High and random medical gap costs revealed

The random scale and nature of out of pocket fees charged by medical specialists revealed in a new official report highlights the need for more equity and transparency in the health system, the Consumers Health Forum says.

The report into out of pocket charges for services outside hospitals released by the Australian Institute of Health and Welfare today (Thursday) shows nearly three quarters of specialists’ patients incur out of pocket costs which can vary markedly, and more than 1.3 million patients delay or don’t see a doctor because of cost.

“That many people do not access the specialist care that has been recommended by their GP presents a disturbing insight into the unbalanced access to care that is a reality in Australia today,” the CEO of the Consumers Health Forum, Leanne Wells, says.

“The AIHW report shows that 72 per cent of specialists’ patients incur an out of pocket charge and the national median cost is $64. The report demonstrates that patients from higher socio economic status areas are more likely to have out of pocket costs for all Medicare services. This suggests that high costs are not necessarily related to the quality of service, but that there is a link between capacity to pay and the cost charged.

“While the latest bulk billing figures for GP services show that 86 per cent of services are bulk billed, there were still more than seven million GP patients a year who had to pay an out of pocket charge.

“These latest figures contrast with the widely-cited figure that 86 per cent of privately insured patients do not face a gap for their specialist care in hospitals. The 86 per cent figure is sometimes questioned, but the likely difference with the costs facing patients of specialists outside hospital is further evidence of the unpredictable nature of out of pocket costs.

“The erratic impact of out of pocket health bills is underscored by the even greater out of pocket costs personally borne by people getting dental care.  The figures show that Australians paid a total of $5.7 billion for dentists, nearly double the figure paid in out of pocket medical costs.

“That dental care is not covered by Medicare remains an unresolved issue.  But for all those medical services which are covered by Medicare there is a strengthening case for a more transparent system so consumers can ascertain and compare the costs they face before seeing a specialist.

“Our Out of Pocket Pain report earlier this year showed widespread frustration about the “bill shock” many people encountered and the need for more clarity on fees.

“This latest report demonstrates we need transparency on fees across Medicare, for public and private patients. We continue to support the work being done by the Ministerial Committee into out of pocket costs and the potential development of a fee transparency website. This report shows the need for doctors to support such a website in the interests of consumers,” Ms Wells said.





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