The Medical Gap

The Medical Gap is a term used to describe the amount aWesley Reception_2 patient pays when a doctor charges over the Medicare Benefit Schedule (MBS).

The Medicare Benefit Schedule is a list of procedures compiled and updated by the Commonwealth Government.

Each operation is allocated an Item Number and Fee – The Medicare Schedule fee. The Medicare Schedule fee is the amount the Federal Government is willing to contribute to each item.

The Australian Medical Association (AMA) also publishes recommended fees for medical services and BrizBrain & Spine use these fees as a guide.

Why is there a Medical Gap?

The Medical Gap is increasing as the Medicare rebate is not keeping pace with inflation. The Federal Government are not adequately increasing the Medicare Rebate. The Medicare Schedule was established in 1985 but has not increased in line with inflation. The costs of running a quality medical practice have expanded phenomenally with computer software, hardware, information technology, insurance, staffing and Medical Indemnity.

This graph shows the real reason for the medical gap.

AMA Gaps Poster

The graph above shows the change in general price levels compared to the Medicare rebate since 1985.

If the government does not increase the schedule fees the medical gap will continue to rise. The AMA has issued its own Schedule of Fees based on inflation rates and we use these fees as a guideline for billing.