Out of pocket health cost pain

Out of pocket medical bills exceeding $10,000 have become common place for patients with breast cancer and certain chronic conditions, a national survey conducted by the Consumers Health Forum of Australia has found.


The Out of Pocket Pain survey drew 1,200 responses, many from people shocked to learn that despite having health insurance they still had to pay thousands of dollars out of their own pockets for critical surgery, other treatment and diagnostic scans.


The survey report Out of Pocket Pain and a companion report Hear Our Pain containing scores of personal stories of people’s experience with treatment costs is released today, Thursday 5 April.


“The responses to the survey give a disturbing insight into the high costs of medical care and challenge the notion that everyone can access the care they need in Australia,” the CEO of the Consumers Health Forum, Leanne Wells, said.


“We have heard from pensioners and single mothers who have foregone recommended care because of cost, from many people exasperated to find that the insurance they have held for many years will not cover gaps of thousands of dollars, from patients who learn belatedly of unexpected extra costs for junior surgeons, anaesthetists and MRI scans, and from people who have had to call for special access to their superannuation funds to cover the bills.


“Our results affirm what we know from the OECD, ABS and Australian Institute of Health and Welfare: Australian consumers face higher than average out of pocket costs and this translates into people often avoiding visiting a GP, failing to fill scripts and not acting on a specialist referral due to cost. This shouldn’t be happening in a country with the wealth of Australia.


“The expense is made the more difficult by the uncertainty and complexity of the relationship between treatment and costs with varying levels of cover, or no cover, provided by health funds and by Medicare.


Among key results of the survey are:

  • More than a quarter of respondents treated for breast cancer incurred out of pocket costs of more than $10,000
  • More than a third of respondents with chronic conditions like multiple sclerosis reported out of pocket costs of more than $10,000
  • One in six respondents said that out of pocket costs had a significant impact on their lives
  • A frequently-expressed view that using private health insurance would expose people to more costs
  • A third of respondents said the out of pocket costs were not explained to them before treatment.


Breast Cancer Network Australia CEO Kirsten Pilatti said: “BCNA has been outraged by a number of our members reporting extreme variations in out of pocket costs. Only full disclosure will ensure consumers can make the right choice for themselves.


“You ask for a second quote when looking for a tradesman so why would you not do the same for your health? We are encouraging people to ask for full costs upfront and get a second opinion before committing to any treatment that may impact the way they lead their lives.”


The CEO of CHOICE, Alan Kirkland, and the CEO of the National Rural Health Alliance, Mark Diamond, also attended the launch to highlight the impact of out of pockets costs on consumers and rural communities.

Mr Kirkland said:  "It can be completely perplexing and sometimes impossible for patients in need of surgery to work out how much they will be out of pocket. What’s worse, this often occurs when you are at your most vulnerable and least able to bargain over costs.


“There's no evidence of any link between the cost of a medical procedure and its quality or outcome. In short, you could be thousands of dollars out-of-pocket and have a worse outcome than you would from a specialist who charges a lower fee that's fully covered by your private health insurance.


“CHOICE wants to see a more transparent private health system in which consumers are given clear information at the right time, not when it's convenient for specialists, hospitals or health insurers.


“Average prices for common procedures such as knee replacement surgery, gall bladder and colonoscopy should be publicly available. People should be able to find out as early as possible whether the specialist is likely to charge them an out-of-pocket cost so they have the opportunity to ask their GP for other options."


5 April 2018.