Choosing public or private
For many women and their families deciding to have surgery in the public or private system can be one of the biggest decisions. The costs of surgery can be substantial. We are fortunate in Australia to have a public system that allows us to have this complex surgery covered by Medicare.
There are two prominent reasons to choose the private system; you can choose your doctor, and you have minimal waiting times. However, this might not be so black and white. Choosing your surgeon If you want to go through the public system and want some say in who does the surgery, you can do a bit of research (talk to other women, look at surgeons websites, speak to your GP or breast surgeon, speak to your breast care nurse) and then ask your breast surgeon to refer you to your chosen plastic surgeon who works in the public system. Many of the plastic surgeons work in both public and private. It is common then sometimes possible to continue to see this same surgeon throughout all your breast reconstruction procedures. This surgeon may or may not actually perform your operation, but it will be the members of his or her surgical team under his or her supervision. |
"I used both public and private systems. Same surgeon. The difference I experienced was while waiting for hours for surgery in the public hospital I could wait in the waiting room until I was called, total cost $0. In the private hospital I had a private room and a TV, total cost $1900. No difference in quality of the outcome, only in the cost." |
Waiting times
There are guidelines that govern the waiting times for surgery. You can read these below. It may be worth noting though that for public hospitals, excessive waiting times are usually referring to delayed reconstruction procedures. If you are a candidate for immediate reconstruction, meaning your reconstruction will be done at the time of mastectomy, you should not experience long waiting times. You might be an urgent or semi-urgent case. If you prefer or are suited to a delayed reconstruction, you will undergo your single or double mastectomy, then be placed on a waiting list for your reconstruction which then is considered non-urgent. Waiting times vary state to state and hospital to hospital.
Costs
Costs vary considerably between patients having breast reconstruction in the private system. In 2011 the BCNA Breast Reconstruction Project found that women surveyed were out of pocket between $500 and $15,000. And this is just the medical cost, this is not including accommodation for loved ones nearby, travel costs, time away from work, child care etc.
It is also important to consider the different costs of the various procedures, for example implants on the whole may be cheaper than tissue transfer procedures due to shorter surgery times and shorter hospital stays.
If you choose the private system you of course would thoroughly explore all the costs associated with your surgery before you commit. Your surgeon will provide you with a detail quote at the time of your appointment or soon after. If you have concerns about the costs, speak up because they can waive some or all of the gap fees they charge. Usually hospital and surgeons fees must be paid prior to the surgery taking place.
There are guidelines that govern the waiting times for surgery. You can read these below. It may be worth noting though that for public hospitals, excessive waiting times are usually referring to delayed reconstruction procedures. If you are a candidate for immediate reconstruction, meaning your reconstruction will be done at the time of mastectomy, you should not experience long waiting times. You might be an urgent or semi-urgent case. If you prefer or are suited to a delayed reconstruction, you will undergo your single or double mastectomy, then be placed on a waiting list for your reconstruction which then is considered non-urgent. Waiting times vary state to state and hospital to hospital.
Costs
Costs vary considerably between patients having breast reconstruction in the private system. In 2011 the BCNA Breast Reconstruction Project found that women surveyed were out of pocket between $500 and $15,000. And this is just the medical cost, this is not including accommodation for loved ones nearby, travel costs, time away from work, child care etc.
It is also important to consider the different costs of the various procedures, for example implants on the whole may be cheaper than tissue transfer procedures due to shorter surgery times and shorter hospital stays.
If you choose the private system you of course would thoroughly explore all the costs associated with your surgery before you commit. Your surgeon will provide you with a detail quote at the time of your appointment or soon after. If you have concerns about the costs, speak up because they can waive some or all of the gap fees they charge. Usually hospital and surgeons fees must be paid prior to the surgery taking place.
Breast reconstruction is elective surgery
Breast reconstruction following a mastectomy for breast cancer is considered a medical procedure – it is not cosmetic surgery. In all states and territories it is elective surgery, which is defined as surgery that a doctor believes to be necessary but that can be delayed for at least 24 hours.
Elective surgery is categorised into three urgency types:
Category 1 – urgent
Has the potential to deteriorate quickly to the point it may become an emergency.
National standard desirable waiting time for treatment is 30 days
Category 2 – semi-urgent
Causes some pain, dysfunction or disability; unlikely to deteriorate quickly; unlikely to become an emergency.
National standard desirable waiting time for treatment is 90 days
Category 3 – non-urgent
Causes minimal or no pain, dysfunction or disability; unlikely to deteriorate quickly; unlikely to become an emergency.
There is no national standard for desirable treatment time, but 365 days is used as a guide.
Which category a woman’s breast reconstruction surgery is placed into is at the discretion of her surgeon. Often, breast reconstruction surgery is classified as Category 3 surgery; although we are aware that some surgeons categorise it as Category 2. While there is no nationally agreed desirable waiting time for Category 3 surgery, 365 days is used as a guide.
Breast Reconstruction Project Report 2011 p8-9
http://www.bcna.org.au
NOTE: women who are not offered immediate reconstruction at the time of mastectomy “Category 1” are automatically then listed as “Category 3” for their breast reconstruction and depending on the location this wait can go beyond the 12 months. Ask your surgeon for the estimated wait if you are considering delaying your reconstruction.
Elective surgery is categorised into three urgency types:
Category 1 – urgent
Has the potential to deteriorate quickly to the point it may become an emergency.
National standard desirable waiting time for treatment is 30 days
Category 2 – semi-urgent
Causes some pain, dysfunction or disability; unlikely to deteriorate quickly; unlikely to become an emergency.
National standard desirable waiting time for treatment is 90 days
Category 3 – non-urgent
Causes minimal or no pain, dysfunction or disability; unlikely to deteriorate quickly; unlikely to become an emergency.
There is no national standard for desirable treatment time, but 365 days is used as a guide.
Which category a woman’s breast reconstruction surgery is placed into is at the discretion of her surgeon. Often, breast reconstruction surgery is classified as Category 3 surgery; although we are aware that some surgeons categorise it as Category 2. While there is no nationally agreed desirable waiting time for Category 3 surgery, 365 days is used as a guide.
Breast Reconstruction Project Report 2011 p8-9
http://www.bcna.org.au
NOTE: women who are not offered immediate reconstruction at the time of mastectomy “Category 1” are automatically then listed as “Category 3” for their breast reconstruction and depending on the location this wait can go beyond the 12 months. Ask your surgeon for the estimated wait if you are considering delaying your reconstruction.
More about hospital wait lists in Australia - Hospital waiting lists explained
Comparison of public versus private systems for breast reconstruction surgery
Having a breast reconstruction as a public patient means that Medicare will cover all or most costs. All claims for breast reconstructions are reviewed by the Medicare Claims Review Panel and decisions are made on an individual basis. The individual may be required to pay the cost of a permanent prosthesis.
Even if you have your breast reconstruction in the private system, Medicare will pay 75% of the scheduled fee for the procedure. However, keep in mind that many surgeons and anaesthetists charge more than the scheduled fee for their services.
It is your choice whether you have breast reconstruction in the public or private system. Your decision may affect the financial cost and timing of your surgery.
http://canceraustralia.gov.au last updated: 8 October 2013
Even if you have your breast reconstruction in the private system, Medicare will pay 75% of the scheduled fee for the procedure. However, keep in mind that many surgeons and anaesthetists charge more than the scheduled fee for their services.
It is your choice whether you have breast reconstruction in the public or private system. Your decision may affect the financial cost and timing of your surgery.
http://canceraustralia.gov.au last updated: 8 October 2013
Rural and regional residents
With few locations within rural and regional Australia offering breast reconstruction, travel outside your residential location may be necessary in order for you to access the required services.
You may be eligible for subsidised travel and accommodation though your state government.
Patient Assisted Travel Schemes
The Australian Government recognises that geographic isolation may inhibit access to specialist health care for people living in rural and remote Australia. Patient Assisted Travel Schemes (PATS) and other transport assistance are important mechanisms to support this access.
All Australian states and territories operate a PATS. These schemes provide a subsidy to assist with travel, escort and accommodation expenses incurred when rural and remote Australians travel over 100 kilometres to access specialised health care not available within a specified distance from their place of residence.
Find more information here
http://www.ruralhealthaustralia.gov.au/internet/rha/publishing.nsf/Content/Patient_Assisted_Travel_Schemes
You may be eligible for subsidised travel and accommodation though your state government.
Patient Assisted Travel Schemes
The Australian Government recognises that geographic isolation may inhibit access to specialist health care for people living in rural and remote Australia. Patient Assisted Travel Schemes (PATS) and other transport assistance are important mechanisms to support this access.
All Australian states and territories operate a PATS. These schemes provide a subsidy to assist with travel, escort and accommodation expenses incurred when rural and remote Australians travel over 100 kilometres to access specialised health care not available within a specified distance from their place of residence.
Find more information here
http://www.ruralhealthaustralia.gov.au/internet/rha/publishing.nsf/Content/Patient_Assisted_Travel_Schemes