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Australia, U.S. "Insurance" DME
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Airstream Offline

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Post: #1
Australia, U.S. "Insurance" DME
I often see posts from Australia concerning the cost of their DME. When insurance is mentioned, I think there may be a misunderstanding about the health care system Down Under by those of us in the United States.
As I understand it, Australia has national or universal health care much like the Uk and Canada. I think this often referred to as public insurance. Although it is called Medicare, it is nothing like the U.S. program of the same title. Everyone is entitled to Aussie health care- you or your employer don't pay for it directly.
I also understand that private insurance is available, but that is also administered by the government.
So, when you need DME, I guess you either take what the give you for free or buy your own.
I am not an expert on the Australian system. Maybe one of our Aussie friends can correct me or elaborate on how a CPAP or other supplies are obtained under their system. Maybe Zonk will chime in...after all, we made him an honorary American a couple of weeks ago (lol).

To err is human, but to really mess things up, you need a computer.
12-15-2013 07:42 PM
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me50 Offline

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Post: #2
RE: Australia, U.S. "Insurance" DME
http://www.apneaboard.com/forums/Thread-Buying-CPAP-from-overseas
12-15-2013 09:54 PM
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Tez62 Offline

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Post: #3
RE: Australia, U.S. "Insurance" DME
Airstream, you are correct, I have explained a bit in another post which me50 has given the link for, Medicare is a government institution that reimburses patients a percentage of their out of pocket costs for certain medical treatments, the percentage is based on how much you spent over the year. The more you spend on medical treatment the more you get back. We also have private health insurance which can be taken out but is very expensive.
12-15-2013 11:26 PM
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zonk Offline

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Post: #4
RE: Australia, U.S. "Insurance" DME
Hi Airstream
What I know about the US system what read here and seeing Michael Moore documentary which is a bit over the top. Australian Medicare nothing like UK NHS, the system works very well in cases of emergencies but long waiting list for surgeries and much abused by doctors and patients alike
For example, here in south west Sydney there are more medical centers than hamburger joints (not exactly just to make the point, speaking of hamburgers, recently McDonald started home delivery service in western Sydney and plans for more but none of them planned for the affluent suburbs, no much demand there) and almost all of them don,t charge the patient a dime for GP consultation, blood test, xrays, etc.. the system is open for abuse and over prescribed services
Few years ago the government of the day tried to introduce co-payment of $2.50 for GP visit, so patient pay this sum of of money out of pocket for each GP visit but the next prime minister came along and scrapped it. Now there is talk to bring it back and increase it to $6 (less than price a big Mac meal) which would save millions in tax dollars. Even such small amount would reduce GP visits otherwise ... Greece, here we come

Yes there is a private health insurance and is growing. I don,t have hospital cover and cannot afford one even if wanted. There is a penalty for each year over the age of 30 is added to cost of the premium, not sure how it works but the penalty is more than the premium. Last year had septoplasty surgery privately, the waiting list is too long in public hospital and not sure if wanted some trainee doctor near my nose.

I,m sure there is more we can talk about but now have to cook dinner, the boss just put in the order Dielaughing
12-16-2013 01:59 AM
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DrWho? Offline

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Post: #5
RE: Australia, U.S. "Insurance" DME
I have to agree with zonk. I'm a low income earner and have a health care care and get social security payments if my income for the fortnight is below a certian level. The advantage of the health care card is i get free medical attention at the local medical centre and medications discounted to $5.80 a script. Also, being a low income earner and having a healthcare card the local health department supplies me with a CPAP machine. Not sure if every other state or territory do though.

I'm not a Doctor but a fan of The Doctor. any views,comments etc are my own
12-16-2013 03:50 AM
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zonk Offline

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Post: #6
RE: Australia, U.S. "Insurance" DME
Durable Medical Equipment (DME)
http://www.apneaboard.com/wiki/index.php?title=DME

We don,t have the equivalent. I have small insurance cover with Bupa (British company took over an Australian company) for dental, optical and others (not hospital) does not pay for any supplies just $500 rebate towards the machine providing machine purchase locally (not from overseas) so I have to spend $2000 to claim the rebate. Maybe for primary machine, not a backup
Australian government subsidize private insurance by paying 30% of the premium to every policy holder but that does not prevent greedy insurance keep raising the premiums.

Private health insurance in Australia is nothing short of rip-off in comparison to US health insurance system
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12-16-2013 05:13 AM
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DeepBreathing Offline
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Post: #7
RE: Australia, U.S. "Insurance" DME
I think the Australian system is actually pretty good. By no means perfect, and vulnerable to rorting, but I'd rather get sick here than in some places. It's certainly the case that nobody (or almost nobody) goes bankrupt in Australia because of medical expenses.

Medicare is the universal health care system which pays a set amount for a wide range of medical interventions. The doctor may choose to bill Medicare direct (in which case there is no out of pocket expense for the patient) or he may bill the patient on a fee for service basis (in which case the patient can claim back the basic payment from Medicare). It's up to you if you want to go to a "bulk billing" doctor or a fee for service doctor. Services such as blood tests are usually bulk billed. Medicare is paid for by a fixed percentage levy on your taxable income (1.5% if I remember rightly). So everybody contributes and everybody gets some benefit.

The benefit extends to free hospital treatment in a public hospital. For serious illnesses and accidents the treatment is generally very good. For "elective" surgeries (which includes things like knee and hip reconstructions) there can be an excessively long waiting list.

Private health insurance is optional, and expensive (though I think it's still a lot cheaper than you pay in the States). It's hard to give an exact comparison because there are lots of different levels of cover and packages. Eg a young person might take out a cheap cover which pays very little for hospital cover but emphasises things like physiotherapy to cover sports injuries. An older guy like me will insure to the max for hospital cover. There are also a lot of "ancillaries" like optical cover - these are all bundled up into different packages. The rules keep changing but there are incentives (ie tax deduction) to take out private cover and tax penalties if you don't. In addition, if you don't take it out when you're young then the premiums are higher later on in life. (It's an incentive to get young healthy people into the system and help subsidise us oldies). It's highly regulated, but the rules keep changing so I'm not up to date on the exact details.

Unfortunately private cover doesn't give a very good coverage for CPAP. My machine (S9 VPAP Adapt) cost nearly $4,000 but I only got $500 back. On the other hand the sleep test (in a private hospital) was fully covered with no out of pocket.

Another aspect of our system is coverage for prescription drugs. The government negotiates with the drug companies to force down the purchase price of approved drugs, and subsidises the cost. For low income people the out of pocket is pretty nominal ($5 or $6 I think) while for the rest of us it varies according to the particular drug, but seems to be way less than the equivalent drug in the States. And if you spend more than a certain amount ($1000, 2000 - I'm not sure) then the price goes down for the rest of the year.

As Zonk said, the system is vulnerable to rorting but overall I think it's a pretty good balance between a complete state controlled system and a free market one where people face the choice of dying or going broke (and then dying).

DeepBreathing
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
12-16-2013 05:45 AM
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Moriarty Offline

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Post: #8
RE: Australia, U.S. "Insurance" DME
There is also a difference in the approach of Australian Medical Insurers and the US HMO type insurers.

Whilst the AU insurers will have their 'preferred' providers and negotiate so-called 'Gap-Cover' deals with some providers they do not limit the treatments to those that they think you need. If a doctor says you need it, and it is in the list of things covered by your policy then you will get the benefit set out in the policy.

By way of example - We pay approximately $4200 per year for top hospital and 70% extras cover for my wife and I.

Our out of pocket this year so far in about $1500 on $7000 worth of dentistry and Medical expenses including a Cataract surgery and a Gastroscopy. Of course not all years have been like this year but then that is the point of insurance.

The price for a family is the same as for a couple - ie twice the rate for a single.

While there are some GPs and specialists that bulk bill it is not compulsory for them to do so and there is no regulation on fees. If you go to a doctor that does not bulk bill then you must pay the gap which is not insurable.

There are some areas - particularly in the major cities - that are overserved with doctors with the result that bulk-billing is more common due to competition. Other areas - particularly regional and rural areas - are under served with doctors with the result that those areas do not get much bulkbilling except for pensioners and designated low income health care card holders.

In general though I agree with DeepBreathing in saying that the AU system is fairly good on balance.
(This post was last modified: 12-16-2013 06:37 AM by Moriarty.)
12-16-2013 06:37 AM
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me50 Offline

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Post: #9
RE: Australia, U.S. "Insurance" DME
My cardiologist said I need to have a ct angiogram. The insurance company didn't think it was necessary so their doctor in the review board called my doctor and he still disagreed with my doctor. In the end, they agreed to disagree and I will get the test. How can a doctor that doesn't know me personally, my family history, etc., say that I don't need a test when my doctor, who does know my history and me says that I do? Just food for thought.
12-16-2013 08:50 AM
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DeepBreathing Offline
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Post: #10
RE: Australia, U.S. "Insurance" DME
(12-16-2013 08:50 AM)me50 Wrote:  My cardiologist said I need to have a ct angiogram. The insurance company didn't think it was necessary so their doctor in the review board called my doctor and he still disagreed with my doctor. In the end, they agreed to disagree and I will get the test. How can a doctor that doesn't know me personally, my family history, etc., say that I don't need a test when my doctor, who does know my history and me says that I do? Just food for thought.

That doesn't happen here. Between Medicare and the insurance companies, most things are covered one way or the other. You don't seek approval from either - your doctor orders the procedure and you get it done. Medicare / insurance pay up according to the published schedules. You might be out of pocket to a greater or lesser extent but you don't have insurance bean counters dictating the standard of medical care. If you don't have private insurance you might be up for a lot of money (or a long wait for non-life threatening situations), but there is always a safety net somewhere in the system. You won't go bankrupt.

DeepBreathing
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(This post was last modified: 12-16-2013 09:11 AM by DeepBreathing.)
12-16-2013 09:10 AM
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