6PR Mornings interview with Dr Rachel David on out of pocket costs for cancer patients

Station: 6PR
Program: Mornings
Date: 9/4/2019
Time: 9:38 AM
Compere: Gareth Parker
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia


GARETH PARKER: We want to test this policy of Bill Shorten’s about no out of pocket costs for cancer patients. It’s pretty hard to argue that helping cancer patients is a bad idea, it’s clearly a good idea and its very welcome and I think that’s one of the reasons that the Opposition Leaders are pursuing it because if his opponents criticise it, he says – well you don’t care about people with cancer. I think there’s some very worth stuff in what he’s proposing. I think the idea that all MRI machines can be Medicare rebate-able is a good idea.

I do wonder about some of the other aspects of this. For example, in Western Australia right now my belief, and tell me if I’m wrong, but my belief is that cancer treatment in the public hospital system is pretty much excellent, its timely and it’s free. For people in the private system there are often out of pocket costs and they will vary because it’s really up to your doctor to set his or her own fees and it’s up to your private insurer who you engage with to decide how much they rebate for what treatments.

Your experiences I’d like to hear. Dr Rachel David’s the CEO of Private Healthcare Australia which represent the insurers – and this is really where this debate lies – I think this is where most of the out of pocket costs are. They’re not really in the public system, they’re in the private system. Rachel, good morning.

RACHEL DAVID: Good morning Gareth.
GARETH PARKER: What do you think about this? Is this actually going to work? Is it possible to eliminate out of pocket fees in the private health system?
RACHEL DAVID: Well look, there are a couple of things here and first I should say that the health funds really welcome the focus on out of pocket costs occurring for specialist consultations. Some of your listeners might not realise this but under the legislation around private health insurance the health funds aren’t allowed to fund Medicare services out of hospitals where a Medicare rebate is payable. So we can’t insure for the gap for those services which I think is why Labor has done this. And I think it’s actually pretty worthwhile. You know, a large number of people seek private cancer treatment so that they can have their own specialist responsible for their care for convenience and for rapid access to treatment. But it is a bit unfair that they’ve made this contribution, their hospital treatment gets covered but when they’re seeing the specialist out of hospital which sometimes goes on for many years they do have to pay these gaps which can accumulate over time. So I think that’s what the Opposition is trying to address.
GARETH PARKER: In terms of public hospital cancer care, there’s not really any out of pocket costs at the moment are there?
RACHEL DAVID: No, unless for some reason someone’s had the treatment in a public hospital and then they’ve gone on to see a specialist as an outpatient in the private sector or they’re having scans in the private sector. Now that’s pretty common. Often the first thing that the public hospitals cut back when things get tough is outpatients so it is pretty common for someone to have their initial treatment in a public hospital and then go and see someone in private. So it’s also important that that gets addressed as well.
GARETH PARKER: Okay. Is it true that doctors who work in the private system effectively set their own fees?
RACHEL DAVID: That’s right and look I was a bit disappointed to read in the press today that what appears to be a small group of doctors is claiming this isn’t enough money. I think we do need to focus on the fact this is helping patients and people in a very vulnerable situation. What the Opposition has done is pretty much offered to double the Government fee for a consultation in outpatients to see a private specialist for cancer. I don’t know how many people are in this private cancer physicians group – I’ve certainly never heard of it before today, but I was pretty disappointed. I think the majority of doctors will take this up and I think it’s a very important measure to give patients some sense of security about the affordability of their treatment in future.
GARETH PARKER: Right. But what’s to stop a doctor to pocket the additional rebate, the additional benefit, and then just charge more fees?
RACHEL DAVID: Well nothing at the moment, but should the ALP get into government, what they’ll need to do is to apply a very stringent compliance measure around this proposal. So what would need to happen is they can’t force doctors to take it up – that would be unconstitutional – so it would need to be an opt-in system and then there would need to be some kind of compliance or audit process undertaken by the Federal Government to ensure that people that were taking the high rebate and saying that they were bulk billing were actually doing that.
RACHEL DAVID: And that’s something that we would fully support.
GARETH PARKER: So- but the bottom line is that the sort of headline promise of no out of pocket costs for cancer treatment is, in that sense, its impossible to fully deliver because its up to individual medical practitioners to decide whether they play ball or not.
RACHEL DAVID: It’s correct to say that it’s up to the individual medical practitioner. I’d like to think that particularly in this very sensitive area that doctors would play ball with a government that attempts to address out of pocket costs, and I believe honestly that most of them will. But it’s not constitutionally possible to enforce this and I think there will be some challenges in the implementation and I’d like- but I’d like to think that a future government would commit to something like this. And we’d certainly- I mean health funds would certainly help on behalf of their members.
GARETH PARKER: Rachel, thank you. Appreciate your time.
RACHEL DAVID: Thanks Gareth.
GARETH PARKER: Dr Rachel David from the private healthcare industry. So it’s going to need a really robust agreement isn’t that Bill Shorten’s going to need to sign with the medical profession that they all agree. Now will they get that agreement – I don’t know. What I do know is that doctors are pretty good at negotiating with governments over the journey.
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