Login
Home
Health Insurance
Wellness
Travel Insurance
Life Insurance
Retirement Solutions
About MBF
Contact Us
Demutualisation
Get a quick quote
Health insurance options
Switch to MBF
Member benefits
in2life
Using your insurance
Common questions

Stroke

This fact sheet is to help MBF members and their families be better prepared for the healthcare experience after diagnosis of a stroke.

Not all of the information here will be applicable to everyone, so it is important to discuss your individual circumstances with your doctor and other healthcare professionals in the team caring for you or your family member. Please, never hesitate to ask 'why' or to have something explained until you understand it. If, after you have been given an answer, you still feel that there are unanswered questions, ask again or ask someone else. Communicating openly with the healthcare team helps them to help you or your family member. Further research and reading will also help you make more informed decisions.

 What is a stroke?

A stroke is the term used to describe the effect on the body caused by damage that happens when blood flow to the brain is blocked (ischaemic) or when a blood vessel in the brain bursts (haemorrhagic).

Ischaemic stroke is caused by blocked arteries. This blockage may either be a blood clot that breaks off the wall of a larger blood vessel and lodges in a smaller vessel in the brain (medically known as an embolic stroke) or fatty deposits that gather on artery walls, narrowing them to the point where the blood can't get through (medically known as a thrombotic stroke).

Haemorrhagic stroke is caused by bleeding in the brain. This usually happens when a blood vessel bursts, often due to long-term high blood pressure, or bursting of a weak spot in the blood vessel wall - a ballooning out of the wall known as an aneurysm.

In all of these cases there is blocking of the vital supply of oxygen and nutrients that causes brain cells to die. As a result, the body can lose control of the functions governed by that part of the brain, including speech, movement and / or memory. The severity of a stroke and its effects will depend on the size of the blockage (clot) or extent of bleeding from the aneurysm, where it occurs and sometimes how long before treatment can be initiated that might be able to limit the damage.

Top

 Stroke treatment, rehabilitation and preventing subsequent strokes

Stroke is a medical emergency. The depth and scope of treatment, both immediate and in the following days will depend on the type of stroke, its size and position, the general health of the person who has the stroke and, critically, how soon after the stroke's onset that definitive treatment is received. The facilities and expertise available at the hospital concerned can also be important factors. A hospital with a dedicated stroke unit offers the most comprehensive treatment, care and rehabilitation options.

Broadly, treatment can be divided into three stages-emergent, rehabilitation, and prevention.

Emergent treatment is provided to save life and to limit damage to the brain by restoring blood flow using a variety of techniques. Whether this is possible and to what extent depends on many factors, especially the type of stroke and the timing of treatment. Brain cells immediately affected by stroke can die within an hour or so (this area of dead cells is known as an infarct), damage which is generally irreversible. However, in some cases, speedy attention can help restore blood or oxygen flow to the area surrounding the infarct to limit further damage and resulting debilitation.

This damage and its causes will be assessed by a range of tests. These may include blood tests, CT or magnetic resonance scan of the brain, electrocardiogram of the heart to test for unusual rhythms, ultrasound of the heart, chest x-ray, ultrasound of the arteries and more.

A relatively new, highly specialised 'clot-busting' treatment called 'thrombolysis' with a drug called tPA is available at the stroke units of some major hospitals. It is considered this must be given within three hours of the stroke's onset and can be highly effective at breaking up the blood clot and restoring blood flow. However, it is suitable only for certain people with certain types of ischaemic stroke (blocked arteries) and can only be carried out by specially trained experts as the risks of the potential undesirable effects in the wrong patient are considerable.

Other treatments to restore blood flow may include administration of 'blood thinning' medication, oxygen or, less commonly, surgery, especially for management of bleeding into the brain.

Rehabilitation includes various types of therapies and other specialist support. The major focus of rehabilitation is to assist with regaining as much function as possible to areas that have been impaired by the stroke. This may involve help relearning old skills or the learning of new skills and techniques to compensate for functions that may be lost. Increasingly, evidence suggests that the sooner rehabilitation begins, the more effective it can be.

Once again, the type and extent of therapy received will depend on the individual circumstances. It may include speech therapy, physiotherapy (including hydrotherapy, occupational therapy to help develop the skills needed to carry out various day-to-day activities as independently as possible) and more.

Depending on the severity of the stroke, rehabilitation may be necessary for weeks, months or more. It may begin in the hospital immediately after the stroke, then be continued after discharge during day visits to a specialist rehabilitation hospital; or in some cases transfer to a rehabilitation hospital may be recommended.

Prevention focuses on reducing the chances of a subsequent stroke. This is a major risk after an initial stroke. This may include medication to reduce high blood pressure, medication to reduce cholesterol levels (both of which are risk factors for stroke); or medication such as warfarin or aspirin to help reduce blood clotting. It may also include treatment for irregular heartbeat (medically known as atrial fibrillation), another known risk factor for blood clots and stroke.

Surgery may also be recommended to remove fatty deposits on the walls of the arteries that run up through the neck and are primarily responsible for blood flow to the brain. Narrowing of these arteries and the consequent blockage of blood flow due to deposits are common causes of stroke.

Adjustments to lifestyle can also have an enormous preventive effect. A low-fat, low salt diet; regular exercise (after first consulting your doctor); not smoking and limiting alcohol to one or two drinks a day are a good start.

Top

 Questions to ask your doctors

The particular treatment regime and rehabilitation plan that is right for you or your family member will depend on your own unique circumstances. Ideally, your treatment will be undertaken by a team of health professionals, including a stroke specialist who may also be a neurologist (doctor who specialises in the nervous system), a GP, a geriatrician (aged care) or other specialists. Various therapists experienced in individual areas of stroke rehabilitation will also be involved.

In all likelihood, the initial admission to hospital following the stroke will have been through the emergency department and initial treatment will already have started. From that point, some questions you can ask that will help you play an active role in getting the best treatment outcomes are listed here.

The nature of a stroke and the emergency nature of subsequent treatment mean it is often a family member or friend (rather than the patient who has had the stroke) who is asking questions and making some of the vital decisions about care. Please bear this in mind when considering the following questions to ask your doctors.

Some questions to ask about the immediate treatment:

  • Will you please explain my current condition, in simple terms?
  • Does this hospital have a dedicated stroke unit? Is there a nearby hospital that may offer more specialised care? If so, is it safe for me/my family member to be transferred there? If at all possible, opt for transfer to a specialist stroke unit.
  • Can you tell me the name of the doctor who will head the treatment team? Is he or she a stroke specialist? If not, is there one that you can suggest?
  • Can you tell me the names of the other doctors who will be involved in the treatment? Can you explain why they will be involved and what their roles will be?
  • Can you explain the treatment that is being given and why? What are the expected outcomes? Over what timeframe can we expect to know the outcomes?
  • Do you know what, if any, functions may have been impaired by the stroke? If so, do you know whether this is permanent? If you don't yet know the full extent of the effects, when can we expect to get an estimate of this?
  • Can you map out for me the likely treatment regime and timeframe once we do know the extent of the damage?
  • Have you already started rehabilitation to address the effects of the damage that we are aware of at this stage? If not, is there a reason that this is being delayed? When can we expect rehabilitation to start?
  • Can you outline for me the preventive treatment we can expect in the future?
  • Do you know the charges that will be related to this treatment or if each doctor concerned charges a 'gap' that Medicare or my health fund won't cover? Is there someone just as suitable that is more likely not to charge a 'gap'? Even so, choose your doctor first based on their experience and expertise.

If surgery is recommended, ask the surgeon:

  • Are there alternative treatments? What are the expected outcomes? What are the possible complications and/or side effects associated with this treatment (including surgery)? Is there anything I should or could do to reduce the risks?
  • How many of this type of surgeries have you performed? How many do you do each year?
  • How long do you expect hospitalisation to be required? Do you expect that I/my family member will go home after discharge, or do you think a rehabilitation hospital will be the next step?

Some questions to ask about rehabilitation (once the patient's condition is more fully assessed):

  • Will you explain what, if any, rehabilitation will be required? Where? If you don't know now, when do you expect to know?
  • Can you map out for me the expected course of rehabilitation, including who will be involved and what each healthcare team member will be doing?
  • What outcomes are we aiming for? What is the best case scenario? What is the worst case scenario? Is there a timeframe you can give me or some milestones that we may look out for to measure progress?
  • How should we prepare for rehabilitation? Is there anything we can do to boost our chances of good outcomes? Do you have any written material I can take home with me as a guide? Or other reading or reference material that may assist?
  • Do you expect that community support will be needed to help with home care? If so, who do you recommend and how do I arrange it? Do you know what costs are involved?
  • Do I need an occupational therapist to visit my home to recommend changes to help me/my family member be as independent as possible once I/my family member is discharged? If so, who will that be and how do I arrange it? Do you know what costs are involved?
  • Do you know for how long rehabilitation will be necessary? Is there a particular point where it will end and, if so, what is it?
  • Can you explain to me the charges associated with rehabilitation? If doctors are involved, do you know if they charge a gap that Medicare or my health fund won't cover? For example, do they participate in the MBF Medical Gap Cover Scheme? Even so, always choose your doctor/s first based on their experience and expertise.

Top

 What MBF pays toward hospital treatment and rehabilitation

Understanding how the healthcare system works can be confusing. This brief summary outlines what you can expect in terms of your private health cover, hospital and medical costs.

As soon as you are able to, you should call MBF to check the details of your cover in the hospital concerned.

 Your hospital costs

All levels of MBF hospital cover help pay for in-patient treatments provided that:

  • they are provided to you while you are formally admitted to a hospital;
  • they are treatments for which Medicare pays a benefit;
  • they are not an Excluded Service on your level of cover; and
  • you've met all the standard conditions of your membership (like serving the relevant waiting periods).

Your MBF hospital cover will help pay for the following treatments and services so long as you are formally admitted to the hospital and the above conditions are met:

  • shared accommodation (or private room if available);
  • surgery related expenses including operating theatre, and intensive care, if needed;
  • certain drugs supplied as part of your inpatient hospital treatment;
  • certain therapies such as physiotherapy, occupational therapy and speech therapy when provided by the hospital and associated with your hospital treatment; and
  • after discharge, rehabilitation and associated therapies when they take place as part of a same-day admission (day surgery).

Remember, if you are not in an MBF Network Hospital and/or public hospital, you may incur substantial out-of-pocket expenses for your hospital charges.

Please note that surgeon's and doctors' charges will be part of your medical costs.

 Your medical (doctors') costs

There will likely be more than one doctor or specialist involved in your treatment and care. These health care professionals may include the stroke specialist, the radiographer and a pathologist who completes your laboratory work (such as blood tests). You may not meet them all in person.

Each doctor will charge for his or her services. See Going to hospital and Gap and informed financial consent for a guide to these costs.

Key things for you to know about medical costs and your health cover are:

  • MBF will pay benefits toward your doctors' charges for the service you receive:
    • when formally admitted as an in-patient in hospital or day surgery, and
    • when the service relates to treatment included under your level of cover, and
    • when you are entitled to a Medicare benefit for the treatment.
  • The Medicare Benefits Schedule Fee ('MBS') is the amount determined by the Commonwealth Government for the purpose of paying Medicare Benefits. For eligible in-patient services, Medicare pays for 75% of the MBS; MBF pays the remaining 25%.
  • Many doctors charge above the MBS, creating a 'gap' - an amount the patient has to pay.
  • MBF does not pay any amount charged by your doctor above the MBS unless there is an agreement in place between your doctor and MBF. This agreement is known as the MBF Medical Gap Cover Scheme.
  • MBF has created the MBF Medical Gap Cover Scheme to help reduce gaps paid by members. Doctors who participate in this scheme have agreed to accept the MBF benefit as full payment for your treatment. If a doctor has agreed to treat you under the MBF Medical Gap Cover Scheme there will be no 'gap' to pay for that doctor's charge.
  • It may be that not all doctors involved in your hospital treatment are 'no gap' doctors. So you may have to pay a gap for some doctors' services, but not others.

Remember, doctors are independent of MBF and can decide whether or not to treat you under the MBF Medical Gap Cover Scheme.

Click here for a list of 'no gap' doctors or call MBF.

 Other costs relating to your treatment and recovery

If you have MBF extras cover, MBF may also help with the cost of a number of other healthcare services that may assist with the treatment and recovery from stroke.

Depending on your level of MBF extras cover, limits of your cover and waiting periods these benefits may include:

  • occupational therapy, to help you re-establish your usual living or working routine;
  • physiotherapy, to help restore movement and function following the stroke;
  • speech therapy, to help regain language and verbal function
  • psychology, such as counseling for you and family members included on your cover;
  • pharmacy (for drugs not listed on the Pharmaceutical Benefits Scheme); and complementary therapies such as remedial massage.

MBF extras benefits are only payable for services provided in Australia by an MBF Recognised Provider. MBF Recognised Providers are health service providers that meet MBF guidelines. Call 131 137 to confirm whether or not your provider is a MBF Recognised Provider.

You can enjoy higher benefits on all preventive and general dental services and selected physiotherapy, optical, pharmacy and gym membership services (restrictions on claiming apply) by using the growing MBF MemberCare network of service providers. With our MBF MemberCare network of providers, you are guaranteed of receiving at least 70%-90% of the charge back on selected services depending on your level of cover, up to the annual limit of your cover. Find an MBF MemberCare service provider.

Top

 Where to find out more including support options

Top

 More about going to hospital, MBF Network hospitals, no gap doctors, and MBF MemberCare providers

As well as calling MBF, you can find plenty of useful information about your health cover and what to expect when you go to hospital right here on this website.

Top

Last updated: 05-06-07

Print this page