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Out-of-pocket costs for patients unexpected and unaffordable

09 April, 2018

‘It’s not surprising that so many patients have reported significant out-of-pocket medical costs, even when they have private health insurance ’, Australian Healthcare and Hospitals Association (AHHA) Chief Executive Alison Verhoeven said today.

Verhoeven was commenting on the recent release of the Consumers Health Forum’s Out of pocket pain report.

‘People’s first-hand accounts of their experiences paint a picture of a private health system they see as high cost, complex and confusing.

‘The Australian Government’s decision to instigate a review of out-of-pocket costs is therefore very timely.

‘There are several ways in which unanticipated and sometimes unaffordable bills can land in the patient’s lap.

‘For example, although many specialists do provide details of the fees they will charge for their services, a person may be required to see several different health service providers for their condition.

‘To continue the example, before procedure A can be started, test B must be performed, and if that test shows factor C, then health provider D should be consulted. If test B is performed outside a hospital it may not be claimable on health insurance—and so on.

‘With each provider charging for their services and no clear idea on the claimability or benefits payable on the various items, either from private health insurance or Medicare, the overall amount of money the patient is required to spend adds to something significantly more than first anticipated.

‘Patients are often urged to ‘shop around’ and negotiate on fees if they are not satisfied. But it can be very difficult for people to negotiate fees with their doctors, particularly when they are very unwell and with the limited information currently available about what might be a reasonable fee.

‘Even when patients do shop around they can be notified after the event that their treating specialist used the assistance of another health service provider whose bill isn’t covered by private health insurance or Medicare.

‘The fact that some patients are dipping into superannuation to pay five-figure medical bills shows how some out-of-pocket costs are getting out of hand.

‘It also shows that the Australian Government would benefit from including more consumer and patient organisations on its review committees if they want to know first-hand the impacts the current system is having on ordinary Australians.

‘The current out-of-pocket costs review committee is dominated by doctor organisations, private health providers and private health insurers—the very people who benefit most from leaving the system as it currently is.

‘As the private healthcare system, its out-of-pocket costs and increasing confusion continue to run away from us, we reiterate our own call for a Productivity Commission review of the health system, including an appropriate and affordable balance between private and public healthcare that is patient-centred rather than provider-centred.’

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Eunice Wingrove | Tuesday, April 10, 2018, 1:16 AM
That all sounds so spot on of my experiences and I'm sure of many other patients. The biggest concern is lack of information about what will be covered by Medicare (and has its scheduled fees been realistically updated) and my private health insurance (with top cover) who I believe are doing a great job (HCF) by providing a variety of 'preventative' services and also reduced-cost 'extra' services to reduce the chance of clients becoming ill or improving their chances of rehabilitation - along the lines of my belief that "prevention is better than cure". I do suspect the Productivity Commission approach (albeit a big cost) is the only way we can reassemble the health care supports in a way that everyone is held accountable for their 'charges' and as much red tape has possible is reduced regarding the referral system. Thanks for the opportunity to comment! :)
Juliah | Tuesday, April 10, 2018, 2:17 AM
Disgraceful. Why do specialists feel they are worth high out of pockets? The government needs to step in and stop this. Not all but some are very greedy people. I feel for those who are on a pension and trying to cope with very high out of pockets.
Roger Graham | Tuesday, April 10, 2018, 3:37 AM
I don’t get out of pocket expenses because my health fund pays the AMA fee rate to my doctors. Why not ask the funds why they don’t offer that option before complaining about the doctors fees.
owen crombie | Tuesday, April 10, 2018, 3:57 AM
There has got be something wrong with a system where I pay my Medicare levy, and my top level private health insurance and then get a bill at the end of it for $2000 for a knee arthroscopy, where a public patient,at does not pay any private health insurance pays nothing at the end.
Narelyn Nash | Tuesday, April 10, 2018, 4:01 AM
Totally agree with the stuff up of the current medical system. We pay both Medicare Levy and Private Health Insurance and have currently been out of pocket of nearly $10,000 for my husband's prostate surgery. MRI's not covered under either Medicare or private health. Disgusting to see so many other people affected by this surgery especially as it is one of the major cancers in men. You are damned if you do and damned if you don't have private health insurance. We did not have the choice to wait for a public wait list.
Jim Walter | Tuesday, April 10, 2018, 5:15 AM
Doctors' fees are not the major cost. But having said that, i do think that many specialists don't have a feel for the financial fears and financial limitations of the general public. I have to be careful here to completely own my own view, but i believe that this statement particularly applies to more recent ethnic groups entering medicine.
Jackie | Tuesday, April 10, 2018, 5:32 AM
Private health fund is a scam, they charge an arm and leg and paid up to nothing
Janet Thompson | Thursday, April 19, 2018, 7:14 AM
While blame is placed on doctors (who deserve their fees as what is more important than health?), doctor organisations, private health providers and insurers, there is no mention that no longer are the general public now able to claim the out of pocket expenses against tax returns which at least enabled some return of excessive out of pocket gap fees.
Julianne | Friday, April 27, 2018, 12:52 AM
Having undergone 5 separate spine operations in the last 4 years I can tell you that the OOP costs have been enormous. In one operation alone I was $15000 out of pocket just for the surgeons fee. Generally my operations cost me $10-$15K out of pocket. It is the Scheduled fee that is out of touch with reality. Some of the scheduled fees are ridiculously low for such expertise. All of my doctors studied for 10+ years with little reward and they hold my life if their hands. I am walking and breathing and have a good quality of life, thanks to my team. The scheduled fees need to reflect reality.