Report backs calls for cost transparency

Consumers are being left in the dark by hospitals and specialists when it comes to out-of-pocket costs, according to a report by a prominent consumer group.

A report into out-of-pocket medical expenses has found people routinely incur expenses in the thousands, describing the health system as one of high cost, complexity and confusion.

The Consumers Health Forum of Australia report surveyed 1200 people.

Out-of-pocket medical costs are the difference or ‘gap’ between what doctors charge and what the Government, via Medicare, and/or a private health fund - contributes for a service.

The report says it “revealed profound problems with Australia’s public-private health system with many patients facing harsh choices between long delays in treatment or exorbitant out of pocket costs. The causes are deep-seated, complex and difficult to resolve.”

CHF demands more clarity for consumers.

CHF CEO Leanne Wells says, “given the costs involved, consumers require clarity and certainty in ascertaining the fees they face, in total and in detail.”

“This could be provided on an independent, authoritative website containing all doctors’ fees.”

“Not all surgeons are doing the wrong thing by their patients,” says Leanne Wells. “Some are doing better on informed consent and coming closer to providing a single quote for overall treatment costs to patients.”

The CHF survey had 1200 respondents. Those who had incurred costs in hospital were asked to indicate who had discussed their out of pocket costs with them.

Options presented to them were: 1.Specialist, 2.GP, 3.Other, and 4.No one.

Of the 62% who chose to respond to this question, no one discussed costs with 37% of respondents.

Specialists had discussed costs with 47.2% and GPs with 3.4%.

The report states:

“Given that the Medical Board of Australia regards most health professionals as having a legal duty to inform patients of financial implications of treatment, these figures should and do raise considerable concern.”

The CEO of consumer advocacy group CHOICE, Alan Kirkland, wants a more transparent private health system where consumers are given clear information at the right time, not when it's convenient for specialists, hospitals or health insurers.

“Average prices for common procedures such as knee replacement surgery, gall bladder and colonoscopy should be publicly available.

“People should be able to find out as early as possible whether the specialist is likely to charge them an out-of-pocket cost so they have the opportunity to ask their GP for other options."

Private health insurers repeat calls to make charges to consumers more transparent.

Dr Dwayne Crombie, Managing Director of Bupa Health Insurance, says patients must be given the chance to have informed financial consent.

"While the majority of doctors are doing the right thing, patients should know when a fee is higher than usual and be able to question why that is so."

"Any out of pocket costs, such as doctors' fees or hospital fees, must be known in advance. This is a critical component of informed financial consent."

"Patients should know in advance what they will be charged for a procedure, how that compares to other specialists, what their health insurer will cover them for and what out-of-pocket costs they will face."

Dr Rachel David, the CEO of Private Healthcare Australia, told Fairfax two of the treatment areas highlighted in the report – for cancer and autoimmune diseases - were largely treated as out-patient or specialist consultations.

Legislation prevents private health funds from covering the gap for these.

"Until this is addressed by the government, the problem is with the Medicare Benefits Schedule and what doctors charge, rather than the funds,” says Dr David.