Interviews and Transcripts

We are finding more and more Australians are not even getting to the specialist, and we’ve seen people who are delaying treatment or not going. Some people are even choosing which kid they take to the specialist. People are being put in impossible choices. Now, what we’re seeing is really large out of pocket costs for people who are referred from a general practitioner to another medical specialist.

Well, this is a really difficult problem for the Government to fix, but it is something that the private health sector needs to work with the Government on pretty urgently because the community is hurting on this issue. And we’ve really, through our work, we’ve found out that at least one in five people who have been referred to a medical specialist by their GP has not attended because of the cost. And not only is that bad for their health, it’s bad for private hospitals that don’t get patients through people that should be treated, and it’s bad for public hospitals when they turn up in the ED with something badly wrong with them.

Look, the insurers could have doubled what they were paying to the Hobart Clinic, but the hospital would have still failed. So it’s not just a matter of fewer people getting in to see a psychiatrist. The psychiatrists themselves have changed how they manage a large number of mental health conditions. A huge amount of this shifted to telehealth, particularly during the pandemic. So it’s actually quite rare these days for someone with a moderate severity mental health condition or addiction to be managed in hospital. And we’re seeing a number actually of psychiatrists on the mainland offering psychiatric care to people in Tasmania via telehealth, and we don’t see any signs that that new clinical model of care, managing someone in the community, is going to change.

Yes, well this is something that’s going to affect 65 per cent of Canberrans, that is people with private health insurance. There’s been this stealthy tax that is on private health insurance, it’s called an ambulance levy although it has nothing to do with ambulances. It’s just a tax on private health insurance premiums that goes into revenue and they decided to put it up without any consultation with our sector. We just found out on budget day and the problem with that is that this is one in a long line of hits to people trying to access private health care in Canberra, including some of the highest doctor’s fees in Australia. So what we’re concerned about is this could really be the straw that breaks the camel’s back for people trying to manage these costs.

Well look, since the pandemic drew to a close, we’ve actually seen quite a marked jump in inflation of doctors’ fees, so that we’re now seeing some quite extraordinary numbers. Like to see a psychiatrist in the community, some are charging over $900 for a first appointment, $600 for a cardiologist or an obstetrician, and some pretty hefty fees even for things like dermatology in the community. Now one thing that is even more worrying than that is that we’re seeing that people are delaying or not pursuing medical specialist referrals because they’re worried about the cost. Between 10 and 20 per cent of people, depending on who you ask, the ABS or one of the universities that studied this, have actually said that, look, they were referred to a specialist for a good reason, but they haven’t gone because they perceive they can’t afford it. The issue for health funds and private health is this is also dampening demand for private hospitals, just as they’ve been beaten up with the pandemic and the lockdowns. So we’re seeing that the number of appointments for a specialist has dropped by 10 per cent even as the population has increased. And our issue from the point of health insurance is we can’t cover- legally we can’t cover the cost of seeing a doctor in their rooms or in the community. The health insurance only kicks in once you’re admitted to hospital.

Yeah, so we’re pretty concerned about what’s happening to people that are in the community that are in that situation. We’re assuming that if they do get sick, they’re ending up in a public emergency department, which is not great for anyone. We also think that a number of these people that are not attending have not even checked what the price is. They’ve just assumed that it’s going to be too much, which means that the Federal Government just before the election made an announcement about something called the Medical Costs Finder website, which is a government website, and they said they’re going to put up all specialist fees and charges on that site. This is incredibly important because it means that people when they’re at their GP, if they raise the issue that cost is going to be a problem for them, their GP can look at the website and pick a more affordable specialist.

Health funds have actually, in the contractual process that they’re obliged to go through by regulation with hospitals, have given them an additional 7.7 per cent in funding since last year, and that’s been about standard throughout that time. So, every year seven, eight per cent on average they’ve got extra, which is about 4.3 per cent additional funding per person. Now as you can see, that’s well above inflation. But also, bear in mind that the Federal Government determines what premium increases the health funds are allowed to raise.

Private health funds are already doing a lot in out-of-hospital care and we want to do more. What we need is high quality services. So just yesterday, we’ve seen Bupa and Ramsay Health Care, Australia’s largest hospital provider, put in a new contract, which means they’re going to expand out-of-hospital care into people’s homes in a whole range of areas, and we need much more of that innovative thinking in the sector.

What we’re pushing for, and the Federal Government has said prior to the election that they’re open to reform, is for people to get a single quote before they have surgery or well before they have surgery so they have the chance to plan for if there are any out-of-pocket costs. Rather than the drip pricing that goes on, where it really is they’ve got actually no idea what they’re going to be up for until, sometimes, even after the surgery.

Well, look, there is huge variation in out-of-pocket fees around Australia for exactly the same procedure and for doctors with the same level of qualifications. The reason that regions like the ACT pay more is because they are away from the big capital cities so the number of doctors is constrained and there’s less competition. But particularly in the ACT, household incomes are higher than average, and so there’s a perception that the market can bear higher prices. But for people in a cost of living crisis, what they don’t have is visibility on the fact that if they were prepared to drive two or three hours, they could actually get a much better deal.