Punish doctors who overcharge?

As Australia’s chief medical officer vows to investigate the possibility of punishing doctors who charge unnecessarily high fees, the Actuaries Institute says high out-of-pocket costs and a lack of transparency around specialists’ fees are undermining the health system.

The Australian reports that Professor Brendan Murphy will determine whether there is a point at which billing becomes unethical and should be considered malpractice. Colleagues have noted the growing number of GoFundMe campaigns seeking donations to pay for life-saving surgeries and cancer treatments.

Pensioners taking out reverse mortgages, people raiding their superannuation and GoFundMe campaigns to cover out-of-pocket expenses indicated a serious problem, he said.

“We feel that is not consistent with ethical medical practice,” he told The Australian.

“One of the questions now is defining at what point it becomes egregious. You could argue that the causing of severe financial pain, material financial pain, is egregious.”

Prof. Murphy will discuss the issue with the Medical Board of Australia, specialist medical colleges and associated groups in a bid to develop a means to better protect patients.

The Royal Australasian College of Surgeons says overcharging patients breaches its code of conduct, but has not been able to determine a threshold for action.

A government website to be launched next year aims to at least partially address the problem. It will offer de-identified data on the range of fees being charged for procedures and professional groups, particularly in gynaecology, obstetrics and cancer services, will be encouraged to add their own information. The aim is to allow patients and GPs to compare specialists by name and price.

Prof. Murphy deplored a common view that the more expensive a specialist’s costs, the better the standard of treatment, adding, “the best guide is the referring GP who gets to know the surgeons or proceduralists they refer to.”

He is also seeking better-quality reporting and information on surgical outcomes, a view echoed by the Actuaries Institute, which says a lack of transparency around patient outcomes is undermining the system.

The institute also wants to see independent healthcare coordinators appointed to help patients navigate treatment options and manage out-of-pocket expenses.

It advocates that all costs associated with a treatment be combined into a single total cost. “While inherently challenging in the private healthcare industry, [this] would be a game changer,” it said in a Green Paper, How to Make Private Health Insurance Healthier, at a summit in Sydney this week.

“This should help patients understand the total cost of their treatment and budget accordingly, target inefficiencies in the supply side of healthcare services and lower the total cost for the chosen healthcare pathway.”

The Green Paper presented a case study of a 57-year old prostate cancer patient whose specialist recommended robotic-assisted surgery. The patient, who had top-level private health insurance, had $20,000 in out-of-pocket costs. If he had undergone traditional surgery, with similar results, his out-of-pocket costs would have been closer to $3000.

It also stated that more than a quarter of patients with breast cancer had out-of-pocket costs for treatment of $10,000.

Private Healthcare Australia chief executive Rachel David said that almost half (44 per cent) of privately insured patients were left with a gap in private hospital bills and that 2 per cent had out-of-pocket expenses of more than $10,000.

Would more transparent fees make your life easier? Would you welcome an independent healthcare coordinator to help you navigate the system?

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Written by Janelle Ward

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