We need more than a website to cut out of pocket health expenses

| March 11, 2019

In an attempt to crack down on specialists charging exorbitant fees, the Morrison government has pledged to create a website listing individual specialists’ fees.

The website is voluntary and doctors will post their own fees. Patients will be able to compare doctors whose fees are listed, and the searchable website will have a special focus on the high fees in gynaecology, obstetrics and cancer services.

The announcement, made on Saturday, follows the release of a ministerial advisory committee’s report on out-of-pocket costs, which the government has had since November.

But while the website is a good first step, transparency alone is unlikely to be enough to ensure Australians aren’t forgoing care because of high costs.

What’s the problem?

A central problem is the lack of transparency around out-of-pocket costs. Patients are typically unaware of the full out-of-pocket costs they might incur at the time of referral and admission.

The Consumers Health Forum’s recent report found Australian consumers face higher than average out-of-pocket costs compared to most countries. This translates into people often avoiding visiting a GP or specialist and failing to fill scripts due to cost.

A report from the Grattan Institute using data from the Australian Bureau of Statistics shows many people already miss out on health care because of cost: 5% skip GP visits, 8% don’t go to a specialist, 8% don’t fill their prescription and 18% don’t go to the dentist. This will happen more if fees go up.

Those who avoid care because of cost are often those most in need, leading to concerns about equity of access. Delaying or foregoing care means when people do visit their doctor, their condition may be much worse than if they had presented earlier. This can affect long-term health outcomes and lead to higher costs over time.

“Value” is also about providing information on the various options for care, including the evidence base of the treatments offered, waiting times for various providers, and how the quality of care might vary between the options.

Consumers, with the help of GPs where necessary, should be able to assess these trade-offs to arrive at a decision that works best for them.

But patients know little about the quality of care provided when they are offered treatment or even whether they will really get better as a result.

Significant numbers of procedures and treatments performed on patients in Australia are considered “low value care” – when treatments have little effect on health outcomes, and may even cause harm. Recent estimates for New South Wales public hospitals suggest that between 11% and 20% of treatments involve low-value care.

These issues are being tackled through the Choosing Wisely campaign which is increasing awareness of tests and treatments that are of low value and may cause harm.

The Medicare Benefits Schedule Review Taskforce is also reviewing how these procedures are funded through Medicare.

Your right to know the costs of care

What are your rights as a patient in relation to the costs of medical treatment? At present, it seems consumers have very few.

There are no consistent enforceable guidelines on health-care providers to provide information on costs. Voluntary codes of practice are in place to encourage fee transparency but cannot be enforced.

The Commonwealth Ombudsman’s website provides guidelines on informed financial consent in health care. Unfortunately these place the onus to gather the relevant information on the costs of care on consumers:

You should ask your doctor, your health fund, and your hospital about any extra money you may have to pay out of your own pocket, commonly known as a “gap” payment.

Health professionals should be required to provide information that will assist consumers make informed decisions.

Why we need more than a website

Gathering information on specialists’ fees and making sense of it is an enormous burden to place on vulnerable patients. This is especially the case for the elderly and those with little education who are reluctant to appear to question their trusted doctor.

We don’t know how effective a website of usually charged fees will be and who will use it. It’s possible it will advantage the rich by increasing their access to information, while not increasing access for poorer consumers.

Published fees may also be used by other doctors to set fees, and could potentially increase fees, if they see their prices are lower than others.

The onus should be on clinicians, and the system, to give patients easily accessible and digestible information as part of the service they provide.

If health professionals cannot provide and interpret these costs to patients, we need to consider other trained workers – health “cost navigators” – who could advise patients as to how to decide on the best treatment for the best price.

The issues of out-of-pocket expenses are serious. They threaten the sustainability of our health system and adversely influence health. We need to ensure patients don’t face prohibitive costs that discourage them from treatment or force them into debilitating financial straits.

This article was written by Anthony Scott and Peter Brooks of the University of Melbourne.  It was published by The Conversation.

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