Iron deficiency and the Medicare gap in women’s health

A mother of five recently attended my practice with profound fatigue. She was struggling to work, care for her children and manage the demands of daily life. Blood tests confirmed significant iron deficiency. The appropriate treatment was clear: an intravenous iron infusion.

The problem was not the diagnosis.

The problem was the cost.

In my practice, patients typically face out-of-pocket costs of approximately $250 for an iron infusion. For some families, particularly during a cost-of-living crisis, that amount is simply unaffordable.

Iron deficiency is one of the most common nutritional deficiencies in Australia and disproportionately affects women of reproductive age because of menstruation, pregnancy and childbirth.

Left untreated, iron deficiency may progress to iron deficiency anaemia, increasing the risk of hospitalisation and, in severe cases, blood transfusion. While oral iron supplementation remains first-line treatment, many patients experience gastrointestinal side effects, poor tolerance or inadequate response.

Australian data suggest iron deficiency affects up to one in five women of reproductive age, making it a common reason for presentation in general practice. Despite its prevalence, access to timely treatment remains heavily influenced by geography, service availability and a patient's capacity to meet out-of-pocket costs. While intravenous iron preparations are subsidised through the Pharmaceutical Benefits Scheme, there is currently no dedicated Medicare Benefits Schedule item supporting iron infusion administration in general practice.

As a general practitioner in Queensland, I regularly see the consequences of this funding gap. In recent months, I have cared for multiple women whose treatment was delayed because they could not afford the upfront cost of treatment.

This situation is neither clinically sensible nor economically efficient. A single iron infusion delivered in general practice may prevent repeated consultations, pathology testing, emergency presentations, hospital-based infusions and, in severe cases, blood transfusion. The cost of a single emergency department presentation or hospital admission can substantially exceed the cost of delivering an iron infusion in general practice. Redirecting appropriate patients to community-based care represents an opportunity to improve outcomes while reducing pressure on already stretched hospital services.

Evidence suggests that timely treatment of iron deficiency reduces progression to severe anaemia, avoids unnecessary hospital-based care and improves quality of life. A relatively modest investment in community-based iron infusion services has the potential to reduce emergency presentations, hospital admissions and blood transfusions, while improving workforce participation and productivity.

For many women, the barrier is not medical uncertainty but financial access to treatment.

This is fundamentally a women's health equity issue.. When access depends on a patient's ability to pay, those most affected by the condition are often those least able to obtain prompt care.

The Commonwealth should introduce a dedicated Medicare Benefits Schedule item for iron infusion administration in appropriately equipped general practices, improving access while reducing avoidable hospital presentations, blood transfusions and downstream healthcare costs.

Across Australia, thousands of general practices already deliver procedural care safely and effectively. Iron infusion services can be integrated into existing primary care models with minimal additional infrastructure.

The infrastructure exists. The workforce exists. The expertise exists.

What is missing is appropriate Medicare support.

No Australian woman should require a hospital admission, emergency department presentation or blood transfusion because a simple, effective treatment was financially out of reach. Introducing a dedicated Medicare Benefits Schedule item for iron infusion administration in general practice would improve access, strengthen women's health equity, reduce avoidable hospital demand and deliver better value for taxpayers.

The solution already exists. It is time for Medicare funding to catch up.

Dr Stephen Hitchin is a Queensland General Practitioner with interests in public health, health policy and equitable access to healthcare.