5AA Mornings interview with Dr Rachel David on out-of-pocket healthcare costs

Station: 5AA
Program: Mornings
Date: 12/4/2019
Time: 10:07 AM
Compere: Leon Byner
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia


LEON BYNER: So I thought it would be very helpful today to talk to the private healthcare people just to nail down why this can happen. Let’s talk to Dr Rachel David. Rachel thanks for joining us.
RACHEL DAVID: Morning Leon.
LEON BYNER: First of all, if people have got a prostate issue and they go for a check and examination and then need surgery, is there anything about that which Medicare does not cover for a start? We’ll get to the private health part in a moment, but are all of procedures required for such an investigation and indeed an operation, covered by Medicare?
RACHEL DAVID: Yes they are. So there is a Medicare rebate for the doctor if you see the doctor in private practice out of hospital. If you go to a public hospital it’s completely free of charge. And for- there is a Medicare rebate for surgery in a private hospital and also it’s covered in a public hospital as well.
LEON BYNER: Alright, that’s the Medicare part.
LEON BYNER: Now obviously, Medicare doesn’t pay everything.
RACHEL DAVID: That’s right.
LEON BYNER: Now with regards to private health insurance. Can you rationalise in your mind where somebody might have gone for work using a da Vinci machine for which they’d need surgery.
LEON BYNER: And they’ve come out of that when they leave the hospital, thousands of dollars out of pocket, thousands.
RACHEL DAVID: Look this is not due to the technology itself, the technology is just a way of assisting the surgeon to complete the surgery and it’s no- necessarily better or worse than the surgeon using a different technique, it’s just a way of assisting the surgeon, a way of doing the surgery. If you have your surgery done by a private doctor they can actually charge what they like, that’s the law in Australia. Health funds will pay the gap for- up to the scheduled fee and some health funds will actually pay more than that depending on which health fund it is. But what health funds can’t do is to chase higher and higher medical fees and still keep health fund premiums under control. So there has to be a limit. Now unfortunately we know from detailed medical research that about two [inaudible] of medical specialists are [inaudible].
LEON BYNER: We’re dropping out. So what you know from medical research is, how many per cent?
RACHEL DAVID: About two per cent of-
LEON BYNER: Two per cent of these-
RACHEL DAVID: It’s not everyone. It’s the absolute minority of specialists but that’s why both the Liberal and the Labor parties have promised that they are going to introduce measures to help consumers and their GPs choose a specialist by giving them access to a much wider amount of information about which specialists charge lower gaps and which specialists charge higher gaps. Because to be honest my personal view is it’s absolutely outrageous that someone should be charging $10,000 out of pocket for cancer surgery because one thing we know for sure is that the size of the out of pocket is not proportional to the chance of a good outcome.
LEON BYNER: Now I need to ask this then.
LEON BYNER: Which is what I think a lot of callers might have suggested yesterday.
LEON BYNER: So let’s say – and these were the examples we had – where you’re on the Gold cover, that’s supposed to be optimum, premium and all that stuff.
LEON BYNER: So you have a fund that’s got an arrangement with a hospital.
LEON BYNER: And therefore notionally when you go in and then when you come out you should virtually have nothing to pay.
LEON BYNER: If you want to avoid those sorts of huge fees, what do you do?
RACHEL DAVID: Look the huge fees are being generated not by the hospital in most cases but by the doctor. We know it’s the huge- it’s the minority of doctors that are doing this but unfortunately if it occurs in an area where people re very vulnerable like cancer, that’s what gets the headlines. So what people need to do is firstly to check with their GP and make sure their GP understands that cost is an issue for them. The next thing they need to do is to contact their health fund because most health funds have a list of doctors that charge reasonable gaps. And the other thing that’s going to happen is that whether Liberal or Labor wins the next election, they’re going to invest in various websites and inform financial consent mechanisms which means that the people are going to get much more information about this stuff before they actually get referred and- before they actually find themselves in front of someone who might be saying that you know, its going to cost them $10,000 to get rid of their cancer. And you know if all else fails, cancer, can be treated in a public hospital but there could be a wait time. And I think that’s what most people with private health cover are trying to avoid.
LEON BYNER: So what you’re saying is that if the fees are within a reasonable ball park, that is the scheduled fee, then the health fund on Gold would normally cover it?
RACHEL DAVID: Yes. Yes that’s exactly right and in fact some health funds will even pay a little bit more than the scheduled fee to some doctors under some circumstances. So look the vast majority of specialists out there are trying to do the right thing and are not charging outrageous gaps. But sometimes if you find yourself in front of one of those guys, it can be really hard to backtrack on the situation and find someone else. That’s why it’s really important before you get referred for surgery that you have a chat with your GP about what your circumstances are and make sure they understand that the cost is important.
LEON BYNER: Rachel thank you very much for coming on today. So there’s Dr Rachel David. So we’ve got two things that are going to happen irrespective of who wins the election, it will be much more transparent as to which specialists and doctors charge what, whether it’s the fee that’s scheduled, whether it’s above it.
* * END * *