How much does your surgeon charge? Medibank data shows huge variation

Some surgeons are charging patients seven times more than their peers for the same operations, leaving patients with bills of more than $4000 that are not covered by their health insurance.

A Medibank report suggests it pays to shop around when looking for a surgeon to perform a range of common procedures in private hospitals, including weight loss surgery, hernia repairs, colonoscopies (bowel investigations) and gastroscopies (investigation of the oesophagus, stomach and duodenum).

The review of more than 100,000 operations for Medibank members in 2015 and 2016 shows many surgeons do not charge out of pocket fees to patients. But among those who do, the fees vary enormously.

For example, 38 per cent of bowel resections (removal of large bowel) in NSW resulted in out of pocket fees for the patient compared to 17 per cent in Victoria, 61 per cent in Tasmania and 5 per cent in the ACT.

For patients who got billed, the average fee in NSW was $1865 – seven times more than the average of $262 in South Australia. In Victoria, the average fee was $897.

Most patients also faced average out of pocket costs ranging from $229 to $793 for other medical services to have the bowel resection, such as the anaesthetist’s fee, assistant surgeon’s fee and diagnostics.

The Medibank and Royal Australasian College of Surgeons report shows weight loss procedures such as gastric banding have become particularly expensive for the health system, costing anywhere from $9000 to more than $33,000 in total. These costs are borne by Medicare which contributes to private care, the health insurer and sometimes the patient.

In Victoria, one quarter of gastric banding operations resulted in an out of pocket fee for patients, with an average cost of $2901 for the surgeon and $806 for other medical fees.

In NSW, 41 per cent of gastric banding operations resulted in out of pocket fees, with an average surgeon fee of $3427 for the surgeon and $832 for other medical services.

There is also great variation in the complication rates for surgeons performing the same work across Australia. Depending on the operation, these rates vary from 0 – 714 per 1000 cases, showing some surgeons have many more complications than others. Complications include haemorrhages and infections.

The report does not identify surgeons or hospitals, but Medibank is preparing to publish lists of individual surgeons who charge low or no out of pocket fees for Medibank members so patients and their GPs can shop around. This should be available in coming months.

Another popular health insurer, nib, has said it plans to publish surgeons’ individual performance data in future so patients can see this information and choose who they want to see.

Medibank Chief Medical Officer Dr Linda Swan would not comment on whether Medibank had plans to publicly report individual surgeons’ data, but she said many surgeons wanted to see…

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