pockets most of the money,

which then (supposedly) is " pooled " to pay for the cost of the expensive

hospital care of the most ill members of the group. And, if you don't have

insurance you don't have the insurance company negotiating low rates for you

so you pay the inflated " full cost " --which is inflated to make up for the

low payment from insurance.

In other words, we have a big mess, sort of like socialism at its most

corrupt. Oh--and if you have a " preexisting condition " it's hard to switch

insurers, and have that condition covered.

On the other hand, unlike Canada where it's a state plan and you simply

can't get appropriate care, at least here you can find doctors to see, and

fire the bad ones.

Terry

>

> Reply-To: graves_support

> Date: Mon, 25 Feb 2002 07:34:49 +1100

> To: graves_support

> Subject: Re: Re: Support group in Australia

>

> Hi Terry

> We have the Medicare system. In fact I have a brochure here in front of me

> and this is what it says:

> Medicare ensures that all Australians have access to free or low-cost

> medical, optometrical and hospital care while being free to choose private

> health services.

>

> Medicare provides:

> * free treatment as a public (Medicare) patient in a public hospital; and

> * free or subsidised treatment by doctors, including specialists,

> participating optometrists and dentists (for specified services only).

>

> Australia's public hospital system is jointly funded by the Commonwealth

> and State/Territory Governments and is administered by State and Territory

> health departments.

>

> Out of hospital services

> Medicare provides benefits for:

> * consultation fees for doctors, including specialists;

> * tests and examinations by doctors needed to treat illnesses, including

> x-rays and pathology tests;

> * eye tests performed by optometrists;

> * most surgical procedures performed by approved dentists;and

> * specified items under the Cleft Lip and Palate Scheme

>

> Whats not covered by Medicare:

> * private patient hospital costs (eg theatre fees or accomodation)

> * dental examinations and treatment

> * ambulance services

> * home nursing

> * physiotherapy, occupational therapy, speech pathology, eye therapy,

> chiropractic services, podiatry and psychology;

> * acupuncture (unless part of a doctor's consultation)

> * glasses and contact lenses;

> * hearing aids and other appliances;

> * the costs of prostheses;

> * medicines (except for the subsidy on medicines covered by the PBS - Pay

> Back System);

> * medical and hospital costs incured overseas;

> * medical costs for which someone else is responsible(eg. a compensation

> insurer, an employer,a government or government authority);

> * medical services which are not clinically necessary;

> * surgery solely for cosmetic reasons; and

> * examinations for life insurance, sperannuation or membership of a

> friendly society.

> These services may be covered by private health insurance.

>

> In the area I live we ONLY have public hospitals. So to have private

> hospital cover in our area is not worth it. However I do have private

> health cover have been paying it for years and (fingers crossed) have never

> had to use it. I might add here, if you arrive at a public hospital and you

> are a emergency you get the immediate treatment to save you life and this

> does not cost you. It is covered by Medicare. The thing is you have the

> doctors that are there, not your regular doctor. But hey, if your life

> was in the balance, I'd want whoever was there! <grin>

>

> Hope this explains it in full. Now its your turn, I'd truly like to hear

> about your health system.

> Sue

>

> Terry wrote:

>> Sue,

>>

>> How does yours work?

>>

>> Terry

>>

>>> <>

>

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February 24, 2002