As doctors, especially GPs, we’re pretty under the pump right now. Frozen rebates, safety net changes on the cards, and a vague suspicion the many ongoing reviews may end up being thinly veiled measures to cut costs in primary care. But if we think we have it tough, let’s turn our sights briefly to […]
As doctors, especially GPs, we’re pretty under the pump right now. Frozen rebates, safety net changes on the cards, and a vague suspicion the many ongoing reviews may end up being thinly veiled measures to cut costs in primary care.
But if we think we have it tough, let’s turn our sights briefly to the plight of those unfortunate enough to be heavy users of the healthcare system. Those whose lives are regularly punctuated by blood tests, scans, GP visits, specialist visits, expensive treatments and hospitalisations.
Each individual practitioner, a single touch-point in a person’s care, has little cause to think too hard about the entire costs that burden their patients.
As someone eloquent wrote about a patient negotiating the healthcare system, “The patient is the only person who sees the whole journey”. This is just as true regarding costs; only the patient and their family know how much they’re really paying out.
But if a few things that came across my desk recently are any guide, the cost of being a patient is burgeoning at an unfettered pace.
Let’s break down some of the costs of being sick.
For a start, the cost of private health insurance is rising at rates well above inflation, typically between 5 and 7% each year. On top of this, as AMA President, Brian Owler, says in his editorial, some funds are downgrading their policies.
In a move reminiscent of Cadbury’s shrinking Freddo Frog and Family Block, some funds are asking customers to pay more just to retain exactly the same benefits, letting them know only after the event.
Meanwhile, the government’s private health insurance survey is sowing a particularly nasty seed – that of risk stratification – by floating the idea that smokers, for example, should perhaps pay higher premiums. Talk about a slippery slope.
Then there’s doctor’s fees and treatment charges. With frozen Medicare rebates, out-of-pocket costs will likely escalate, and if the safety net changes pass the Senate, insult will only be added to injury.
To take one example, it’s been estimated that private patients undergoing a typical six to seven week course of radiation treatment currently pay $12,000 in out of pocket expenses, with $10,000 covered by the Safety Net.
Under the proposed arrangement, the 150% cap will mean the Safety Net will covers only $8,000, leaving the patient $4,000 out of pocket. Other estimates of out-of-pocket costs for a course of radiotherapy have been as high as $10,000.
And some investigations recommended for people with chronic or serious illness aren’t even on the MBS to start with.
In its submission to the MBS review, Breast Cancer Network Australia listed several of these for breast cancer alone:
- Bone density scans for women treated with an aromatase inhibitor
- Breast MRI in particular circumstances
- PET scans
- Lymphoedema compression garments, which by the way can cost over $500 and don’t last all that long
- Oncotype DX gene expression profiling, which can predict whether a woman can safely avoid chemotherapy
But wait, people can claim health expenses on their tax, can’t they?
Yes, but not much anymore, and not for long. The tax offset for medical expenses is in the process of being phased out, so now even those below the means test threshold can claim only 20% of costs over around $2000. Come 2019, even that will be scrapped.
And just last week, a Cancer Council Victoria probe into parking at cancer centres found patients receiving uncomplicated treatment spend $1100 a year on parking fees, while those battling more complex issues spend far more. It’s not likely to be a uniquely Victorian problem.
All this, without even mentioning drug costs or allied health.
Things need to change.