Retirees’ out-of-pocket pain

Australians are risking their health by avoiding medical care because of rising gap fees, according to advocacy group Consumers Health Forum of Australia (CHF).

The forum has invited the public to share their stories about being frozen out of medical treatment or stung by rising gap costs. It intends to submit case studies about the crisis facing consumers to a ministerial advisory committee on out-of-pocket medical costs.

As reported in The Australian last month, research prepared for a different committee – looking into health insurance – indicated the highest total out-of-pocket costs are for hip and knee surgery, urology, and ear, nose and throat surgery. “The largest averages being for spinal, bariatric and brain surgery.”

The CHF is the only consumer representative on the gap-fee ministerial advisory committee. It hopes that responses received in its “out-of-pocket pain” survey will build a convincing case for the creation of an official government website that allows patients to compare medical fees and performance between specialists.

 “Now is an ideal time for people to have their voice heard on this vital issue and relayed to the Government,” CHF chief executive Leanne Wells said.

“Many Australians experience an added setback when they undergo medical treatment with many receiving large bills that are not covered by either Medicare and/or private health insurance if they are insured.

 “In recent weeks the fresh revelations of these high out-of-pocket costs whether they be gap medical bills for a specialist consultation outside hospital or for a procedure performed in hospital, have underlined the costs issues that are eroding access to health care in Australia.

“Not only can people face additional costs of thousands of dollars for a routine operation, official surveys have found striking variations in fees charged, generating confusion and uncertainty about the overall costs facing people opting for private care.

“We need to see a clear picture of the reality of costs facing health consumers and the impact they are having on access to health care. Australia has prided itself on the performance of our health system, its universality and its unique public/private mix.

“We fear we are getting close to the point where we can no longer make that claim. Increasingly, people are choosing public hospital care to avoid the out-of-pocket costs billed by specialists in private hospitals.  This is causing strains in both public and private care and will continue to do so if the trend is not arrested.

“And outside hospital, among insured and uninsured people there are now many who are putting off seeing specialists they have been referred to because of the costs. Nearly half of the respondents 45 years and over to a major national co-ordination of health care study said that the cost of the appointment was a reason they did not see a specialist doctor when they felt they needed to.

“CHF has proposed the establishment of an authoritative website which carries fee and performance details of all specialists. We hope that a strong response to the Out-of-Pocket Pain survey will ensure urgent action,” Ms Wells said.

To complete the survey, go to

Have you ever been caught out having to pay high out-of-pocket medical costs? Has having private health insurance saved you gap costs? Should health insurers be obliged to pay the full cost of procedures they cover, such as car insurers do?

Related articles:
Managing health care costs
Health fund action needed
Older Aussies feel insurance pinch

Written by YourLifeChoices Writers

YourLifeChoices' team of writers specialise in content that helps Australian over-50s make better decisions about wealth, health, travel and life. It's all in the name. For 22 years, we've been helping older Australians live their best lives.

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