It’s like the NHS, but not…

Given my track record, it was a matter of time before I ended up in a hospital emergency department, though I’d hoped to last rather longer than this! Before you start sending me concerned messages, I should assure you I’m basically fine, but I had a nasty fall on some iron-edged steps on Friday night and took a chunk out of my right knee. By Saturday morning, when it was still painful and a bit messy, I decided that maybe it needed some attention.  Not the most exciting way to spend a Saturday, but the silver lining was a new blog subject, so here goes with some initial observations on differences in the healthcare system.

There is no NHS here, but there is Medicare, which serves some of the same purpose. Unlike the NHS, Medicare doesn’t cover ambulance transport, some hospital service costs (e.g. you contribute to the cost of the bed and meals if you’re an in-patient) or dental or most optical treatment. In addition, if a doctor chooses to charge more than a fixed Medicare fee then you have to cover the difference (known as the “gap”). Some doctors “bulk bill” Medicare, but with others you need to pay and then claim the cost back. Both my currently-local hospital and the GP surgery I went to this morning for a check-up on the knee bulk-billed, but I had to hunt around for a CBD GP that did, and that didn’t charge a gap fee.

Getting a Medicare card was, in itself, a bit of a hassle. No issue with eligibility since I’m an Australian citizen (though there is a reciprocal healthcare arrangement with the UK so British people are eligible). The issue was more it not being at all clear online which of the “Medicare service centres” in Sydney would process registrations, and, once I actually knew where I needed to go, having to wait nearly 90 minutes to be seen despite arriving earlier than the place opened. But it was worthwhile getting it sorted so that all I had to do to get free treatment these last few days was wave my shiny new green card.

Private health insurance is fairly widespread over here, with two types of cover: hospital and “extras”. Hospital cover rather speaks for itself, covering ambulances, hospital service costs and private patient costs of many procedures. “Extras” cover all other  dental, optical (including glasses and contact lenses as well as eye tests), physiotherapy, remedial massage, psychiatric treatment, chiropractors and so on, but usually with annual limits and sometimes only a proportion of costs paid. I’ve taken this all out, but I’m still baulking at the cost and may change or cancel it during the 30-day cooling off period on my policy. There’s a scheme whereby, on a means-tested basis, people are eligible for a part-rebate on their Medicare levy (which is 2% of taxable income, taken out of salary) if they have private health insurance, presumably because they’d be more likely to opt for treatment funded by insurance and therefore claim less from Medicare. Interestingly, while private healthcare cover was a benefit I received from my UK employer, paying only the tax on the premium, this isn’t the case here even though I work for a much larger organisation.

Based on my limited experience so far, healthcare feels a lot more commercialised than in the UK, with GP surgeries more overtly being private businesses, and I’ve no doubt it will cost me a lot more than I’m used to. On the flip side, only yesterday I had my pick of appointment times today at several GPs and could book in online even without ever having been before or registered many details let alone needing to have any sort of introductory health check. Many surgeries are even open seven days a week. I was well looked after this morning too: the doctor took a look at my knee then ushered me off to what almost felt like a small hospital ward where a nurse immediately set to work sorting out my dressing.

My hospital experience was much the same as A&E back home: tedious. No issues at all with the medical care, but there was a lot of waiting around despite the place not feeling busy. I waited for triage (albeit quite briefly), to see the doctor, for a tetanus shot, for the porter to take me for an x-ray, for the x-ray itself, to be taken back by the same porter, and (for an hour and a half) for the x-ray results. A total of over three hours I will never get back.

I am sure there’s much more to say on this topic, but for the sake of my health, I hope I don’t experience it too soon!