ABC Radio Melbourne Drive interview with Dr Rachel David on exorbitant surgery fees and redoing patient’s finances

Station: ABC Radio Melbourne
Program: Drive
Date: 6/6/2019
Time: 5:44 PM
Compere: Rafael Epstein
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia


RAFAEL EPSTEIN: So, when the advert says something like top surgeon, renowned surgeon or even miracle worker – and all of those things have been in some of their promotional material – or if they are advising you on how to re-mortgage your house, dip into your super or maybe even advising you on a payday loan, it might be a warning bell that the surgery that’s being pushed towards you mightn’t be a path you should go down. And even those that represent the private health industry are saying enough is enough and there’s a need to control some of the exorbitant fees that are being charged and some of the ways that they’re actually advising you to redo your own finance.

Rachel David joins us. She’s the chief executive of Private Healthcare Australia. Rachel, thanks for having a word to us.

RACHEL DAVID: Thanks, Raf.
RAFAEL EPSTEIN: Tell me, first of all, what sort of specialists are you worried about? What sort of things are they offering?
RACHEL DAVID: Well, look, we’re talking about a very small number of specialists here. We’ve done extensive research into this area – the area of high out of pocket medical costs – and private health will actually cover you for the full cost of your hospital and any associated things like ICU and rehab and will cover the gap for most doctors that are charging a reasonable fee.
RAFAEL EPSTEIN: [Talks over] A reasonable one.
RACHEL DAVID: Yeah. So close to 60 per cent of hospital visits are actually provided gap-free. For the 40 per cent that aren’t, that do get a gap, only 2 per cent of those are being charged these very high fees of over $10,000.
RAFAEL EPSTEIN: [Interrupts] Sorry, how much are they getting charged? Ten grand?
RACHEL DAVID: Over $10,000 out of pocket in addition to what the government and what the health funds are paying, so that’s on top of what MBS, the Medicare system and the health funds are paying-
RAFAEL EPSTEIN: Why are you concerned about them?
RACHEL DAVID: Well, look, we’re concerned about it when patients are in a vulnerable situation. Like, a lot of these surgeries are occurring with people who’ve had cancer, that might be requiring a reconstruction, or are in a situation where they’ve been told that because they’re paying a high amount of money that they’re going to get a better outcome, and it’s also occurring in some areas where there’s quite a lot of desperation around the situation, like weight loss surgery and IVF.

And one thing that we’ve seen that’s been a recent trend is that to fund some of these large gaps, we’re seeing some doctors actually providing financial advice to patients that they’re treating along the lines of reversed mortgages or accessing your super, and we think that’s something that’s crossing a line. If it’s a patient that you’re treating, we don’t think that providing financial advice as to how they should access your services is appropriate.

RAFAEL EPSTEIN: Is there anything stopping a surgeon giving you financial advice at the same time?
RACHEL DAVID: No, there isn’t at the moment. But I just did a quick check online and a ring around my peers in the medical profession and in the health funds, and everyone knows of cases where this has happened. It is very prevalent in these areas of breast surgery – and not just cosmetic breast surgery, but breast reconstructions – weight loss surgery-
RAFAEL EPSTEIN: [Interrupts] So are people taking advantage of- so after a woman’s had to have all or part of her breast removed, they’re pushing expensive procedures on them and telling them how to finance it?
RACHEL DAVID: Yeah. Yeah, and we’ve certainly heard reports of that happening. But if you do a quick check online, you’ll see that there are websites up which are promoting the fact that people can access their superannuation and draw down on it to be able to fund these surgeries, and I’m looking at one right now which has advertisements and links on it for a whole number of doctors and medical clinics.

So, it’s not just advertising the fact to patients that they can access surgeries by accessing their superannuation, but it’s advertising the medical clinics and advertising the doctors on the same site. Now, I don’t know about you but I’m certainly, being female, you’re behind on your super anyway and then knowing that you might have a low super balance and being told by someone in authority you need to take even more money out of it to fund surgery, I think is highly problematic.

RAFAEL EPSTEIN: Is it exploitation?
RACHEL DAVID: Look, for people where there is what we call an asymmetry of information or where someone in authority has a lot more information than the person they’re dealing with or doing business with, we think it’s a real problem. And in terms of people that are vulnerable, that are emotional because of health problems like cancer or the health problems brought on by obesity, this can be really coercive, and if you’re sitting there having a consultation with someone you respect and they’re putting forms in front of you saying: hey, here’s how you take out a quick loan or draw down on your super, it can be very hard for someone who’s not medical and doesn’t have strong financial skills to be able to deal with that.
RAFAEL EPSTEIN: 1300-222-774 is the phone number. I’d love to hear if you’ve ever received financial advice from your medical specialist. 1300-222-774 is the phone number. Rachel David represents the private health industry across the country.

Rachel, who should regulate this? Is this something governments should look at? Insurers? Medical colleges? Who should be putting some rules around this, do you think?

RACHEL DAVID: Look, I think it’s very hard, actually, because of the Australian Constitution, for the Commonwealth to get directly involved and regulate doctors’ fees. But in the issue of doctors providing financial advice and advertising, the Medical Board of Australia, I believe, are the right organisation to take a position on this. We’ve also heard the Royal Australasian College of Surgeons, which is the training body that officially trains surgeons in this country, take a very strong view on very high out of pocket fees and they also have a role-
RAFAEL EPSTEIN: [Interrupts] Isn’t that the problem, though? Forgive me, Rachel. It’s often the colleges, the specialist colleges, take a strong view, they don’t really want to regulate their own members. And again, the Medical Board across the country, they like to have strong views but they don’t like regulating. I mean, no one really wants to touch this, do they?
RACHEL DAVID: Well, I think in terms of who can actually apply sanctions, it’s really the Medical Board that has that power, and what we’d like to see is a bit more scrutiny of some of these practices coming from the Medical Boards.

Also, on the other side, the regulation around superannuation, this is something the Government needs to look at. It’s become far too routine for people to take this path without considering the alternatives or all of their financial circumstances, and the fact that there are now websites up promoting this and making a business model out of this is undermining our entire retirement savings system as well as our Medicare system.

RAFAEL EPSTEIN: You’re worried about this because it gives private health a bad name, no?
RACHEL DAVID: Well, I think what it does is it encourages people-doctors, the small number of doctors that are so inclined, to maintain these very high out of pocket fees, and that in itself puts people off seeking a private health option. And for some people, they need their surgery at a time of their choosing and they want a specialist to be fully responsible for their care, but this is putting them off when the vast majority of private doctors and private hospitals are actually not charging these stratospheric gaps and are trying to do the right thing.
RAFAEL EPSTEIN: Representing the private health industry, she’s the chief executive of Private Healthcare Australia, Rachel David. Thanks for your time.
RACHEL DAVID: Cheers and thanks, Raf.
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