Ben Harris joined Seven News First at 4pm to discuss out-of-pocket costs

Station: Channel 7
Program: Seven News First at 4pm
Date: 31/1/2024
Time: 4:32 PM
Compere: Mike Amor

Interviewee: Ben Harris, Director of Policy and Research, Private Healthcare Australia


MIKE AMOR: Out of pocket fees for common medical procedures have soared by as much as 300 per cent over the past five years. The rising costs have sparked calls for more oversight of billing practises to protect patients from surprise fees. We’re joined live now by the Director of Policy and Research at Private Healthcare Australia, Ben Harris. Ben, good to see you. Thank you for joining us. What kind of surgeries are we talking about here?
BEN HARRIS: We looked at the most common surgeries in Australia, Mike. We looked at cataracts, we looked at hip replacements, knee replacements, angiograms, and a range of other procedures.
MIKE AMOR: 300 per cent, that is staggering. Why have the costs increased by that much?
BEN HARRIS: There are a number of reasons costs have increased, and the costs of medical practise have increased, the cost of hospitals have increased, and the- and we’re seeing a number of factors into that. And it’s cost of living as everyone else. But we know that out-of-pocket costs hurt consumers and we really need to do something about it.
MIKE AMOR: One of the problems, Ben, is that if it becomes too expensive to have some of these surgeries, a lot of people will put them off.
BEN HARRIS: Absolutely. A hip replacement is covered. It costs about $24,000 in Australia. Private health insurance covers hospital, the doctor, the actual hip device. But we’ve seen out-of-pocket costs for hip replacements go up from about $400 to more than $600 in just five years. Now, if you’re paying for insurance and paying an out of pocket cost on top of that, then that’s a major problem.
MIKE AMOR: Yeah, I don’t want to generalise, but a lot of those people are having hip replacements, they’re potentially retired or retirees, so they can’t afford it, right?
BEN HARRIS: Absolutely. 42 per cent of people with private health insurance have an annual income under $50,000. These are people who really can’t afford premium increases or out of pocket costs.
MIKE AMOR: So if you’ve got private health insurance, what do these fees actually cover then?
BEN HARRIS: So for- as I said, for a hip replacement it will cover around $23,000 of the procedure. The out of pocket costs have gone from $400 to $600. So private health insurance covers hospital, it covers the doctor’s fees, and it covers any devices that are needed. But that’s invisible to the consumer. The consumer sees the out of pocket cost. So we’re really worried about out of pocket costs increasing to this degree and this quickly.
MIKE AMOR: You kind of touched on it there. The insurance fees, the premiums are going up as well. So surely that’s covering some of these changes. So what needs to be changed so that the patients with private health insurance should aren’t stung with these unanticipated costs?
BEN HARRIS: There are a number of things around transparency. Doctors actually telling patients what they’re going to be up for is absolutely vital. The government has a website, Medical Cost Finder, where you can actually look up the common procedures to see what sort of out of pocket costs you’d expect. The government also wants doctors to sign up to the Medical Cost Finder website, so you can actually find doctors that don’t charge out of pocket costs. Unfortunately, doctors haven’t signed up yet. But we also need what we call surprise billing legislation, which is used in America and a range of other countries, which basically says if you are not told about a cost beforehand, you don’t have to pay it. So those surprise bills at the end of the process, they’re a real bugbear in the system and they really need to stop that.
MIKE AMOR: Yeah, that they do. Ben Harris, thank you very much for your time.
BEN HARRIS: Thanks, Mike.
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