Lottery on out-of-pocket specialist fees

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Think you’re paying more to see a specialist? Then you could very well be right with a new report finding the out-of-pocket cost to see a specialist varies within discipline and depending on location.

The Medical Journal of Australia (MJA) has published a report, from the University of Melbourne, which reveals that the cost paid by a patient to see a specialist within one discipline could vary by up to 400 per cent. Are patients getting what they pay for? According to report co-author Gary Freed, there’s no way of knowing whether the more expensive option would be the best one.

“There is an issue with regard to whether or not people can afford care in the private sector,” Professor Freed said.

“And number two, we don’t know what that variation in care is actually provided to the patients.”

Analysing Medicare claim data from 2015 for an initial outpatient appointment in 11 non-surgical disciplines, Professor Freed and co-author Amy Allen from the Melbourne School of Population and Global Health, found that neurology had the greatest variance in fees at $189, or 125 per cent difference. As well as neurology, the other fields assessed were endocrinology, cardiology, geriatric medicine, haematology, respiratory medicine, gastroenterology, nephrology, medical oncology, immunology/allergy and rheumatology.

There were variances found amongst all fields, with gastric medicine the lowest at $62.50, the equivalent of 15 per cent.

As no information is available publically about the standard of care received, there is no way for patients to make a decision as to whether or not the additional fee is value for money.

And it’s not only the out-of-pocket fees that are hitting patients hard, the variance in which specialists will bulk-bill is also noted. In regards to bulk-billing, it was found that:

  • the majority of specialists bulk-billed between 30 and 42 per cent of visits
  • specialists in the NT bulk-billed 76 per cent of visits, the highest rate of any state or territory
  • bulk-billing in NSW and SA were just above 40 per cent of visits bulk-billed, whereas WA was below 20 per cent.
  • haematology and medical oncology had the highest rate of bulk-billing visits at 60 per cent and 53 per cent respectively.

In summation, Professor Freed said that the findings indicated that Medicare rebates were too low

“The rebates have not kept up with inflation, so that by the very nature of inflation alone, patients are having greater out-of-pocket costs,” he said.

Professor Freed also indicated that state governments public funding was a contributing factor.

“State governments have not increased funding to meet demand in the public sector for out-patient specialty care,” he said.

Read more at mja.com.au
Read more at abc.net.au

Opinion: Specialist fees a lottery few can afford

Anyone who has ever been referred to a specialist by their GP will have felt the familiar pit of dread in their stomach when faced with the conundrum of how much it will cost. With little indication of how much you will be charged and pot-luck on how much Medicare will rebate, the fear of visiting a specialist is as much about the cost as the medical diagnosis.

As we reported last week, Australian men are likely to be living to 84 by the year 2030, but seriously, how can they afford the healthcare they need to ensure the remainder of the 84 years is productive?

On top of health insurance premiums, which we know are just about to rise again on 1 April, Australians spend $21 billion a year on out-of-pocket expenses. During 2014-15, spending on out-of-pocket expenses increased four-and-a-half times more than Government funding. 

And it’s not just specialists lining their pockets with our hard-earned dollars. Anyone who has visited the dentist recently would likely still be reeling from the bill.  I took my son last week and after a bit of a poke around, a clean and some nifty mouth guard to stop him grinding his teeth, I was $209 out-of-pocket. And that was after my health insurance rebate and some very generous discounting by my dentist.

So, just how is a population that is classed as ageing and more susceptible to lifestyle diseases than generations before supposed to stay healthy, when it seems good health equals big money? That’s the question facing the Government and I’m not sure there’s an answer.

What do you think? Have you found the cost of healthcare increasing? What’s the biggest specialist bill you’ve been hit with? Have you ever not seen a specialist due to cost? 

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Written by Debbie McTaggart

75 Comments

Total Comments: 75
  1. 0
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    I recently saw a neurologist at a cost of $270 and received $128 back from Medicare. Needed an MRI on my neck, but will have to save up before I can return to the neurologist to get results. Perhaps I should try to ignore my issues and forget about going back.

    • 0
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      If Australians did not run to the doctor for zip all the time and did not allow their GPs to overservice then there would be plenty of money to cover specialists.
      The facts are that anything which is ‘free’ is never valued and we have only ourselves to blame.
      And don’t even get me started about smokers, drunks and those with eating habits guaranteed to make them sick. The health system was never designed to fix up negligent lifestyles but it has become so.

    • 0
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      Can’t agree with you there, Mick, sorry. Most people don’t run to the quack for nothing, and I don’t know where you get that idea.

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      Have an xray first as that was all I needed and cheaper to determine that the pain on one side of my neck was caused by osteoarthritis. Physio was recommended but the visit was useless by a young Indian physiotherapist so I changed clinics. Happened to find that one fish oil capsule eliminated the pain which was not bad to begin with so all is fine.

    • 0
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      As a nurse, Mick’s comment is very true!
      WE ARE WHAT WE EAT!

      Pevious comment was in reply to Dallas.

  2. 0
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    I am currently seeing an orthopaedic surgeon, an endocrinologist and a breast cancer specialist. My doctor has given me a referral to a pain management specialist but I just can’t afford the $180 fee. I am waiting for a hip replacement and the waiting time for the hospital is 12 months. I feel like I am just sitting around waiting to die as my quality of life is zero with the pain and limitation on movement.

  3. 0
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    Try using the services of Specialists in Tasmania and you will be shocked. After returning to Tasmania from Victoria a few years ago my husband started to have multiple problems and needed treatment by many Specialists. We were deeply shocked at the difference in out of pocket expenses as compared to Victoria. We have had to maintain our private cover at great expense (still being out of pocket greatly for Specialists’ visits) but after our experience here with the public system my husband would not be with us if we’d had to rely on that system. We have been lucky to have an excellent General Practitioner who still bulk bills and I am pleased to note that the Govt has at last decided to increase their rebates.

  4. 0
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    I’ve been quite confused by the few specialist visits I’ve had. My 5 year eye exam costs a fair gap but is medicare subsidised.
    Twice I’ve had treatments in specialist’s private clinics not covered by Medicare or the private health fund.
    I intend being selective in future if I need treatments and find a specialist who is covered by at least one option and who uses the public system hospitals or a private hospital covered by my fund.
    I really don’t understand the system.

  5. 0
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    When I was diagnosed with Lung cancer and liver cancer following colon cancer, my liver surgeon sat me down and explained that there was a gap between what my health fund would pay and what he charged. He advised that I would be up for around a $4000 out of pocket fee over and above what medicare and my health fund would pay. He said that it was due to indemnity insurance that was much higher than the government allowed for. He also suggested it was a political football, with the government refusing to cover the Indemnity Insurance via medicare but basically arbitrating what that cost had to be. In all I was out of pocket around $15k from a total bill for the three ops around $50k. I also had to pay for the chemo chemicals of around $250 per fortnight over a total of two separate period of 6 months each. My health fund was at the highest level. Complain ? No I am still alive and very grateful.

    • 0
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      inextremetime – but what about if you CAN’T afford it? I have a single friend in her late 60’s, faced with a recurring crippling cancer. She too had high Health Insurance- but ended up selling her house to survive. Now she rents privately – and being too young for the pension, is depleting her spare money rapidly. Waiting list for Govt Housing? – told 8-10 years. She is being treated now for depression and anxiety, and to make matters worse – her cancer has returned. As she jokes, the only reason she is alive is to pay doctors bills. She now regrets her decision – as she said, she would have had a better quality of life (maybe shorter) than the pain, stress, anxiety and cost she has been through. And I tend to concur. Not for me – having worked in the medical field, there are plenty of people getting free chemo treatments – the biggest mistake is saying you have Private Health Insurance. Miraculously, the amounts go up, and you have to pay for it.

    • 0
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      Except Inextratime , your specialist could, maybe should have, taken your financial situation into consideration, that is a good story and a terrible story, good one, of you being here, and another one the bad one is of your specialist deciding that he is worth many hundreds of dollars for precious minutes.
      To be charged like that when a doctor probably has several ops in a surgery day, they must make a fortune.
      But some of them will say , its my right, the greed that is.

      So its a pity the government can’t demand proper cover from health funds instead of profiteering on the health funds behalf, you see privatising means simply we must profit, its why health should never be privatised. only the blind or the greedy can’t see that.

    • 0
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      Inextratime I am glad you brought up the subject of Insurance premiums for Doctors and specialists. For some specialties it can be over $100,000 a year and on top of that add all the extra costs to run the practice and after years of study before they can even start a practice. Having multiple medical problems and being unable to wait for the public system I have private cover but at big cost to my budget. So far I have been lucky in my choice of specialists but find you may need to shop around when being referred by your GP to find one who charges close to the recommended cost or who bulk bills. As an aged pensioner I try and do this.

  6. 0
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    Yes I have had to pay between $68 and $180 out of pocket for Specialist and Optical visits, and count myself very fortunate that it was not more – from what you say about WA being at such a low level for bulk billing.
    We have just had to change Health Funds due to the increases. and find one which gave us
    what we needed but for less.
    It’s enough to increase our health issues with the worry of it all. We are just ordinary Pensioners on the Age Pension.

  7. 0
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    The proposed increase of between 4 and 5%in health funds does not mean that the funds have to abide by this. CBHS have increase our contributions by 8.36% how can they justify double the agreed figure?

    • 0
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      Mine went up 12.9%. Absolute RORT and all I got was mumbo jumbo from my fund saying that ‘increases were needed in order to offer better benefits to their customers’. Still don’t quite get that as they offer LESS benefits, for HIGH premiums.

  8. 0
    0

    I just had an MRI on my back last week in Brisbane, no Government rebate, why I don’t know, out of pocket $475 – a big whack out of my pension!
    Several years ago, had a back fusion in Gold Coast, was in private health care, he charged $10k plus whatever he got from Government which was heaps!
    The medical profession in Australia has long run the Government the way they want, thus why so many of them in Parliament.
    Their fees should be controlled and they should be forced to charge Pensioners/Disabled etc. only the Government fee.

    • 0
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      MRIs are not authorised for all conditions mogo51. You have to meet strict criteria and those criteria exclude many ‘go see’ investigations under the medicare rebates. As you have experienced, you can have the MRI but you have to pay if your ‘condition’ is outside the guidelines.

    • 0
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      Mogo 51 MRIs and a lot of other radiology based tests rose in Cost in January when the current government refused to fund them. There is no refund from medicare for them anymore. You can have them at public hospitals though and there is no fee for them there.

    • 0
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      The only reason you need to see a specialist for an MRI is because Medicare says your conditions requires a specialists referral for a rebate. If you are prepared to pay the cost yourself then you can have a MRI without a referral from a specialist.

      Also only certain places with MRIs are licenced under Medicare for certain conditions. I know the Gold Coast has some of these places that Medicare does not give any rebates.

    • 0
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      Moved up from the Far South Coast – I’ve lost my Mogo………

      Anyway – I think some of these medical professionals over-rate themselves….

  9. 0
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    I have always had issues with Specialists fees and their practice of managing visits. The one we use regularly (annually) usually manages to make the next visit outside of the twelve month window, which means we have to get another referral from our local GP, another cost. Then he charges the first visit fee which is usually 20% more than a follow up?

    Can only blame the government for messing up Medibank, Medicare, etc.

    The other reason is the way Specialists protect themselves from competition by limiting the number of specialists. Only they have control over who gets the next position.

    • 0
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      I said this before but it seems to have been deleted for some reason. The re-referral demanded by some specialists is a real bugbear for GPs too 4b2.

    • 0
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      You can ask your GP for a never-ending referral. I have done this twice. Once my skin specialist was very snaky about it, but the lung specialist is quite happy

    • 0
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      I always get indefinite referrals now but you have to remember that the specialist can only treat what your were referred for and not something else as well.

  10. 0
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    My specialist was to charge roughly $2,300 when he was advised it may be a compo claim the cost went to approximately $3,200, you work it out.

    • 0
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      Doesn’t that seem to happen all the time? When we were all more or less forced to get private health cover health funds were billed by the medical fraternity but we still seemed to have to pay the normal medical fees as a gap payment.
      The first home buyers’ grant to help people into a home didn’t work because the house prices went up by the amount of the grant.
      First home buyers are given stamp duty exemption, won’t help because house prices will go up by that amount…across the board, so everyone will have to pay extra to buy a house. Or am I being cynical

    • 0
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      Agree very Strongly Triss – Business seems to gobble up any goverment grant meant to help the struggling, whether it is housing or health.

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