FULL LIST: Top 100 out-of-pocket price hikes for surgeries in private hospitals revealed

Gap fees for surgeries in private hospitals have grown as much as $5000 in the past five years. SEE THE FULL LIST OF 100 PROCEDURES AND HOW IT COULD AFFECT YOU

Out-of-pocket charges for surgery in private hospitals have soared by as much as $5000 in five years – with health fund patients now needing to fork out at least $1000 extra on more than two dozen procedures.

An exclusive list of 100 surgeries – compiled by the peak body for private health insurers – shows weight loss, medically-necessary breast procedures and a treatment for Parkinson’s disease had some of the steepest in-hospital gap fee spikes between 2019 and 2024.

As Health Minister Mark Butler warned specialist fees were “getting out of control” in some parts of the country, Private Healthcare Australia CEO Rachel David said she’d heard anecdotal reports surgeons had cut back their hours after Covid and were charging more to make up the difference.

Dr David also said that early raiding of superannuation appeared to be pushing up prices as people could afford to pay the steep fees they were being quoted for.

Australian Taxation Office data shows $250m of superannuation was approved for weight loss procedures in 2023-24 alone, the second biggest medical subcategory after dental.

In a move to try to stop the issue, the ATO and healthcare regulator on Thursday announced new early release super guidelines to crack down on over-charging and unnecessary procedures.

Royal Australasian College of Surgeons president Professor Owen Ung conceded there were “outlier” surgeons who were overcharging patients but he believed they were in the minority.

He said out-of-pocket expenses were getting larger because Medicare’s schedule of fees was “so far from reality” and “so far off kilter” the issue was only going to get worse.

“When you’ve got your health fund rebate locked to an inappropriate Medicare schedule then the patient is going to miss out again, because private health is supposed to cover 25 per cent,” he said.

He also noted there had been a “meteoric rise” in medical indemnity insurance costs.

Professor Ung said the system needed an overhaul to have more of a focus on remunerating for better outcomes.

“A lot of the costs in our system are for low-value care, unnecessary tests and things that don’t really improve health outcomes,” he said.

Australian Private Hospitals Association CEO Brett Heffernan said the proportion of health insurance policies with exclusions, restrictions or limitations was increasing and it needed to be addressed.

“Most insured patients face more and higher gap fees because their insurance policy doesn’t cover them adequately. It’s a growing problem,” he said.

“The real issue lies in the design of private health insurance. Many policies do not cover common procedures or only offer partial coverage, leading to high out-of-pocket costs for insured patients.”

Deep brain stimulation for Parkinson’s disease – the world’s fastest-growing neurological disorder – was number one on the top-100 list with a massive $5210 gap fee jump.

Experts said this was not due to technology improving or becoming more expensive.

Obesity-related surgery took out the second highest increase with a biliopancreatic diversion (done to reduce stomach size and help with major weight loss) logging a $5000 average jump that accumulated over a whopping eight price hikes.

A body lift procedure to remove loose skin after major weight loss meanwhile rose by $2830 and was the fifth highest jump.

The out-of-pocket cost of having surgery has risen sharply in five years for dozens of procedeures.

The average out-of-pocket for a tummy tuck (another weight-loss related procedure) rose by $2040 in five years and was ranked 12th in the list.

A breast lift to address significant sagging had the sixth highest jump ($2820), followed by medically necessary breast reduction surgery, which rose by $2800.

Penile implant surgery – to help men with erection problems – had a $2850 gap fee spike, the third highest in the list.

Prostate surgery (including robotic and keyhole) also now on average comes with a $2070 bigger out-of-pocket expense compared to five years ago.

Mr Butler said increasing specialist fees were causing real harm to Australian patients.

“People (are) simply now unable to afford to visit their specialist it’s having a huge impact on their health,” he said.

“Costs are highly variable, with some specialists charging high fees, much higher than a specialist just around the corner of the same quality.”

In a significant move, the government is working to make it compulsory for all specialists to publish their fees online on its Medical Costs Finder website – due to only a small number voluntarily doing it – to provide more transparency.

It’s hoped this will happen early next year.

Originally published as FULL LIST: Top 100 out-of-pocket price hikes for surgeries in private hospitals revealed