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DOCTORS’ fees have once again been in the news, following a recent Four Corners report that put a brutal spotlight on the huge out-of-pocket medical expenses some patients pay.
Take, for example, the case of John Dunn, a privately insured patient in need of surgery after a diagnosis of aggressive prostate cancer. John wound up with a bill of $25 000, an eye-watering $18 000 of which was out-of-pocket expenses, after Medicare and private health fund rebates. Most of this went to his GP-referred surgeon, who charged $16 000. But there were also fees for the anaesthetist (over $3000), the biopsy ($1600), the magnetic resonance imaging ($450) and sundry other expenses.
“It shocks you,” Mr Dunn told Four Corners. “You live in this world where you have Medicare, a universal health fund, and you’ve got a private health fund, you’re paying in substantial fees, and lo and behold, you’re 18 grand out of pocket when you have one operation.”
Reports of egregious out-of-pocket expenses tend to be anecdotal, and it’s hard to get a clear picture of what is happening across the board. But a new Research Letter published in the MJA goes some way towards this. It looks at the Medicare data of a population-based cohort of 452 Queensland patients diagnosed with one of the five major cancers (breast, prostate, colon/rectum, melanoma, lung), identifying all billed services for consultations, tests, imaging, procedures and medication.
The study authors, led by Associate Professor Louisa Gordon of the QIMR Berghofer Medical Research Institute, found that median out-of-pocket expenses were highest for patients with breast and prostate cancer ($4192 and $3175, respectively) and lowest for patients with lung cancer ($1078). The median proportion of fees covered by Medicare was 63%. Around a quarter of cancer survivors paid upfront doctors’ fees of more than $20 000 over 2 years.
Professor Gordon says that the study showed a huge variation in out-of-pocket expenses, from $23,000 over 2 years at the extreme high end, to just a few hundred dollars for some patients.
“It’s certainly difficult to predict what the costs might be,” she told MJA InSIght in an exclusive podcast. “Patients have to have conversations with all their health care providers and that’s the challenge. They may not meet the anaesthetist or the assistant surgeon during their visits and they may not know what they’re going to need after surgery. It’s quite a complex pathway to navigate.”
Professor Gordon says that a broader problem in her view is that the private health insurance market is failing people.
“People are not getting good value for care and the government is continuing to prop up the private health system with subsidies. I think the government needs to face the fact that it’s a costly system and maybe we should think about shrinking the private health insurance market and putting that money back into the public system.”
Leanne Wells, CEO of the Consumers Health Forum of Australia, says that the new research clearly shows that for many patients, costs pose “a very heavy burden” and call into question equity of access in Australia’s private–public health system.
She says that there are two immediate steps that should be taken. The first is greater clarity and transparency on medical fees, including the provision of a single bill to patients giving the overall cost of a course of treatment and an authoritative website listing the fee scales of individual specialists.
The second step would be a Productivity Commission inquiry into government assistance to private health insurance.
“A fundamental problem right now is a dearth of solid data about the private health market, supply and demand of services and specialists and measurement of cost effectiveness in health care,” she says.
“We think the question of subsidies for private insurance does require scrutiny and that is why we recommend a Productivity Commission inquiry to explore questions such as the impact of health insurance subsidies on the overall operation of the health system.”
Dr Tony Bartone, newly elected to the presidency of the Australian Medical Association (AMA), says that the problem of out-of-pocket expenses is multifactorial, and doctors certainly shouldn’t cop all the blame.
“Funding is a key component. Gaps exist because of the longstanding lack of funding, leading to a divergence between the provision of good quality of service and the rebate, whether it’s the Medicare Benefits Schedule rebate or the matching private health service rebate.”
But he says that the other issue is the need for a full and frank discussion with the patient about the financial implications of treatment.
“Informed financial consent needs to be understood as a requirement in this area,” he told MJA InSight. “Most doctors practise that, and patients should be aware that it underpins good ethical and transparent care. I do believe the majority of doctors are doing the right thing by patients.”
He points to data from the Australian Prudential Regulation Authority which show that 89% of all private hospital procedures are performed with no gap fees, and a further 6% are performed with a known gap, usually capped at no more than $500.
Dr Bartone adds that the AMA has vigorously condemned the overbilling that he says is practised by only a small minority of doctors.
“We cannot support or endorse egregious billing. At our recent conference, our members almost unanimously called out egregious billing as abhorrent, and we’ll speak loudly against it whenever we get the opportunity.”
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Firstly, if you don’t value your self, no one else will either. If you are willing to service those country patients for $200 or $300, guess what…next year the insurer will see if you are willing to work for $150…and then for $100, why not? less for you more for them!!!
Secondly, the more you give the more they will take, it is not a one to one relationship where reciprocity matters.
We need to start charing like bankers and asset managers. You want your arm fixed to get back to work, well, how much do you earn, i’ll take 20% of your earnings for the rest of your life, since with out getting your arm fixed you have no income.
Health insurers are now a CARTEL. AHSA is a cartel except that the stupid morons in ACCC have granted them an authorisation. We should all either corporatise like lawyers, accountants, engineers, etc. There should be only the 4 pillars of medical service companies in Australia just like the banks, its the only way to fight back against the hospital and insurer cartels. After all, if you are a single company then as per the law, you are not competing against each other and you are free to set your terms and conditions instead of dancing to the rentier’s tune like yo are doing now.
There is also the option of doctors banding together and applying for authorisation from ACCC for collective bargaining as a ” advocacy group ” , this is the same authorisation AHSA has. After all, how can it be that 20-30 title health funds that are suppose to be in competition with each other both for patients and for doctor services are allowed to band together and engage in price fixing.
You will not beat them by complaining on this website, you have to grow a back bone and learn how the game is played. But alas, doctors are stupid idiots and therefore deserve to be ensalved or conscripted into cheap labour.
Again a discussion on the cost to the economy of health care with little acknowledgment of the benefits that accrue to having a healthy workforce. After all, even pensioners often act as carers, child minders and other non-paid positions.
I am surprised that no one has so far mentioned about some of the pathetic medical insurers and their random assignment of fees ” for a given procedure” and their shrewd and cunning ways to refuse to make payments for Patients after the patient has been in hospital classified as “Private” thus leaving the Provider with no way of getting reimbursement of fees .The notorious poor insurance companies in this category seem to have 3 alphabets starting in N and H or 4 alphabets starting in B.
And I am not talking about large Specialist fees or Surgical fees , but mere $130-300 range invoices for 2 or 3 day treatment in country hospital for a GP VMO….an these insurers refuse payment using various ruses and lies resulting in no fee recoverable for a significant number of “Private” inpatients….Notorious ones are these insurers with 3 alphabets starting in and H and 4 alphabets starting in B ….Others generally are very reasonable and it is the smaller Insurance Companies that seem to be prompt in payments and tend to make payment without trying to find lies and ruses to cop out from paying….
I would be interested to hear what Specialists would have to say on this given these cunning 3 alphabet insurers (starting in N and H) and the 4 alphabet one starting in B must be upto their tricks with Specialist fees and random assignment of their (insurers) designated fee for procedures…..
Fascinated that in the bleating by the ‘poor health insurers’, no one thought to mention that even a reasonable gap amount that is but $1 more than what the patient’s fund regards as the fee for that operation results in the fund pocketing its own rebate and paying only up to the Medicare Schedule Fee, which increases the patient gap.
And it’s not as if funds have a monopoly on determining that reasonable fee: all the fund fees are different too!
I sympathise with Indra Karalasingham, in a society where people are happy to pay more out of pocket for a tank of petrol than an hour of a highly trained GP’s time.
Single billing sounds attractive, but it is as impractical as quoting you your electricity bill in advance. Will you have teenagers staying and using more hot water, or will your cancer be more extensive than the MRI suggested and require adjuvant therapy?
Single billing is implemented in some major overseas institutions like the Mayo Clinic where all doctors are salaried employees, and all testing is done in-house. However, the upfront costs are about ten times higher than the Australian rates, and even then, no-one is guaranteed a capped price to cure their cancer, or treat any potential complication of their hip replacement. Getting one extremely high bill ($35,000 US for one of my patients with a simple wrist fracture in a US ski-field) is worse than getting multiple smaller bills which add up to a much lower total.
Similarly, listing “the fee scales of individual specialists” is more complex than putting a restaurant menu online. Is your soft tissue tumour a simple one which takes an hour of easy surgery, or a recurrent aggressive one which takes over six really difficult hours, like one I did last month? The Medicare item numbers and Medicare fees are the same. A simple carpal tunnel release or a redo of a failed one? Same Medicare number/fee. Are you a pensioner who needs to feed himself, a symphony orchestra musician, an NRL player, or a self-employed builder who needs to use a jackhammer as soon as possible? Medicare doesn’t differentiate. Treating your fracture at midnight Saturday or 9am Tuesday? Same Medicare fee.
It may surprise many patients to learn that Medicare fees are less sophisticated than taxi fares, which specify a fee per kilometre, a fee per minute for waiting time/delays, fees for tolls, after-hours, excess baggage, cleaning etc. No-one expects a taxi fare home from a night out to be the same for a 2km trip from Hornsby to Normanhurst at 8:30pm tomorrow, as a trip home to Canberra from the Sydney Opera House, leaving at 12:30 am on 1 January.
You can walk to the shops, take a $3 bus trip or a $12 taxi, ride a $300 secondhand mountain bike or a $25,000 carbon fibre racing bike, drive a $30,000 Commodore or a $500,000 Bentley. Walking is the most exercise, the bikes are quickest because you can park right in front of the shop, the Bentley has the biggest boot and is probably (sorry Jeremy Clarkson, never driven one) the most comfy if you have a bad back. The bus has the biggest government subsidy, being publicly owned, and the bikes would presumably be condemned by Prof Gordon, as they are private vehicles propped up by government subsidies like toll free bike lanes and no licence or registration costs. Walking or biking with shopping is not an option for many disabled people and even many healthy elderly, or pregnant women with toddlers. People in outer suburbs of Sydney may only dream of public transport, or of shops within walking distance.
The fact that a wildly expensive Cervelo with carbon wheels, or a Bentley with a humidor, is available, does not force anyone to buy it. The sales tax on a Bentley, or the top marginal income tax rate on a $16,000 surgical bill, will subsidise a lot of taxi rides or Medicare bills for my blind patients. There are laws governing false advertising, and doctors have even more draconian regulation than bike or car sellers. This year my after-tax, out of pocket cost for my health insurance is over $5000 for 2 people. My wife and I get nothing for that, unless we get sick enough to need an operation, but it is a voluntary transaction, not something we were forced to do. It means that if we do need an operation, we can get a top surgeon to do it, in a reasonable timeframe.
Doctors are very sheepish to admit that if Mr Dunn had gone to a public hospital, his surgery would probably have been done by a trainee surgeon. That is how we all learned our surgical skills, and at some stage, each of us was doing our first case of a particular operation. Unlike learner drivers, there is no guarantee that a more senior person will be present, and even if they are, a split second mistake can cause an accident which may not be fixable. We all know that P-Plate drivers are more dangerous, even though they are licensed to be unsupervised. It is routine that someone like Mr Dunn can be admitted to a public hospital for cancer surgery without ever having met the person who will be doing the operation, and if it happens to be change of term, or the hospital has no outpatient clinic, may never see the operating surgeon for followup.
Many Australians choose to buy a Commodore because it is more comfortable and convenient than a cheap bike (and the car is certainly safer in a collision), or an even cheaper bus fare. The ABC does not shine “a brutal spotlight” on this “huge out of pocket” expense. Why is there a problem if some people choose to spend a similar amount of money for an operation?
The sad fact is that when I trained in the 1970s and 80s, public hospitals did have outpatient departments where people could be assessed and treated in a timely fashion by trainees and fully qualified specialists, free of charge, cheaper than a bus ticket. Successive governments of all political persuasions have cut these facilities from most hospitals to save money, so that appointments and tests are done outside the hospital. Again, few patients realise the appalling cock-up of our federal system, where the state government can save its budget by cutting hospital services, forcing people to use more out-of-hospital or private hospital facilities, subsidised by the federal government via Medicare.
The issue is not whether a Commodore is worth tens of thousands of dollars, but whether it is reasonable to cut existing government bus services and thus force people to buy one. “18 grand out of pocket when you have one operation”? – I’ve paid more than that repeatedly for several cars over the last 35 yrs, and would be very happy to pay that to save my life.
GPs are not silly to Bulk Bill .Its damn foolish of anyone to suggest that without looking at the reality on the Ground. The reality is there is undue pressure from public expectation to several others that have to come in to make Bulk bIlling an unchangeable entity for majority of General Practice. Go do a survey and you will find that majority if not almost all GPs would prefer stopping Bulk Billing , if it was enforced as the accepted national norm, instead of having to individually having to make the change and find they are treated as out casts .
With regard to over utilisation , if Bulk Billing is stopped , over utilisation by people who use it for silly reasons will stop and perhaps, wasteful utilisation of services will reduce…. just as wasteful utilisation of hospitals and services will too if MBS items for hospital items are also carefully scrutinised !!
It’s the baby boomers, sitting there on their unearned fortunes via property inflation, demanding:
1. we work and pay taxes to subsidise their multiple investment properties,
2. we work and pay taxes so they can collect the pension in the $2-3M house
3. demand caps on fees, practice restrictions etc so they don’t have to pay their way
4. call the younger generations greesy when in fact the greed is as evidenced above
I don’t think so, you will pay and pay you will through the bleeding nose!!!!
Thank god for the constitution that prevents the mongrels from ensalving us. Learn your rights doctors, you are not powerless.
BTW, the gapcover agreements are not contracts, they are not enforceable, and they are patient benefits. If they fund doesn’t pay, send the patient a NOTICE OF FUND default and demand payment. You have every right to deliver your services on your terms and conditions and with the price you set. You do not need to be a puppet to insurance or government. This is guarranteed in the constitution section 51 which as per the high court in PSR case has held for many many many years that doctors are not to be conscripted in every sense of that word, ie legally, economically or in any practical way.
In my humble opinion, the gentleman who went public regarding the fees, could have been a deliberate set up. If he didn’t like the fees, why did he discuss it with the surgeon . He chose to pay the fees, which means he accepted the fees for the quality of care and expert service he got . Then he does a turnaround and goes on National TV to whinge about fees . Shouldn’t he have discussed with Surgeon regarding the fees or chose other options.
I find it very odd that no fees (MBS) or other fees have increased very little in 10 or 20 years, but there are those who complain, but they have money for the Pokies, cigarettes and every other non essential item you can think of, but despite they want Bulk Billing or demand low fees…. think how much the fees have changed for tradies, building a house, land price, petrol price, cost of travel ……Unrealistic expectations….fuelled by expectation that Doctors fees should be suppressed …go look at Corporate Chiefs making 10-15 million dollars a year and bonuses …. and no one questions them….interestingly Britain is passing legislation in the next few weeks limiting companies from paying executive salaries with a significant difference to employees …(not sure how they will quantify significant difference) …..And I am sure companies will figure ways to get around it !!
The fundamental problem is that Medicare is open ended with, potentially, no price signal if patients can find a GP silly enough to bulk bill, of which there are many. Over 80% of GP services are bulk billed (not the same as 80% of patients of course) so there is no price signal especially for GP services which almost certainly are over utilised. As someone once commented, Medicare is like car insurance that covers you fully for minor carpark scrapes but if your car is written off or stolen, you are given a book of bus tickets.
It all has to be paid for by someone, either out of pocket, by insurers or by the tax payer but by introducing a price signal there would be a reduction in unnecessary consultations and tests. The patient has to know what they are paying for, so even if the Medicare rebate is accepted as full payment, by giving the bill to them they know for what they are paying.
GP have become far to dependent on the government.
A far bigger problem than out of pocket costs to the patient is the manipulation of the Medicare item numbers by surgeons and others who end being recompensed much more than if they had accurately billed and charged AMA rates.
I love it when recently retired clinicians or those in the twilight of their careers advocate for a cap on fees:
Graduated high school in 1970:
– University (free)
– Age at graduation (likely 23-24)
– Training (efficient)
– Age at fellowship (likely 30-32)
– Housing near major hospitals (affordable)
Graduated high school in 2005:
– University ($100,000 plus on HECS)
– Further university (let’s face it, we almost all have at least a Master’s extra – $30,000)
– Age at graduation (26-29 if you’re lucky)
– Training (an absolute nightmare with many ‘unaccredited years’)
– Age at fellowship (likely 40-45)
– Housing near major hospitals (multiple millions)
Oh, and fund reimbursement has fallen off a cliff relative to CPI.
But the oldies are right – those of us establishing our careers should have tight caps on what we can charge.
It’s very easy to throw stones from ivory towers. I guess we’ll just clap whilst they rattle their jewellery.
In my experience are the Anaesthetists, who also have no professional etiquette and no bedside manner
I personally feel as long as the Specialist tells the patient beforehand what the costs are and gives the patient the choice of exploring costs of others etc and then making a decision to still pay that fees , that should not be a problem.
But I am really annoyed as a GP and in a very remote location I am continuing to Bulk Bill patients and getting a paltry $38 for my consultations despite my years of experience and wide variety of skills , that no one, not the RACGP or any of the medical representative bodies have bothered to publicly demand cessation of Bulk Billing for GP’s .
GP’s have been undervalued and undermined and continue to do so because they do not have any representative body with a back bone to stand up for them.
It annoys me that as a solo GP in an extremely remote location after bulk billing for over 10 years, If I change to Private Billing , because it will be seen as changing the Status Quo and against the National Trend, it will create an Uproar, that I am best to leave this location and move on because it is unviable to continue to under sell myself and work harder and longer to justify being in this location.
Most Tradies have hourly rates more than mine , and when I first moved here , there was a modest Hospital income that offset bulk billing then, but even the Hospital income has been Eroded by the Local Area Health devising measures to cut the GP VMO income significantly.
After 10 years, on review I find that my income today is at least 20 % less than 10 years ago, this despite inflation and change in cost of living over this period.
I have always bulk billed , but note the Specialists coming to nearby Large Centres (outside metropolitan cities), have never bulk billed ever !! And the population’s expectation to carry on bulk billing ….This is where I feel GPs have been let down by the RACGP and medical representative bodies….How is it realistic to ask a GP to bulk Bill when my consultation fee is approx. $38, despite my years of experience , when a Specialist Consultation fees in nearby regional Centre id $350.00 to $500.00 even for an initial consultation and any subsequent consultation.
I am contemplating my options as I do not want to create displeasure among my patients , as their expectation of Bulk Billing is unrealistic , but this has been built up nationally, to make people think that Bulk Billing by GPs should be the norm.
The Colleges and medical representative bodies have continuously let GPs down and instead of trying to demand or campaign that non Bulk Billing or Private Billing should be the norm for GPs, continue create unrealistic public expectation and thus resulting in GPs who do not Bulk Bill or change from Bulk billing to Private Billing become treated as Outcasts ….Very Very Poor and Unrealistic Situation….
$16000 or even $30000 to be rid of cancer is cheap, people pay $250 for a haircut, $450 to get the aircon serviced.
Australia has the most expensive houses, energy cost, labour cost, bulding cost, parking fees, toll roads, council costs, and most debt in the whole of the OECD but we don’t have the most expensive health care system!!!!
But we should, because doctors are too cheap in this country and they should all be charging minimum $5,000 for surgery:
1. preop consult $250
2. ordering tests – test ordering fee $300
3. review of test results – test review fee $1000
4. call patients for results $150
5. Refer to cardiologist or other – referral fee $250
6. review appointment for consent to surgery $300
7. Do the surgery…$1000/hour assume 2 hours = $2000
8. Post-op visits for 2 days $250*2 = $500
9. Take phone calls to discuss with colleagues and nurses $500 (the colleague your surgeon spoke to did not charge you, but they should just like the lawyers would)
10. Discharge summary and GP letter $300
11. Post -op review appointment $300
12. Disumbursements in secretarial charges, paper printing, stationary costs, travel costs $1000
total: $6850
thats not unreasonable is it…for the above the health fund would want to pay $1200 or around $50/hour
What a joke!!!
1. doctors are not slaves
2. that people are willing to pay high fees, and that there is demand for conscription, caps and the like is evidence that services doctors deliver do carry a HIGH value
3. Doctors should be allowed to gain from their investment specially given that that they are prevented from gaining from their expertise in other ways. For example, while you can patent almost anything, a surgeon is legally prevented from patenting a new operation they invent!!!
4. Doctors actually earn a pittance in comparison to the economic value they create. Compare this with your even more highly paid fund managers charging a % of your assets for doing nothing.
5. Doctors charge and earn less than lawyers who work under very controlled, relaxed, non-critical conditions
6. The college of surgeons both here and the USA has undertaken research and has bpublished data showing that fall in return on investment in surgical careers is the key reason why 18-22% of surgical trainees leave in their 1st year of training (you can FOI the college for that)
7. The Australian Constitution section 51 expressly prohibit any form of conscription either economic or practical or legal of medical providers and for good reason. Since doctors provide a high value high cost service, they do not
8.patients do not see the behind the scenes of medical practice and what goes into the delivery of their care and only want to pay nothing and get everything.
9.The new mentality that if I can’t afford it then someone else should pay for it eg tax payer. (not just in health care but also child care, housing, food, etc), if the tax payer won’t pay for it, the doctor should by way of reduced income, reduced return on investment, reduced time, reduced quality of life, etc…
10. Being jealous of someone else’s earning power, is not a reason to return to slavery, conscription, forced labour, etc
11. The cost of delivering a service can be determined in may different ways including the value of the service to the customer. If a customer highly values a service they are willing to pay top money for it, then they indeed have no reason to complain about it. To say that, this is a highly valued service for which we dont actually want to pay is indeed SLAVERY
12. Doctors could charge in the following ways:
a $X as fee for service all inclusive (current model)
b like a lawyer, charge a separate fee for every paperclip, meeting, phone call, discussion with colleagues, the surgery, the after surgery visits,
c like a fund manager/bank/financial broker, if i fix your arm so you can get back to work then i get 5% of your income for the next 20 years
13. There is no reason why doctors should be singled out fro every other profession to have income caps, enforced limits on where they can practice, type of practice, ability to profit from innovation, ability to profit from unique knowledge or position of influence (see media and lobbying industry that works only on selling influence), ability to profit
14. PROFIT & MONEY are not dirty words in medicine
15. Your intellectual assets are the biggest assets and just like no one would sell their house to someone for cheap because they felt sorry for them, a doctor should not be expected to sell their skills and intellectual assets for cheap. Indeed as people who sell labour, doctors are entitiled to get the highest price they can for their labour as do all other people in the economy.
16. Everyone, absolute everyone, seeks to improve their lot in life, improve their income, improve their economic position and doctors are no different and have the same rights as others. They are not salves to the rest of the economy. That they can earn a high income is necessary since they cannot build assets in the same way that other businesses can and do.
17. Doctors earn too little when you look at lifetime earnings and most are in fact behind in life compared to their contemporaries who went into other areas.
Out-of-pocket medical fees are certainly out of control……………….as there are actually no formal controls on medical fees.
Individual written Informed Financial Consent seems an essential legal requirement for any proposed out-of-pocket fees.
Referring Practitioners should be very familiar, not only with the clinical and technical expertise of the Specialists to whom they refer, but also the fees their patients are likely to incur.
Australia has a very good Health System, unfortunately bedevilled by some fundamental and interrelated problems.
In particular:
1. Failure of fair and efficient distribution of health services and practitioners to properly service the population.
2. Failure to provide fair and equal reward for services provided……a problem increased by the distorting effects of the uncapped Fee-for-Service system.
3. The vain hope that market forces will solve 1 and 2.
Any solution(s) would seem likely to be painful, especially in the short term.
Hamish Foster
Surgeon
Recently retired
Overcharging is certainly multi-factorial. Some doctors feel that high fees are a sign of their own excellence and unfortunately so do some patients. It is often said that if a doctor, and especially a surgeon, wishes to become busier then the best plan is to increase the fees. Patients feel the most expensive must be the best.
The root of the problem is that the rebates from both Medicare and the health Funds have not gone up with the CPI or AWE over the last 40 years. 40 years ago the vast majority of patients were covered fully by their Private Health Insurance.
The AMA suggested list of fees is in keeping with inflation over that time and I assume the fees are what the AMA considers to be fair and reasonable. Otherwise wouldn’t the AMA set lower fees?
The major health funds are in business for profit for their share holders and are basically guilty of under insuring their clients.
The Doctor’s Health Fund (previously known as the AMA Health Fund) offers a Top Cover to its members which covers to the AMA fee. I hold Top Cover in this fund. It is not that much more expensive than the usual “Alliance Fund” level of cover. Other health funds could offer the same level of cover.
If people could cover themselves for the AMA fee then it is very likely that the vast majority of patients would not have out of pocket expenses.
Then the AMA and other bodies could chase down the few egregious chargers.
By saying that most charges are no gap or small known gap anyway, I believe the AMA is not supporting its own level of suggested fees and is shooting itself in the foot.
The federal government is propping up the private health system to the tune of billions per year by subsidising membership fees. The government needs to stop subsidising private health that thrives on our neglect of preventative health and redirect tax payers money to creating a healthy society through promotion of primary and secondary prevention.
High out of pockets costs are not just confined to a small number of doctors or practices. That is patently not the case given the high OOP costs for the entire population. It is now a feature endemic in the Australian healthcare system. Our specialists as a whole are among the highest paid in the OECD nations. I agree with the new AMA president it is multifactorial but the behaviour of the specialities has a lot to do with it. Maldistribution of the workforce is also a major factor – take the fact that there are over 100 psychiatrists with a registered practice in the LGA of Mosman and not one in the LGA of Blacktown on the other side of Sydney. The fact that Blacktown’s population is 10 times that of Mosman makes the situation beyond obscene. It means people of Blacktown which will experiences significantly elevated levels of psychological distress and higher rates of mood disorders and suicide than the residents of Mosman have no access to early intervention and treatment beyond the door of the ED at Liverpool Hospital. This is just one of numerous egregious examples across the nation.
The real discussion is not about OOC costs, but how we can have a publicly subsided model of care that supports the right of the professions in medicine to decide when they practice, what they charge and how any graduates can practice in each speciality. Medicare is desperate need of root and branch reform in order to again be a truly universal health care system working for the health and interest of the nation.
Let us not forget that the MBS fee schedule has only increased by about 30 percent of CPI since Medicare started. Practice costs especially indemnity insurance have increased by more than CPI.