Bariatric Surgery Costs: Explained
Many patients having surgery need to contribute towards the cost of their treatment; in public hospitals these costs are covered by State Government (which seeks to limit it’s costs by limiting access to all but essential services). The majority of specialist treatments (specialist appointments and elective surgery) occur in the private system where treatments are funded by private insurance, Medicare payments and patient payments. Private insurance covers the large majority of costs associated with treatment (hospital costs) but will usually contribute only a couple of hundred dollars per operation to the doctor/surgeon providing treatment. Medicare payments have not been indexed to CPI (Consumer Price Index) so contribute less every year.
In our practice we have two surgeons, two physicians, 2 nurses, 3 admin staff, dietitians and psychologists, as well as the general expenses involved in running a busy office. The bulk of the fees associated with the services we provide are to cover these expenses and wages.
Covering the Costs of Bariatric Surgery and Aftercare
Regardless of whether a medical service is provided in the public or private system the overall actual costs are reasonably similar. There are many treatments not offered in public hospitals which is why patients choose to use the private health system. Please see the various options for payment of treatment below:
Self-funded surgery in a private hospital (patients without health insurance)
In this situation patients will have to cover all of the costs associated with their admission. It is generally impossible to determine an exact figure for the total cost of surgery, for example, unforeseen events such as additional necessary treatment will incur further costs. To give you a rough idea of some of the costs involved in hospital admission:
- Bed costs approx $1,200 per day.
- Theatre costs approx $2,000 per hour, in addition to this the costs of theatre equipment, approx $2,500- $5000 depending on the operation.
- Admission to Intensive Care Unit (ICU), if required, approx $3,000 per day.
Hospitals in Sydney, NSW will provide quotes to patients before admission and expect an up-front payment on or before the day of admission for the quoted amount. As well as the hospital quote, patients will need to get quotes from the Surgeon and Anaesthetist, and these fees will need to be paid before surgery.
Private patient in a public hospital
Being a private patient in a public hospital allows patients to opt for treatment by the Consultant (Specialist) of their choice. It is very unlikely that patients choosing this option will get ‘gap accounts’ from their treating doctors so it is a very cost-effective option for patients who have medical insurance. The main problem with this option relates to the fact that many treatments are not offered in public hospitals, and that public hospitals often have a long waiting list (waiting times are determined by a patients illness not insurance status) which can be over 12 months.
Public patient in a public hospital
Hospital treatments are provided free of cost. Patients will be admitted to hospital under a Consultant (Specialist) but are typically treated by training doctors employed by the hospital. Costs of treatment outside hospital (medicines and appointments) still need to be paid for by the patient – Medicare provides a subsidy for these items and patients are required to pay a component of their outpatient medical costs.
Private patient in a private hospital
Patients choosing this option have a choice regarding what treatment they receive, who treats them, and how long they have to wait until they are admitted to hospital for treatment. The health funds will pay for the costs of the hospital admission and all of the items used during the hospital stay, they will also ‘top up’ the Medicare fee paid to treating specialists (amount varying between 20 and 80% depending on the health fund and the treatment undertaken).
As there is a difference between Medicare payments and medical charges there can be expenses in addition to what the health fund pays and what the patient will have to cover. This occurs because Medicare frequently pays the same amount for a simple procedure as it does for a complex one (for example an operation on a blocked prostate gland taking about an hour to perform receives the same fee as total removal of the stomach which takes 5 hours).
‘Gap Costs’ indicate the amount that patients have to pay to undergo treatment. We calculate gap costs depending on the complexity of the surgery performed and the time it takes. For weight loss surgery (bariatric surgery) we are happy to offer ‘no-gap’ surgery, however patients are charged a ‘clinic fee’ (see FAQs); this contributes toward the expenses of our clinic and allows us to provide follow-up care without charging above the Medicare fee for up to three years after surgery. In addition, we offer patients the reassurance that should any related surgical diagnostic procedures or complication management be required, we provide this without charging above what health funds/Medicare will cover.
What are the costs of Bariatric (weight loss) surgery?
Weight loss surgery has been conclusively shown to increase life expectancy and quality of life for patients suffering morbid obesity. While the surgery itself may seem expensive, it can actually be seen as a positive investment for the majority of patients as it often improves employment options, decreases medical costs and improves cash flow through reduced living costs (reduced food bills). Safe and effective bariatric surgery, performed on appropriately selected individuals is one of the only truly cost-neutral or positively geared interventions available in medicine today.
NSW is the only state that doesn’t offer Weight Loss Surgery in the public hospital system. Our program fee varies between $4,000 and $6,300 and covers patients for surgery, complication management (including re-operation) and follow-up for up to 3 years after surgery.