I'm in Australia - had my surgery June 2010 and don't have my first post surgery MRI scheduled until June next year (so two years from surgery). Not sure if this is usual as they were confident that they got it all. Had a CT Scan immediately after surgery and all fine.
Would be interested to hear from any others in Australia if this is the usual practice.
I had wondered if the difference is due to the different types of health system. In Australia we can access the public health system (which I did) which is no cost but may be longer waiting times depending on the urgency of what you're in for. But when I was looking in to surgery (and panicking somewhat) I got some quotes of how much it would cost if I wanted it done in the private system and didn't have insurance, and was told $10,000-$15,000 total. I was surprised about this due to hearing on this site about how much it costs in the US which seems to be ten or even twenty times this - although your insurance generally covers it - maybe that's why they do more frequent MRIs?
I'm in the U.S. and, obviously, can't respond to your query regarding the Australian health care system protocols for AN surgery patients. However, I will attempt to address the second part of your post regarding the rationale for the U.S. system's costs for AN surgery and the frequency of MRI scans.
The U.S. health care system is privately funded, for the most part, but approximately 20% of all U.S. residents are enrolled in the government health care program known as
'Medicare', available to citizens 65 or older and those who are disabled (
at a small annual cost, currently approximately $1200.) Because, ethically, hospitals have to accept any sick person who presents themself, whether they are insured or not, most hospitals run at a financial loss. The federal taxpayer-funded
Medicare and the state-run
Medicaid programs do not reimburse the hospitals (
and doctors) at anything close to the real cost of the services rendered, adding to the financial burden on them. Their solution has been to increase the costs of services to sometimes astronomical levels, knowing that the majority of their patients will be insured and the insurance companies will pay the bill. Of course, the hospitals are forced to 'negotiate' with the private insurance companies so they always set their initial charge very high. For example: a $10,000. bill may be negotiated down to $700. I've seen this happen on my own bills. With
Medicare/Medicaid patients, the government (
state or federal) set the price they'll pay for a 'covered' treatment and there is no real negotiation involved. If the hospital agrees to accept Medicare/Medicaid patients, they must agree beforehand to accept whatever fees the government agrees to pay. Of course, private insurance companies are profit-making businesses, not charities, and they simply pass along the escalating cost of hospital services in the form of higher annual premiums for their customers., shifting the cost burden to the consumer, as you would expect.
This situation has driven many doctors (
but few hospitals) to decline to accept patients that are insured with the government program (
Medicare or Medicaid). It has also prompted a proposed government health insurance program called the
'Patient Protection and Affordable Care Act' (PPACA) which was passed by congress last year and is
highly controversial. The program has been legally challenged by 25 or more states and it's legality is expected to be adjudicated by the U.S. Supreme Court later this year. In my view, the U.S. has a fine health care system and although it isn't 'free', it is still worth what we pay, which, whether insured under a private plan or through
Medicare/Medicaid, is not unreasonably expensive, in most cases, although with a population of over 300 million people, you will always find situations where a person or family experienced financial ruin due to steep medical bills. My church has helped some members with high medical bills and secular charities also help, although some folks are too proud to ask and there is nothing we can do about that, even though we understand their reluctance to ask for help.
My neurosurgeon agreed to take whatever my (
private) insurance paid for his services and he told me
"don't worry about money, just concentrate on getting well". I was happy to take his advice. I later learned that my insurance company paid my neurosurgeon and his assistant (
also a neurosurgeon) $28,000. (U.S.) for a very complex nine-hour surgery. I don't believe he was overpaid. However, the hospital bill, everything included (
operating room, intensive care, meds, etc) came to over $60,000. for a five day stay - and I suffered no complications. The frequency of MRI scans is really the doctor's prerogative. Because the risk of tumor re-growth is higher in the first two years post-op or post radiation, more frequent MRI scans are ordered. Once that time period has passed with no sign of tumor re-growth, the MRI scans are spaced further apart. MRI scans run into the thousands of dollars and the private insurance companies won't pay for them unless they are deemed 'medically necessary'. I imagine that the taxpayer-funded Australian health care system is even more prudent in this regard. Most taxpayer-funded government-run health care systems are like this.
Please forgive the length of this post but it involved some complex issues and I thought your questions deserved a detailed response.
Jim 
