Dr Rachel David spoke to ABC radio Canberra about rising out-of-pocket costs in the private health system

Now, the average out-of-pocket fee for a private medical procedure in Australia is $240, but if you’re Canberran, the average is nearly 150 times- 150 per cent more than that. So if you’re in the ACT, the average out-of-pocket fee is not $240. The average out-of-pocket fee is closer to $600. So why are you paying so much more than people in other jurisdictions?

Well, the industry body, Private Healthcare Australia, has released those figures. Its CEO is Dr Rachel David. Dr David, thanks for coming on the program.

Yes, you absolutely can, and it happens quite frequently. We have some data from one of our funds, Medibank, that runs a no-gap facility in the middle of Sydney, and people from as far as Newcastle come to have surgery in that facility because cost is important to them.

The reason, Alice, that we’ve released this report is in support of a decision that’s been made by the Health Minister and the Albanese Government to publish our medical specialist costs on a government website so people have the chance to compare, and if it’s important to them, discuss with their GP that cost is important to them so that they can go to a specialist that’s affordable. [Indistinct]…

Well, look, firstly, I think we need to empower consumers much more. You’re in a very disempowered and vulnerable position, even at the point when the GP refers you to a specialist. And I think one thing we’re looking at doing is working with consumer and patient groups to give people a script to tell their GP: yeah, cost is really important to me. The Government’s got this website. Can you go on the website and help me find someone who’s affordable, even if it’s not near where I live? And I think that’s a really important starting point.

And the second thing is people need to talk to their health fund. Because often health funds have programmes that they run and that can help give people information about doctors and services that charge less.

Do you find, Dr David, that people are then are hesitant at the moment to ask about cost and broach that issue?

Look, I think they are. I think people are in a vulnerable position if they’re unwell. A lot of people in the community think they can’t ask because they’ve got doctors on a pedestal. Some people are embarrassed because they don’t want to reveal that they might be struggling financially. And- but I think it is a really important conversation to have. You would certainly have it if you were going to a car mechanic, or if you were, you know, booking a holiday overseas, and both those things can be life threatening if you get on the wrong path. But for some reason, we don’t have that conversation in relation to medical care. And, you know, it is actually means that 20 per cent of people last year who were referred to a specialist for a very good reason didn’t go because they were concerned about the cost.

Yeah. That’s worrying. This is 666 ABC Radio Canberra. You’re listening to the Afternoons program. My name is Alice Matthews and on the line is Dr Rachel David, the CEO of Private Healthcare Australia, that has released a report showing that here in the ACT, we have the highest average out of pocket fee for private healthcare, for private medical procedures.

A couple of texts have come in on 046-7922-666. One listener asking: does that out of pocket cost relate only to the surgeon, or does it include the anaesthetist? Are there any hospitals here that have contracts with health funds? You may not be able to address the specifics of that one, Dr David, but it is a good question because quote unquote invisible out of pocket fees is also something that you’ve looked at.

Yeah. Look, it does include anaesthetists and surgeons, and I believe the medical cost finder publication of specialist fees will include anaesthetists and surgeons as well. A lot of people are very surprised by the bills they get from anaesthetists. And one thing that we’re pushing for very strongly is that people are given a proper quote well in advance of surgery, so they’re not under duress, which includes all of those medical charges. And if they’re not given a proper quote, then they shouldn’t have to pay.

And in fact, we think the consumer law should be strengthened around that particular point because we’ve heard so many stories about people getting information about medical bills by text, upon the day of surgery, or even after, which is just not acceptable in the modern world, particularly for people who are unwell.

On the issue of contracts, the major hospitals in Canberra do have contracts with the major health funds.

Thank you for answering that. Another listener, Dave of Queanbeyan, has sent in a photo showing our new costing per month from April, says Dave. It’s basically showing the premium as of 1 April is 518, which is up by $21 or so for- of the month for this texter. And your research shows that there has been, I think it was around a 12 per cent rise in fees over a decade. What is causing a growth in the out of pocket costs separate there to, I guess, the premiums people are paying?

Well, look, we actually- it’s actually a 12 per cent rise in a year.

Medical out of pocket costs are pretty stable, but we’ve had a period of hyperinflation that’s occurred towards the end and after the pandemic. So there are a couple of things that we do know. There’s some things we’re still researching. And one is that in general there’s been inflation in the economy. And once prices go up, they tend to be very sticky, particularly in healthcare. And inflation in the health sector is higher in general than CPI. So that’s the first point.

The second point is that during the pandemic, a number of procedural specialists or surgeons on people- you know, that are doing surgical procedures made the choice to work less and actually charge more to boost their income, and they’ve actually been able to achieve that. You know, people have been paying the bills. It’s starting to come off now. We’re seeing a lot of people not actually attending, which is starting to cause some strain, but that’s what we think is behind that 12 per cent spike.

Yeah, I think it’s a good starting point, but we also need to get a lot tougher on this issue of proper, informed financial consent before surgery. There are a lot of doctors who do the right thing, but what patients actually need is a quote well in advance of surgery being booked, which has all the out-of-pockets on it, whether it be surgeon, anaesthetist, assistant surgeon and then they’ve got the opportunity if- you know, they’re not happy or they’re not satisfied with that, or they can’t afford it, to actually give their GP a call and say, no, look, I’ve got to go down a different path here.

And the third thing that we’ve advocated for is the consumer law to be strengthened. So if people aren’t properly informed of out-of-pocket costs, they don’t have to pay.