Patients hit by gap fees due to being “locked in” to private system

Public Health

By David Rowley

16 Apr 2019

Private surgeons’ fees and radiotherapy are the main culprits in excessive out-of-pocket costs for cancer patients who are unneccesarily ‘locked in’ to the private system, Chief Medical Officer Professor Brendan Murphy has told a Senate Estimates hearing.

In most cases out of pocket costs were less than $1000, but patients should nevertheless be told they have a choice at every stage in their treatment because there is good capacity to manage them in public medical oncology and radiotherapy units, Professor Murphy told the Community Affairs Legislation Committee on 10 April.

The Estimates hearing was told that a few cancer patients had out of pocket fees of up to $20,000, but these were rare and mostly restricted to patients in Sydney and Melbourne who had a “very big surgeon fee element” – sometimes as much as $10,000.

Professor Murphy said that in most cases out of pocket fees tended to accumulate over the course of cancer treatment in the private system with the main costs coming from surgery, radiotherapy, imaging and chemotherapy.

“Once people start a cancer journey in the private system, they tend to get locked into it and are not necessarily offered a choice,” he said.

“One of the clear messages [from our review] was that people who see a surgeon, or a radiation oncology provider, without knowing in advance what they’re going to be charged, are informed of the bill in practice—they feel they can’t extricate themselves from that relationship and get another opinion. So, there was a clear driver  … to promote transparency so that people could find out what someone was charging before they actually made the initial appointment.”

Professor Murphy said there were “perfectly good alternatives in the public system” and patients with a cancer diagnosis would receive appropriate treatment such as surgery within the standard performance indicator benchmark waiting time of 30 days.

But while in theory patients in the public system should not face any out-of-pocket costs for treatment, Professor Murphy acknowledged they could still face costs for scans if they chose to have them done privately and for prescription costs for PBS drugs.

“The oncologist may want to do a scan that is not currently available in the public hospital, hasn’t been through the MSAC and may not be absolutely essential for the diagnosis. They may make a private external referral to get that done,” he said.

Meanwhile, a Senate Estimates hearing was told that a government initiative to force specialists to reveal their fees on a public website is unlikely to become reality until 2020.

Professor Murphy told an earlier hearing that the task of developing a searchable website of specialist fees to allow patients to make comparisons had proved complex and would take time.

“There’s a fair bit of work to be done before we could go live. On the website development, particularly with an early focus on cancer specialists, there’s a lot of consultation to be done and a lot of information. The advice is that developing a website could—it’s unlikely to do anything this year; it’s likely to be next calendar year before we can get anything that could be in a position to go live,” he said.

The AMA  has been critical of health minister Greg Hunt’s  “gap fee” initiative, saying the fee transparency website will do nothing to inform patients about their likely out-of-pocket costs unless it also lists what patients can expect back from Medicare and their private health insurance fund.

“The AMA supports and actively encourages full transparency of doctors’ fees, and unreservedly condemns egregious billing, which occurs in a very small percentage of cases,” said AMA President Dr Tony Bartone.

“But that transparency must extend to both the size of the MBS rebate and the private health insurance contribution to the cost of treatment.”

“While it appears that this website will include information about MBS rebates, will it show the specific rebate for a given procedure, or just the average out-of-pocket cost in tiers?

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