Medical Costs Finder disclaimer
This tool is a general guide to the costs of specialist treatment. It shows general information on typical costs but cannot to be used to determine a person’s actual costs.
You must talk to your health providers (for example your doctor, specialist or hospital) and your health insurer about your specific costs and health insurance cover before you begin treatment and have your out-of-pocket costs independently confirmed by them.
The out of pocket costs information in the tool relies on information provided by doctors and other health providers. It may not be complete. You must rely on your own independent enquiries about the accuracy and reliability of the information before acting on it.
This disclaimer is for the Medical Costs Finder. It is in addition to our broader site disclaimer.
Medical Costs Finder data sources
The Medical Costs Finder presents results based on Hospital Casemix Protocol (HCP1) data collected by Government.
The HCP1 data insurers send us includes data they receive from hospitals about admissions and medical treatments.
The HCP1 data used in the Medical Costs Finder reflects:
- fees charged for treatments provided in private hospitals to patients with private health insurance
- what Medicare and insurers paid for these procedures
We use data from the most recently publicly available financial year. Current results are based on 2018-19.
Health insurers must provide HCP1 data in line with legislated data provision rules. The tool’s results are only as accurate as the HCP1 data insurers provide us.
Terms we use
For the Medical Costs Finder we’ve shortened the description of some treatments the Australian Government subsidises through the Medicare Benefits Schedule (MBS).
These shorter descriptions give you a basic idea of what the treatment is. You can see the full description of each treatment by searching the MBS item number at MBS Online.
The Medical Costs Finder also refers to ‘clinical categories’. Clinical categories were created as part of health insurance policy regulation. They are used to group medical procedures.
Geographical data presentation
The Medical Costs Finder uses the Department of Health’s database of declared private hospitals to determine where a hospital is.
The tool can provide results locally, by state or territory, or nationally.
When you search the tool, it collates data from all relevant admissions. However, it will only show you a result if there is enough combined available data to ensure you can’t identify a person, hospital or provider from it.
The smallest region the tool can display results for is a Primary Health Network (PHN). A PHN is a local grouping of health services and providers. The tool uses PHNs to identify geographic areas smaller than a state. Tasmania, the Northern Territory and the Australian Capital Territory are each a single PHN.
If the tool can’t show you a result for a PHN because those results might make it possible to identify a person, hospital or provider, it will show you results for the state or across all of Australia instead.
We refer to hospital admissions in this disclaimer and in the Medical Costs Finder to help you better understand the results.
However, the tool actually uses data related to what’s called a ‘hospital separation’.
A hospital separation occurs when:
- a patient leaves the hospital, or
- a patient stays in hospital but their admission status changes – for example, they were admitted to hospital as an acute surgical patient but stay in hospital and become a rehabilitation patient
Effectively, the tool treats each hospital separation as a distinct admission even if the patient doesn’t actually leave the hospital and enter again.
The tool will show you fees, Medicare and insurance payments, and out of pocket costs for hospital admissions where any gap was paid for the admission as a whole. This includes costs for all MBS subsidised treatments provided by a doctor or other health provider during the admission. Health providers could include surgeons, assistant surgeons and anaesthetists. Treatments could include diagnostic imaging and pathology.
For example, a patient is admitted for surgical grommet insertion. The MBS item for grommet insertion is 41632 and it incurs an out of pocket cost of $425. The patient also has anaesthesia (MBS items 17610, 20120 and 23031), which costs a total of $210 out of pocket. The tool will therefore show a total medical out of pocket cost for this admission of $635.
Hospital admissions in the data for each of the included procedures are those where any of a set of identified MBS items was the main or principal item for the admission. Hospitals identify a main or principal item for each admission as part of the HCP1 dataset. The tool will show you the MBS items used to identify relevant admissions for the procedure you have searched.
The tool doesn’t show what patients paid for hospital charges such as accommodation or theatre costs, or the cost of medical devices. It does show how much insurers typically paid for these.
In most cases we apply further criteria before including an admission in the dataset to make the results more useful. For example, we exclude admissions that last longer than is considered typical for a particular treatment.
Pregnancy and birth
The admitting hospital allocates a Diagnostic Related Grouping, or DRG, to every admission.
The HCP1 data we are sent identifies both:
- the main MBS treatment item for each admission
- the admission’s DRG
The DRG assigned to pregnancy and birth procedures tells us the kind of delivery and how complicated it was. We use it to divide admissions for pregnancy and birth procedures into:
- Caesarean sections and vaginal deliveries
- minor or moderately complex procedures and very complex procedures
Although you might not know what kind of delivery you will have, presenting the results like this can help you understand the costs associated with different kinds of deliveries.