Specialist care out of reach for many

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? 

Related articles:
Can you afford your healthcare?
Medicare rebate freeze to be lifted

Written by Debbie McTaggart


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