Gap or No Gap for hip or knee replacement surgery and other surgery?

With healthcare costs and private health insurance increasing every year, a hip or knee replacement can become a pricey surgery. With surgeon and practices having increasing overhead costs such as indemnity cover and staff costs, as well as equipment costs, it is no doubt that the patient will also bear a higher cost on the surgery.

For the patient’s sake the government has reduced the rebate for prosthesis down to 17.5%, but this is still not enough given all the other costs associated.

Recently some funds have aligned with the surgeons to offer a no-gap surgery to help reduce the costs to the patients. This however has its disadvantage as the surgeon will have to treat each surgery the same despite the different complexities. For example a surgeon’s ability to decide on what implant to be used on a certain patient depending on the complexity of the surgery may be compromised to avoid the extra costs of that implant. The extra cost that may be saved is not passed onto the fund member, but instead to the shareholders or the executive board of the fund.

The Australian Medical Association has a recommended fee structure for surgeons to use, however this is only a guide, and the surgeons do not have to follow this. Most surgeons do charge a gap which can vary depending on the complexity of the surgery.

The best advice is for patients to do their own research and find the right surgeon from them. This would normally come from word of mouth, and internet research. We discourage patients not to go by their fund “go to fund doctors” as their surgical experiences may vary.

Disclaimer – Individual results can vary – patients are asked to discuss their specific restrictions with their surgeon after surgery.

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