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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