With soaring health care costs patients are paying more and more for their health care
Private health insurance premiums are increasing annually and so are the costs to surgeons / practices with indemnity cover, practice/staff costs.
The government has also reduced the rebate for prosthesis by 7.5% followed by another 10% which is a total of 17.5% reduction on costs of prosthesis for hip or knee replacements. However the funds still increase the premiums annually despite saving 17% on prosthesis costs and not passed onto to members.

More recently some funds have aligned with some surgeons to offer no gap surgery to some patients to reduce costs – but this also means that the surgeon may have less autonomy and all patients could be classed the same for example a less complex hip replacement may be classified as the same as a more complex hip replacement in some cases. As a result the surgeon’s ability to decide on whats best for the patient in terms of implants may be compromised. The extra cost saved by the funds is a profit but not passed onto the fund members but only passed onto share holders/executive board.

Most surgeons usually charge a gap which can vary from procedure to procedure and complexity of the surgery itself. The Australian medical association has a recommended fee structure but this is only a guide in keeping up with inflation.
There is no fast solution to this problem and the patients should do their research well about who they go to see for their procedure, speak to relatives or friends, talk to their GP and do some internet research / reviews on the surgeon/doctor. Patients should Not be encouraged by their fund to go to “the fund doctors” whose surgical experiences may vary.  Word of mouth is usually the best advice.

Disclaimer – Individual results can vary – patients are asked to discuss their specific restrictions with their surgeon after surgery.