The cost of surgery for sports injuries in Australia

Surgery for sports injuries in Australia is expensive by the standards of most consumer items, but on a world scale it is actually quite cheap (and good value). Unlike other consumer items, it is very difficult to make cost comparisons between surgeons and therefore most people make the decision on which surgeon to use based on quality rather than cost.

Approximate costs for surgery can be estimated in the table below. Every Australian has access to Medicare rebates for doctors' fees, but in being part of Medicare, Australians are not allowed to take out full insurance to cover all fees charged by surgeons and other doctors above the Medicare schedule amounts. Surgery in public hospitals is free for Australian citizens but choice of surgeon is not allowed and most surgery requires joining a lengthy waiting list. In recent years, 'no gaps' private health insurance products have been promoted and these are relevant for certain areas in Australia. Many orthopaedic surgeons in South Australia, for example, accept the rebates from 'no gaps' products and so a good surgeon in Adelaide may be found without out-of-pocket medical expenses. In New South Wales, where the cost of living is higher, but health insurance rebates are exactly the same, very few top orthopaedic surgeons agree to accept the 'No Gaps' products, meaning that patients will face 'gaps' even with full insurance.

Surgery in sports medicine can roughly be divided into day-case procedures (arthroscopes of most joints) where hospital fees are minimised and full admission procedures (including joint reconstructions) where hospital fees for the uninsured patient are much more expensive. An approximate guide to the costs is presented in the table below:  

The above doctor fees are covered mainly by Medicare, but in most cases the 'gap' cannot be insured against, so this represents out of pocket expenses for the patient, even with private health insurance.

Hospital fees may be covered fully by private health insurance, but may be subject to excess payments or complete payment by the patient in the case of someone without private health insurance.

Therefore total cost for an arthroscopy procedure may be $4000-$5000, or for a reconstruction $8000-9000, with the patient subject to a percentage of these costs depending on insurance status.