This is one of the hot questions at the moment that keeps coming up all the time and it’s not hard to see why:
- Public waiting lists for hip and knee replacement are out of control; at time of writing it can be 3 years or more from date of GP referral to date of hip/knee replacement surgery in many public hospitals around Australia. This is partly due to the backlog from Covid but other factors weigh in. The Sunshine Coast is certainly not performing better than the national average thanks to our demographics.
- Private health insurance premiums keep spiralling and other cost of living pressures are making people consider dropping their insurance.
- Private health insurance is complex and can be hard to understand- what’s covered/why is there a gap?
Let’s start first with patients who have health insurance
To be covered for hip or knee replacement in Australia you requires ‘gold’ or in some cases ‘silver plus’ hospital cover
Your health fund pays the vast majority of the $23000+ total cost of a hip/knee replacement outlined below….but then you often get a few extra charges even though you’ve got ‘gold’ hospital cover. The problem is that the ‘gold’ hospital cover with most funds pays over 85% of that $23000+ bill to the hospital and the prosthesis (hip/knee replacement) manufacturer. The ‘leftovers’ are divided between the surgeon, anaesthetist and assistant, and the amount the different funds pay varies.
Some insurance funds’ ‘gold’ level cover pays barely more than the standard medicare rebate to the health care professionals performing your operation/anaesthetic, so your surgeon/anaesthetist/assistant will often charge a gap because although your fund premiums have been increasing at above inflation since as long as you can remember, the rebates they pay to doctors have been indexed to less than the cost of living inflation for the last 40 years.
What about ‘No Gap’ agreements with health funds?
If you have financial difficulty please talk to the team here at Coastal about how we can ensure you get the care you need at a price you can afford without compromising your long term outcome.
Please be reassured that at Coastal Orthopaedic Surgery we will never agree to the inappropriate use of cheaper implants or require you to be discharged from hospital before it is safe as part of a ‘no-gap’ arrangement with your health fund.
But what if I don’t have private health insurance?
With the cost of private health insurance and cost of living in general, many Australians can’t afford health insurance – and public waiting lists are accordingly excruciatingly long in many places. The good news is that a self-funded (no health insurance), high-quality hip or knee replacement performed by a fellowship trained specialist hip and knee surgeon can cost as little as $23,000 or so depending on how many nights you stay in hospital and whether you have other health problems, reasonable preoperative strength etc.
Surprisingly, a self-funded hip or knee replacement performed by a skilled, experienced specialist hip and knee replacement surgeon with rapid recovery expertise can actually cost less than one by somebody who doesn’t perform hip and knee replacements regularly.
How can that be? If you have a hip or knee replacement performed by a specialist hip or knee arthroplasty surgeon who is capable of performing your operation as a day surgery procedure, then you save approximately $1500 per night (yes that’s what staying in hospital costs thanks to round the clock nurse monitoring etc). Staying in hospital for a week after your operation thus costs about $10,000 more than going home on the same day. So going to a hip and knee specialist with rapid recovery day surgery expertise can result in you saving far more money on your hospital stay than you spend on their specialist expertise…. And you get the best surgeon doing your operation.
So ironically, a good self-funded hip or knee replacement is one of the only living costs that’s gone down in recent years due to the advances in surgical techniques such as minimally invasive anterior approach hip replacements and rapid recovery knee replacement surgery, allowing you to head home sooner with less pain and better mobility.
In summary
Needless to say, it’s all pretty confusing so my team are always happy to help explain what costs are involved in your operation and provide you with preoperative quotes so that there are no surprises.
Insured or uninsured, I try to get my hip and knee replacement patients back in action as soon as possible but ultimately your safety is the number one consideration. You’ll therefore need to stay in hospital as long as is required to ensure you are walking well and have minimal discomfort when you leave.
