Medicare

[Loopylu]

If people on low incomes are struggling to afford prescriptions or procedures then it's ignorance more than anything.  There are safety nets for prescriptions, but you have to know about them and apply for them, adn they don't seem well-publicised.  Likewise, as I mentioned before, most GP's refer patients to private specialists without thinking - and I've met people who didn't even realise they could've gone public for nothing.

Marissa- the point I was making is that in the UK you would get the prescription for free if you are on benefits or a low income. Children and retirement age people also get free prescriptions. In Wales, everyone gets free prescriptions.  In Australia, people who exist on $40 a day Jobseeker or equally low State aged pensions are still expected to fork out $6 for each item of medication. I know it was a cause of considerable stress for my diabetic mother in law who existed on the State aged pension and nothing else.

As for your point about colonoscopies, I had a very interesting chat with the surgeon in the Australian public system who treated me for an anal polyp requiring removal.  He complained of people routinely demanding a referral for a colonoscopy when there was no clinical need and the GPs being too afraid to turn them down. He felt it was a terrible waste of Medicare resources and prevented those with real symptoms or a family history from accessing the public service in a timely manner.  He was also concerned about the risks to patients who undergo a procedure which can cause damage to the bowel unnecessarily.  As I mentioned, there is a litigation culture in Australian medicine that results in these perverse outcomes and then important but expensive testing of women who are at extreme risk of breast cancer is not funded by the PBS because there is so much waste in Medicare.

 

 

[Loopylu]

3 hours ago, AussieMum said:

 

There are definitely publicy funded genetics tests looking for BRCA gene mutations, Lynch syndrome, etc, that are accessed through Hereditary or Familial Cancer Clinics.   But there are qualifying criteria for Medicare funding, eg, family history including how many and how close the relatives are, is there a family member who is better suited to testing (due to their position in the family tree), etc, and if you have a high-risk mutation then you may also qualify for early cancer screening, surveillance MRIs, etc.  If you don't qualify for free testing, you can elect to self-fund. 

Yes they exist but if like my friend your family are overseas and you can't prove that there is a family history ( her mother and aunt had breast cancer and her grandmother died of it) then you are left out of the Aussie system. A bit like people on temporary visas not being able to access Jobkeeper....

[Loopylu]

On waiting times, I can advise that it took 3 months under the NHS for my twin boys to have ENT surgery to remove adenoids and tonsils and 3 years in the Australian public system for my daughter to get equivalent surgery and then she had to have two surgeries - the first for adenoids and the second for tonsils (6 months apart).  She was referred to the ENT clinic but only got an appointment after 2 years and this was after she spent 4 days in the Children's Hospital with potentially life threatening periocular cellulitis which was likely caused by an infection resulting from her enormous adenoids.  

On treatment standards and waiting times - my Aussie Mother in Law died in hospital (Royal Brisbane) ALONE without any of her 4 children waiting for promised surgery to remove a growth of mold near her brain stem that had already caused her to go blind in one eye and left her in excruciating pain.  They kept saying every day that they were going to operate the next day but the surgery never transpired.  We were not told that she was at risk of dying and we were not called to be with her. She had to wait 5 years for a hip replacement and only got one when she managed to fall and break her hip and their hand was forced....

[Skani]

6 hours ago, Marisawright said:

For older Australians, I think they still remember the scare campaigns by the health funds years ago, i.e. If you go public, you'll be waiting years ...  It's a load of cobblers IMO.  It's true there are waiting lists if you go into the public system, but how is that different to the NHS?   I don't believe the waiting lists are any worse.  I've only seen a specialist in the public system twice and  I waited about 3 months,

It's not a load of cobblers - it depends very much on your location and the resourcing of the local public hospital.  I get the impression Melbourne is well served.  However at my local public hospital patients have been known to wait over 2 years for a colonoscopy (even in the presence of worrying symptoms) or more than 2 or 3 years for hip or spinal surgery.  A friend of mine waited 3 months for an initial consultation at the gynae. outpatient clinic, then a further 19 months for an operation.  The condition wasn't life threatening but it was causing so much distress that she had to resign her job.

Edited November 10, 2020 by Skani

[Amber Snowball]

5 minutes ago, Skani said:

It's not a load of cobblers - it depends very much on your location and the resourcing of the local public hospital.  I get the impression Melbourne is well served.  However at my local public hospital patients have been known to wait over 2 years for a colonoscopy (even in the presence of worrying symptoms) or more than 2 or 3 years for hip or spinal surgery.  A friend of mine waited 3 months for an initial consultation at the gynae. outpatient clinic, then a further 19 months for an operation.  The condition wasn't life threatening but it was causing so much distress that she had to resign her job.

When I left in 2018 I think the waitlist for a non urgent hip or knee was about 5 years in East Melbourne. It was a couple of years in Geelong when I arrived there in 2005. 
Unfortunately non urgent to the hospital is rarely non urgent to the patient. People are often in terrible pain.

[Toots]

9 minutes ago, Skani said:

It's not a load of cobblers - it depends very much on your location and the resourcing of the local public hospital.  I get the impression Melbourne is well served.  However at my local public hospital patients have been known to wait over 2 years for a colonoscopy (even in the presence of worrying symptoms) or more than 2 or 3 years for hip or spinal surgery.  A friend of mine waited 3 months for an initial consultation at the gynae. outpatient clinic, then a further 19 months for an operation.  The condition wasn't life threatening but it was causing so much distress that she had to resign her job.

You wouldn't think we lived in the same state Skani.  Maybe things have changed over the last few years but approx 4 years ago my GP sent me for a scan then very quickly I saw a gynaecologist then before I knew it I had an op to fix things at Latrobe hospital.  So far we have been very fortunate with Medicare.  Touch wood we don't need to visit the doctor often at all.  Yearly blood tests, flu shots that sort of thing.  I have to go to a cardio man at Launceston hospital twice a year.  So far no problems with joints etc.  A friend had to wait 14 months for her knee replacement.  Is that new hospital in Hobart up and running yet?

[Skani]

10 hours ago, Toots said:

You wouldn't think we lived in the same state Skani. ...... Is that new hospital in Hobart up and running yet?

Yes, I've watched with envy your quick access to the Mersey Hospital (although I know Covid lockdowns interfered with staff flying in from the mainland).     I  wonder if they'd accept a patient from the south  if I ever needed it?    I assume the delays down here are due to a lower ratio of medical staff to population - which is basically 50% of the state plus  the more complex cases from all over.

It's not a new hospital - basically a rebuild of one old wing but  it has been completed.  

[Toots]

1 hour ago, Skani said:

Yes, I've watched with envy your quick access to the Mersey Hospital (although I know Covid lockdowns interfered with staff flying in from the mainland).     I  wonder if they'd accept a patient from the south  if I ever needed it?    I assume the delays down here are due to a lower ratio of medical staff to population - which is basically 50% of the state plus  the more complex cases from all over.

It's not a new hospital - basically a rebuild of one old wing but  it has been completed.  

Re the Mersey Hospital, many services including the intensive care unit and maternity services have been closed over the years and the emergency department had limited hours during the Covid lockdown.  It's only in the past few weeks the hours at that department are back to normal.   If the emergency service was required you would have had to go to Launceston which is a bit of a drive away.  You are right about the complex cases going to Hobart.  I know a few people from this area who had to go to Hobart for surgery.  Usual story   .............  surgeon not available here at the time.

[Loopylu]

On ‎10‎/‎11‎/‎2020 at 15:45, AussieMum said:

I've had bulk billing GPs sign me up for a chronic health condition treatment plan with referrals to a dietitian and an exercise physiologist (when I just needed a doctor's certificate because I had gastro and my regular doctor's was full) because it meant they could charge Medicare for an extended appointment.  I was not well enough to be in the mood to argue but I haven't been back to them since. 

 

Perhaps if the LNP did not freeze Medicare rebates for years on end the bulk billing GPs would not feel the need to supplement their incomes in this way?

[AussieMum]

6 minutes ago, Loopylu said:

Perhaps if the LNP did not freeze Medicare rebates for years on end the bulk billing GPs would not feel the need to supplement their incomes in this way?

Medicare rebates definitely have lagged behind what costs are incurred running a medical practice.  But that doesn't mean GPs should be rorting the system the way this one did.

I've had a mental health care plan from my usual GP a few times over the years and I have no problem at all paying for a double appointment each time it needs to be set up or reviewed because it does take extra time to do the paperwork.  But this GP filled in a couple of forms at record speed and pushed me out the door in a usual 10-min bulk-billed appointment slot - they did absolutely nothing to warrant being able to charge Medicare extra for something I didn't want and didn't ask for (yes, I needed to lose weight at the time but that was completely unrelated to my visit). 

[Marisawright]

26 minutes ago, AussieMum said:

Medicare rebates definitely have lagged behind what costs are incurred running a medical practice.  But that doesn't mean GPs should be rorting the system the way this one did.

It reminds me of a story when I was in the UK.  I had a Kiwi friend whose father was Professor of Dentistry at a New Zealand university.  She had been in the UK for a year, so she trotted off to a dentist for a checkup.  She was shocked when he told her she needed three fillings!     She phoned her dad at once.  He told her not to bother, and he'd check her teeth when she came home for Christmas (which was another six months away).

You guessed it - he checked her teeth and they were perfect. 

A dentist friend once told me that he can spot a British mouth immediately, because they are so full of fillings.  British dentists didn't get paid for doing cleaning or preventive dentistry - so if they wanted to get paid, they had to do a filling or an extraction.  I hope that has changed these days!

[Loopylu]

On 12/11/2020 at 15:05, Marisawright said:

It reminds me of a story when I was in the UK.  I had a Kiwi friend whose father was Professor of Dentistry at a New Zealand university.  She had been in the UK for a year, so she trotted off to a dentist for a checkup.  She was shocked when he told her she needed three fillings!     She phoned her dad at once.  He told her not to bother, and he'd check her teeth when she came home for Christmas (which was another six months away).

You guessed it - he checked her teeth and they were perfect. 

A dentist friend once told me that he can spot a British mouth immediately, because they are so full of fillings.  British dentists didn't get paid for doing cleaning or preventive dentistry - so if they wanted to get paid, they had to do a filling or an extraction.  I hope that has changed these days!

And I had exactly, if not a worse experience, in Brisbane CBD where the dentist wanted to apply protective coating on my 40+ year old teeth and also replace an NHS filling which had seen better days and perform a root canal, all costing several thousand out of pocket.  I got a second opinion from a suburban dentist who was horrified that protective coating was offered to someone my age (BTW I got it done previously by my NHS dentist at age 15 for free) and confirmed that I needed a simple replacement filling and no root canal treatment.  Never had a problem since in the last 10 years and never went back to the CBD dentist.  

[Toots]

40 minutes ago, Marisawright said:

It reminds me of a story when I was in the UK.  I had a Kiwi friend whose father was Professor of Dentistry at a New Zealand university.  She had been in the UK for a year, so she trotted off to a dentist for a checkup.  She was shocked when he told her she needed three fillings!     She phoned her dad at once.  He told her not to bother, and he'd check her teeth when she came home for Christmas (which was another six months away).

You guessed it - he checked her teeth and they were perfect. 

A dentist friend once told me that he can spot a British mouth immediately, because they are so full of fillings.  British dentists didn't get paid for doing cleaning or preventive dentistry - so if they wanted to get paid, they had to do a filling or an extraction.  I hope that has changed these days!

The school dentist who used to travel from school to school with all the dental equipment necessary in a caravan drilled and filled every child's teeth.  Nobody left that caravan without receiving at least one filling.  This was in the late 50's early 60's.  After I left school and went regularly to various dentist I never had another filling.  A few years ago I had toothache in a back molar which was chipped and had developed an infection.  The dentist hummed and hawed suggesting root canal but as it was right at the back of my mouth, I told him to pull it out.  He was quite shocked.  I don't miss it at all.  I was glad to get rid of it.

My two son are 36 and 35.  Neither one has had a filling in his life.  I dare say Marisa the NHS dental care has improved drastically since our day.

[Bulya]

I use public these days and it’s been exceptional.  TKR 7 weeks ago, chose my surgeon and had a private ward.  Free physio twice weekly, Tuesday session one on one.  I can roll up to a medical centre and get an X-ray on a weeekend without an appointment.  Free ambulance to the local hospital two weeks ago.  Seeing the renal specialist regarded as the best in the SE of the country, all free.  Walk in blood test today, free of course. I  don’t think we’re missing much and most of the medical staff are ex NHS, and damn glad not to be there...

[Loopylu]

3 hours ago, Bulya said:

I use public these days and it’s been exceptional.  TKR 7 weeks ago, chose my surgeon and had a private ward.  Free physio twice weekly, Tuesday session one on one.  I can roll up to a medical centre and get an X-ray on a weeekend without an appointment.  Free ambulance to the local hospital two weeks ago.  Seeing the renal specialist regarded as the best in the SE of the country, all free.  Walk in blood test today, free of course. I  don’t think we’re missing much and most of the medical staff are ex NHS, and damn glad not to be there...

It depends where you live as to what level of service you get. My husband has had two TKRs on the public system in Qld in the last 3 years. Had to wait a fair while for these in excruciating pain as with Stage 3 CKD at the time (now Stage 4) he could not take anti-inflammatories.  No choice of surgeon, on a public ward and one shared rehab class once a week and he had to make his own way there on the bus - no free ambulance. If you live in regional Qld then your chances of getting this surgery in a timely fashion are greatly diminished. BTW, he was told you are only allowed one TKR for each knee on Medicare so if the first one wears out, tough! Same applies for hips. This is problematic for us as my husband is only in his 50s but has arthritis that you would expect to see in someone in their 70s and replacement knees only have a lifespan of 10 -15 years.  No such limit on the NHS where I know of people who have a second replacement. 

I have met ex NHS staff working in public hospitals (mainly paramedics and midwifes) who are very frustrated with the system here as they are highly trained but not permitted to use their skills and therefore see patients suffering unnecessarily as they have to wait for a doctor to carry out the relevant procedure.  

[Bulya]

7 hours ago, Loopylu said:

It depends where you live as to what level of service you get. My husband has had two TKRs on the public system in Qld in the last 3 years. Had to wait a fair while for these in excruciating pain as with Stage 3 CKD at the time (now Stage 4) he could not take anti-inflammatories.  No choice of surgeon, on a public ward and one shared rehab class once a week and he had to make his own way there on the bus - no free ambulance. If you live in regional Qld then your chances of getting this surgery in a timely fashion are greatly diminished. BTW, he was told you are only allowed one TKR for each knee on Medicare so if the first one wears out, tough! Same applies for hips. This is problematic for us as my husband is only in his 50s but has arthritis that you would expect to see in someone in their 70s and replacement knees only have a lifespan of 10 -15 years.  No such limit on the NHS where I know of people who have a second replacement. 

I have met ex NHS staff working in public hospitals (mainly paramedics and midwifes) who are very frustrated with the system here as they are highly trained but not permitted to use their skills and therefore see patients suffering unnecessarily as they have to wait for a doctor to carry out the relevant procedure.  

Queensland.  I have CKD Level 2 in my remaining kidney and being very well looked after. Hope everything turns out well for you both. 

[Loopylu]

13 hours ago, Bulya said:

Queensland.  I have CKD Level 2 in my remaining kidney and being very well looked after. Hope everything turns out well for you both. 

Thanks Bulya - hopefully you stay at Level 2 for a LOOOONG time! My husband is weeks/months away from dialysis and it is just a waiting game as his kidney function is currently 15%. It's taken about 10 years to drop from Stage 3A (when the CKD was diagnosed) to bottom of Stage 4 and during that time the CKD clinic and consultant have been great.  Whether we are in the UK or Australia, we are so lucky to live in first world countries where usually the level of health care is excellent. Both countries have good and bad doctors/nurses/hospitals. The main difference is that the UK press are keen to focus on the negatives with the NHS as part of a Conservative agenda to privatise healthcare whereas Australians (including new Australians from the UK) tend to swallow the government/Murdoch propaganda about living in the best country in the world and therefore believe everything must be better here. 

[Bulya]

1 hour ago, Loopylu said:

Thanks Bulya - hopefully you stay at Level 2 for a LOOOONG time! My husband is weeks/months away from dialysis and it is just a waiting game as his kidney function is currently 15%. It's taken about 10 years to drop from Stage 3A (when the CKD was diagnosed) to bottom of Stage 4 and during that time the CKD clinic and consultant have been great.  Whether we are in the UK or Australia, we are so lucky to live in first world countries where usually the level of health care is excellent. Both countries have good and bad doctors/nurses/hospitals. The main difference is that the UK press are keen to focus on the negatives with the NHS as part of a Conservative agenda to privatise healthcare whereas Australians (including new Australians from the UK) tend to swallow the government/Murdoch propaganda about living in the best country in the world and therefore believe everything must be better here. 

The difference being Australia is a franchise, not a country.  

[MARYROSE02]

On 06/11/2020 at 14:30, Marisawright said:

@DavidIII, one thing that may surprise you is that most doctors don't work for Medicare.   You pay them per consultation.  They are all in business for themselves, so they can charge you whatever they like. 

In the old days, you had to pay the doctor in full, and then fill in a form to claim on Medicare. But you don't get all the money back - Medicare only pays the standard fees, which are less than what most doctors charge.   Nowadays, the receptionist will often have an online system whereby you sign a form authorising the practice to collect the standard fee straight from Medicare, and you only have to pay the balance. 

There is also a bulk billing system.  Under bulk billing, the GP agrees to charge the standard fees.  You pay nothing, and the GP collects the fees direct from Medicare.  That means the GP makes less money, but they are also allowed to "bulk bill" the government, which greatly reduces administration. They also don't need staff to handle or manage money.   Bulk billing saves you money, but there's an incentive for GP's on bulk billing to churn through large numbers of patients quickly.  

If you need to see a specialist, most GPs will refer you to a private specialist.   There are public specialist clinics, (and some of them are world class), but the waiting lists are long, and most Australians don't want to wait.  However, the waiting lists for public specialists are no worse than you're used to in the NHS - so if you're happy with that and would prefer free treatment, speak up and ask about being seen in the public system.  An example of the difference that can make - my spinal fusion cost $35,000 with a private specialist, whereas my friend's dad had the same op on the public system for absolutely no charge (before you swoon, I did get $25,000 back from my private health insurance). 

Thanks for explaining that, Marisa. How do you know all this stuff?! I knew that some doctors bulk billed and some didn't but I did not know how it worked.

I found a bulk billing GP here in Surfers Paradise very easily. Actually, they may have billed me for the first appointment which I suspect is because they see a lot of holidaymakers and visitors although I don't know for sure. It is easy to see a GP here - mine being open seven days a week and there is or was a 7 x 24 hour one (I went there on Xmas Day a couple of years back). It's still there but Covid may have made it cut back on its hours. Almost next door to that practice is a 7 x 24 hour chemists too. You can make appointments or just go in the surgery and wait at place I go to. 

I don't have private medical insurance so I pay in full - dentists, partly the podiatrist - you can get 5 appointments with a discount in a calendar year form your GP. If the service is bulk billed I pay nothing. 

I've been to see one specialist - neurologist and some of his fees were covered on Medicare. I am going to see another specialist soon and it seems to be the same set up. If I need a colonoscopy (oh joy) I imagine I will have the choice to wait for it to be done in a public hospital or pay to have it done sooner - $1,000 minimum? I think I paid that 3 years ago.

I guess what I like about Australia, and I am a recovering hypochondriac, I can see a doctor any day of the week, without having to make an appointment. I realize that might not be the same out in the Bush.

[MARYROSE02]

On 13/11/2020 at 19:57, Bulya said:

The difference being Australia is a franchise, not a country.  

I don't understand the term "franchise!?"

[Bulya]

4 hours ago, MARYROSE02 said:

I don't understand the term "franchise!?"

Surreptitiously the same but in reality every state/territory is completely different.  Different road rules, education system, name for food, football, weather in fact just about everything.  That’s how franchises are 

[Loopylu]

3 hours ago, Bulya said:

Surreptitiously the same but in reality every state/territory is completely different.  Different road rules, education system, name for food, football, weather in fact just about everything.  That’s how franchises are 

You obviously haven't been to the UK lately.  It's the same there now.  Wales, Scotland and Northern Ireland pretty much self-determine on most things. In education, Scotland has highers, England has A Levels and the Welsh have the Welsh Bac.  Healthwise, everyone in Wales gets free NHS prescriptions.  Wales and Scotland are not in full lockdown like England.  Unfortunately, the ignorant ABC reports that the whole of the UK is in lockdown and seems woefully unaware of the fact that there are separate countries with separate rules within the United Kingdom.  

Edited November 15, 2020 by Loopylu

[Skani]

12 minutes ago, Loopylu said:

 Unfortunately, the ignorant ABC reports that the whole of the UK is in lockdown and seems woefully unaware of the fact that there are separate countries with separate rules within the United Kingdom.  

Don't think so:

Quote

Last week Prime Minister Boris Johnson ordered all of England to go into a new national lockdown that will last until at least early December, while the devolved nations of Wales, Scotland and Northern Ireland have all had their own forms of lockdown restrictions in place.

  https://www.abc.net.au/news/2020-11-12/uk-reaches-50000-covid-19-deaths-on-remembrance-day/12874800

[Loopylu]

Sorry, but I heard on the ABC/Triple J radio news that the UK had gone into 4 weeks lockdown and commented on the inaccuracy to my teenage daughter who was in the car with me at the time.  They may have got it right on the website but were misreporting on the radio news and let's face it, not many people read full news articles these days and only listen to the headlines which, in this case, were patently wrong.

Edited November 15, 2020 by Loopylu

[Bulya]

43 minutes ago, Loopylu said:

You obviously haven't been to the UK lately.  It's the same there now.  Wales, Scotland and Northern Ireland pretty much self-determine on most things. In education, Scotland has highers, England has A Levels and the Welsh have the Welsh Bac.  Healthwise, everyone in Wales gets free NHS prescriptions.  Wales and Scotland are not in full lockdown like England.  Unfortunately, the ignorant ABC reports that the whole of the UK is in lockdown and seems woefully unaware of the fact that there are separate countries with separate rules within the United Kingdom.  

Seperate countries so a little different.  I get the point you’re making though.