When told that cardiac surgery is required a patient should not be placed in the position of whether he or she can afford such treatment. Especially when one’s very life may depend on having the operation performed or ‘face the eventual consequences’.

Before Medicare was introduced into Australia many poorer people in the community unnecessarily died because they couldn’t afford such an operation and many more died prematurely because they couldn’t afford to undergo a diagnosis to determine their condition. Those who did go ahead and have the operation but didn’t have sufficient funds to pay the hospital or the surgeon, or weren’t insured to cover such costs, found they would be taken to court for not paying an outstanding debt. They then stood to have certain of their possessions seized by the court and sold by public auction to recover costs.

If insufficient costs were recovered in this way they would be imprisoned. This was common practice in Australia right up to 1972 until the newly elected Whitlam Government legislated for total health reform and introduced the initial Medibank that universally covered all Australians against incurring debt due to health conditions.

In the years since that time Medibank was superseded by Medicare with the main difference being that Medicare would pay for all health related matters up to a certain amount and then deduct what was considered a fair amount for the GP or surgeon not having to handle so much paperwork or chase bad debts. Many doctors and surgeons refused to accept the amount paid by Medicare and continued to charge the full cost. This became known as the ‘gap’ and for many it required insuring against.

Life insurance is important in many forms and health insurance took on a new importance at this time to ensure that people could have their full medical costs met so they could choose their doctor or surgeon of choice. Although many doctors and surgeons were satisfied with the payment made by Medicare for the services they performed, many more were not and insisted on the gap payment being met.

It is very hard to put a set cost on any form of cardiac surgery, including aortic surgery, because of there being so many out-of-pocket expenses involved. These expenses may be affected by the following factors:

• The patient’s medical history, especially age, genetic history, weight, lifestyle and any other factor that may be considered a risk.
• The surgeon’s reputation and experience and his or her willingness to charge within the Medicare payments or if a gap payment will have to be paid.
• The location of the surgical centre, whether it is in a public or private hospital.
• The medical facilities that are available.
• What amount of high tech equipment is used.
• The type of surgery being undertaken,
• The condition of the patients heart.

The Australian Government keeps investing large amounts of funding to meet cardiac patients needs and this is becoming even more pronounced owing to the rising costs of health technology, our aging population becoming increasingly reliant on such types of surgery and continuing advances being made in medical science. Funding has been particularly significant in the areas of safety and quality in our hospitals and ensuring they are equipped with the latest medical technology.

If you are admitted to a hospital as a public patient there will be no cost as you will not be charged for accommodation, surgery, medication or any other in-hospital services. If you are admitted as a private patient and have private health insurance you will be charged for your accommodation and all the services provided. These costs are usually covered by your private health insurer unless you have taken out a ‘front end deductible’ policy. This means you will pay a lower premium for the cover but in return agree to make a personal contribution towards the hospital charges. Privately insured patients will be charged for medical and diagnostic services provided by their doctor for such things as x-rays and pathology tests.

If you are a privately insured patient and your doctor is a specialist who works full time at the hospital (if it is a public hospital) there is usually no charge made for the surgery undertaken, the doctors fee will be covered by a combination of Medicare and private health fund rebates. However if your doctor is a Visiting Medical Officer and operates a private practice and sets his or her own fees, these fees may be higher that the total you get back from Medicare and your private health insurer. That extra amount, the ‘gap’ fee is an out-of-pocket expense and will have to be paid by the patient to the doctor exactly as happened in the pre-Medicare days – before you are admitted to the public hospital.