Since both the public health service as well as the private health sector in Australia provide a range of breast reconstruction services, patients should be aware in advance of the advantages and disadvantages of seeking treatment in the two health systems. The ultimate choice lies with the patient of course, but will be greatly gauged by the proposed expenses involved as well as the timing of the surgery.
How The Cost Of Breast Reconstruction Surgery Is Paid For
For Australian patients, Medicare is the governing body that decides how much patients will have to pay for the operation. For public patients, the cost of the reconstructive surgery will be covered entirely or mostly by Medicare.
For women who seek treatment as private patients, Medicare will take care of 75% of the scheduled fee, but it is important to remember that privately operating practitioners will likely have a higher charge for their services than the scheduled fee. If a public patient opts for external breast prosthesis, Medicare will not reimburse its price.
In any case, patients will incur a cost that may involve treatment or non-medical related expenses such as transportation costs, hospital stay, insurance premiums, food, child care services and accommodation. Many breast cancer patients in fact reach out to loved ones such as friends, extended family and other networks for financial assistance to help cover the cost of breast reconstruction surgery as a result of breast cancer. This is in the form of an online fundraiser that is easy to manage but effective in reaching hundreds of supporters for financial assistance.
Public patients seeking treatment in a public hospital:
Women who are registered as public patients will undergo the medical procedure free-of-cost. However, they are not able to select a surgeon of their choice to perform the reconstructive surgery.
For immediate reconstruction, there can also be a conflict of schedule securing a surgeon for the mastectomy first and then another for the reconstruction of the same operation.
Pubic patients seeking delayed reconstruction will have their name placed on a wait list that may go beyond a few months and up to two years.
Private patients seeking treatment in a public facility:
Individuals registered as private patients in a public hospital do not have to pay for the hospital stay. They are also free to select their preferred reconstructive surgeon but will have to pay his fees. Once again, being placed on a wait list can range between a few months to a few years.
Private patients with health insurance in a private hospital:
Such patients choose their own reconstructive surgeon and can schedule both a breast surgeon and a reconstructive surgeon for an immediate reconstructive procedure. Some of the expenses will be covered by the private hospital fund but health insurance may not fund all expenses. Instead some gap payments might need to be paid out-of-pocket- and the whole payment cleared prior to the operation.
Occasionally there might be a wait list or other restrictions based on the duration of membership with the private health fund.
Typically there is no wait list for patients who register for treatment in a private hospital.
Private patients without health insurance in a private facility:
These patients also enjoy all the benefits of selecting their own reconstruction surgeon as well as scheduling different practitioners to perform an immediate reconstruction procedure. However, they have to foot all the bills personally including hospital costs and gap costs for the medical practitioners. Hospitals may also demand all payments to be cleared before the operation.
Patients can have the reconstructive surgery done quickly without having to deal with any long wait lists.
References:
1) Comparison of public versus private breast reconstruction surgery: http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer/treatment/breast-reconstruction/deciding/factors-affecting-decisions-about-breast-reconstruction/comparison-public-versus-private-breast-reconstruction-surgery