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AIHW Patients out-of-pocket spending on Medicare service

BCNA News 16 Aug 2018

The AIHW Patients’ out-of-pocket spending on Medicare services, 2016–17 released today confirms BCNA’s findings from our 2018 State of the Nation report around the amount of variation that exists in out-of-pocket costs for patients with breast cancer.

The AIHW report shines a spotlight on how much Australians pay out-of-pocket for specialist, general practitioner (GP), diagnostic imaging and obstetric services (otherwise known as the ‘gap’). BCNA is particularly concerned by The ABS Patient Experience Survey within the report that shows an estimated 6.5% of people aged 15 years or over, which equals 1.3 million people, said the cost of services was the reason that they delayed or did not seek specialist, GP, imaging or pathology services when they needed them. Even more concerning is the higher proportion of the population (7.3%) who reported delaying or not getting specialist services due to cost. Delays in seeking treatment for serious illnesses such as breast cancer can have a significant impact on survival outcomes.

Availability of bulk billing services has a major influence on out-of-pocket costs for people with breast cancer. Whilst it is good news that nationally, 21.1 million people had at least one Medicare-subsidised GP visit in 2016–17, 34% of these patients paid something in the year toward the cost of their services and ten per cent of patients with costs across Australia spent an average of $42 or more per service. 23% of patients who required diagnostic imaging paid something toward the cost of their services.

The AIHW report does not include services that were paid for completely by the patient or subsidised by private health insurance.

“Medicare only covers a small portion of allied health appointments so we still don’t know how much people with breast cancer are paying for services provided by allied health specialists, including exercise physiology, physiotherapy and lymphoedema treatment” , said BCNA CEO Kirsten Pilatti. In addition, commonly incurred personal expenses are also not identified in the data, such as travel costs, parking and private health insurance premiums. “These are the hidden costs of care that we are not capturing accurately”, said Kirsten.

Out-of-pocket costs for patients can affect people’s ability to get the care they need, when they need it. Being able to get health care at the right place and right time, is essential to high quality care. This report shows out-of-pocket cost vary significantly according to where people live with patients in some areas more than 8 times as likely to have out-of-pocket costs as patients living in other areas. Patients in some areas spent 3 times as much as patients in other areas for specialist services.

BCNA will use the findings from the AIHW report to support our advocacy efforts around high costs of care to ensure all Australians with breast cancer have access to affordable health services and no one is forced to delay seeking treatment because of cost.