Fees for Services

9 October 2009

Dear Patient,

This letter is designed to explain my fee structure for surgery if you elect to be treated as a private patient.

My staff always provide quotes for planned surgical procedures.  You will benefit from a two-specialist surgical team where an assistant is required.  My co-surgeon is my husband, Dr Geoffrey Reid, a recognised advanced laparoscopic surgeon.  Hence we can offer, for example (where appropriate), laparoscopic hysterectomy and radical laparoscopic surgery for endometriosis.  For this expertise you will receive the same assistant’s fee (20% of the surgeon’s fee) as for a GP assistant.  You will also receive a bill for the anaesthetist, and usually for pathology tests.  Your surgical fee includes any visits necessary during hospitalisation.

In order to provide a dedicated gynaecology service, my practice is not subsidised by obstetrics.  Hence I am able to give undivided attention to your consultations and complex surgery, without labour ward interruption.

Women are facing larger gaps – the difference between the cost of providing a private service and what the government is prepared to contribute, i.e. the Medicare rebate.  The gap is increasing because the rebate is falling in real terms while the costs faced by gynaecologists in running a quality medical practice are rising dramatically –  for example the cost of medical insurance and staff wages etc.

There are two scales of surgical fees.  The schedule fee is set by the government and increases annually by less than 1.5%.  Over the last 20 years, this has fallen progressively behind the Consumer Price Index (CPI).  The Australian Medical Association (AMA) has set a second scale of fees, based on the schedule fee in 1985, and subsequently increased to keep pace with the CPI.  There is an increasing difference between the two fees, giving rise to the gap between the fee recommended by the AMA and the fee which is reimbursed by Medicare and the health funds.  The government also legislates against people taking out full insurance for such gaps.

It is worth noting that in the schedule fee, the government undervalues women’s health by setting substantially lower fees for comparable procedures for women than for men.  An example of this is endometrial ablation, a similar technique to prostatectomy.  The schedule fees for these procedures are $556.55 and $941.10 respectively.  These procedures take a similar time, involve similar risk and use the same equipment.  Being derived from the Medicare scale of fees, the AMA fees still fail to address the relative disadvantage to gynaecologists and their patients.

In addition, gynaecology now offers women operations such as hysterectomy by less invasive methods, avoiding large incisions and dramatically shortening recovery times, allowing early return to work and normal activity.  The operations take longer than conventional surgery and are much more demanding for the surgeon, requiring a higher level of (self-funded) training and skill.  The schedule fee structure fails to acknowledge this considerable increase in complexity.  For example, the fee for a standard abdominal hysterectomy is $623.25, and for laparoscopic hysterectomy it is $724.85.  Only a relatively small number of gynaecologists are able to provide these choices.  In 2005, only 12% of hysterectomies in Australia were performed laparoscopically.

I hope this helps you understand the issue better.  Please feel free to discuss any aspect of your charges with us.


                                                                       *        *        *        *        *        *