Patients in Australia are encountering significant challenges with unexpected and high out-of-pocket medical costs, as highlighted by a breast cancer patient's experience and a recent survey.
Luan Lawrenson-Woods, a private patient, faced over $30,000 in out-of-pocket costs for surgeries alone. This included an unexpected fee from an assistant surgeon, an experience that underscores the difficulties patients face in understanding and managing specialist and surgical fees.
Escalating Medical Bills: Survey Reveals Patient Struggles
Recent findings from a survey of 4,000 individuals, released by Private Healthcare Australia (PHA), paint a stark picture of the financial burden on patients:
Over half of respondents received a larger medical bill than anticipated.
Specialist fees for in-hospital care have seen a significant rise, increasing by 22% over the past three years, with the median hospital out-of-pocket expense now reaching $270. This financial pressure is having a tangible impact on patient access to care.
Approximately one in three patients (out of 2,300 referred to a specialist) admitted to delaying or cancelling specialist care in the last three years due to cost concerns. Furthermore, the number of initial specialist consultations declined by 8% between 2019 and 2024, leading PHA to suggest specialists may be charging existing patients more.
The survey also revealed that 38% of patients reported receiving an unexpected bill, while 29% were charged illegal 'administration' or 'booking fees' not visible through Medicare.
PHA Chief Executive Rachel David stated that affordability issues are causing patients to return to the public system or their general practitioners, potentially delaying necessary diagnoses or condition management. The organization advocates for increased consumer protections, better utilization of the healthcare workforce, and more competition among specialists. Updates to the federal government's Medical Cost Finder website are expected to improve transparency regarding specialist fees.
Doctors and Insurers Respond to Cost Concerns
The medical sector, represented by the Australian Medical Association (AMA), maintains that Medicare and private health insurance rebates have not kept pace with health inflation. This discrepancy, doctors argue, necessitates charging out-of-pocket fees.
AMA President Danielle McMullen noted that healthcare costs are rising, and patients are consequently delaying care. She also described insurer contracts with preferred provider doctors as complex, with varying rebate amounts for the same procedure across different insurers, even with top-tier coverage.
The AMA issued a position statement criticizing insurers for alleged abuse of market power and