ABC News Mornings Interview regarding out-of-pocket costs

Station: ABC NEWS
Program: Mornings
Date: 04/03/2019
Time: 11:46AM
Compere: Laura Tchilinguirian
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia


LAURA TCHILINGUIRIAN: Well, the issue of the fees charged by medical specialists is in the spotlight today. The Federal Government has foreshadowed a plan to help consumers get more information about out of pocket expenses for medical attention. It’s a joint project between the Department of Health and Private Healthcare Australia. Dr Rachel David is the chief executive of Private Healthcare Australia, which is the peak representative body for Australia’s private health insurance industry and she joins me now. Good morning.
LAURA TCHILINGUIRIAN: Dr David, just explain to us exactly what your action on gap fees involves.
RACHEL DAVID: Well, what we did with the Department of Health was a very detailed research project where we actually asked over 6000 consumers who had been a patient to the hospital over the last two years, what they actually paid their doctor and gave them the opportunity to have a look at their bills; so we’ve now got a very accurate perception of what gaps are charged and where. We have determined that four out of ten people that were admitted to hospital were charged a gap. Now, that’s good news but that’s because the majority of people that went into hospital were either charged no gap or a known gap when they had private health. But the difficult thing that we did find out is when people started to get angry was when they weren’t informed about the gaps in advanced. Now, a third of those people that were charged a gap didn’t know that they were going to be charged extra charges by their doctor and those people were the ones who went away from that experience with bill shock and feeling a sense of disappointment about private health. What we’ve learnt is that that doesn’t need to happen and the government’s website that’s been proposed will help people get information about gaps in advanced of treatments.
LAURA TCHILINGUIRIAN: So you don’t have to legally inform someone about the gap before their procedure?
RACHEL DAVID: No. So what – so private medical specialists in Australia are able to charge what they like; that’s the law. And there’s nothing compelling them to inform people in advanced of surgery what the fees are likely to be. In fact, what we determined from the survey that we did was a lot of the concerns related to charges by anaesthetists and assistant surgeon that people didn’t realise they’d be getting. And so what we’re advocating is that people get a quote upfront for their treatment which includes all of those charges and if that happens, most people are actually quite happy to pay. The issue is when they’re blindsided about extra charges.
LAURA TCHILINGUIRIAN: Well, one of the big issues is the over the top fees that some specialists do tend to charge. Just how big a contrast have you found in that research?
RACHEL DAVID: Look, there was a lot of variation but what we found was that only two per cent of people had been charged what we call an egregious fee or an over the top fee, which is many times the MBS or even the AMA’s recommended fee. The important thing that people should realise is that paying a high amount for surgery or other medical treatment doesn’t guarantee a good outcome. In fact, the medical colleges and educational institutions have been very clear that there’s no correlation between higher cost medical services and quality and in fact, the reverse may even be true. So if people have been quoted a very high amount for treatment, they really need to question that or go back to their GP and discuss an alternative.
LAURA TCHILINGUIRIAN: Because most of us don’t, do we? We just accept it and go ahead with it. Can we shop around?
RACHEL DAVID: Look, people can but often by the time they’re actually sitting in front of the specialist, that can be a very intimidating environment, particularly if you’re also dealing with a confronting diagnosis at the same time. Where this needs to get sorted out is in the referral process from the GP and the type of information that needs to be available through the government’s website, which is something that is being discussed at length, is giving both the consumer or the patient and the GP very quick access to what a range of specialists’ charge. And that includes specialists that don’t necessarily live nearby because for some treatments, it might be worth the while of the patient travelling into a neighbourhood or even a state where gaps are lower, than they are in their immediate neighbourhood.
LAURA TCHILINGUIRIAN: Which some people do do. Are there particular fields or specialist fields, Dr David, that do charge more – that are known to charge more?
RACHEL DAVID: Look, it does depend a lot on where you live. People who live in an area where household incomes are high and where there are fewer doctors, tend to get charged higher gaps. So one of the highest gaps that we see are in Canberra, where that’s the case and some of the lowest gaps are in places like Adelaide, where you’ve got a lot of doctors and lower household incomes. So it is very much a feature of the market that you’re living in, but there are some specialties that tend to attract higher gaps for some procedures; orthopaedics or bone and joint surgery is one of them as is plastic and reconstructive surgery. So for those things, it is worse; if you know that you have a condition that’s going to be treated by that specialty, it is worth talking to your GP and looking online before you’re actually sitting in front of someone, shopping around.
LAURA TCHILINGUIRIAN: Some valuable advice there. Dr Rachel David, thank you so much.
RACHEL DAVID: Thanks, Laura.
LAURA TCHILINGUIRIAN: That is the chief executive of Private Healthcare Australia, Dr Rachel David.
* * END * *