Greedy doctors will force price regulation

IT’S becoming clear not all medicos are ethically equal when it comes to charging, writes Margaret Wenham. The profession is going to have to admit and deal with it, or face price regulation.

IF you and I had a dollar for every time I’ve written about our “bastard, hybrid” public/private health system for which a great many of us are paying three times — via the Medicare levy, private health insurance plus out-of-pocket costs — then all those latter-mentioned gap payments wouldn’t be a problem.

OK that’s a terrible exaggeration. I haven’t written about it hundred and hundreds of times — yet — and that’s what it would take to cover some of the all too common gap payments people are having to stump up.

I’d even have had to write about it 52 times to cover the gap paid after a GP visit last week just to get the necessary follow-up referral for a recommended cortisone shot in my right foot and then another 75 times to cover the out-of-pocket cost of the shot.

But I’d have to dust off the keyboard around 3000 times to help one of our trusty readers, who has helpfully kept tabs on what his private health insurance premium rises have been for nearly a decade — and I reckon by now he must be looking at more than 90 per cent over the past nine years, what with the 7.7 per cent hike he was hit with this year — because he emailed me yesterday to give me the wash up of a recent gall bladder op that included out-of-pocket costs of just under $1000 for his surgeon alone.

Then there are the cases covered by the ABC’s Four Corners “Mind the Gap” programthree weeks ago. In that we learned John Dunn from Canberra was $18,000 out-of-pocket following prostate cancer surgery, Sydney man, Greg Lamont was left with $11,000 in gaps following a hip replacement, and Madonna Buiter from Chinchilla ended up $16,000 out-of-pocket after her breast cancer diagnosis.

ABC’s Four Corners “Mind the Gap” programexposed just how out of pocket many Australians now are. (Pic: supplied)

The most recent hard evidence of us having our pockets picked even after paying very high, ever-escalating private insurance premiums on top of forking out 2 per cent of our taxable income for the Medicare levy (noting that only 1.5 per cent of this is earmarked for the actual Medicare levy, the balance .5 per cent since July 2016 being raised for the NDIS), was published last week when the Medical Journal of Australia ran a short paper by the QIMR Berghofer Medical Research Institute on a study of the gaps being paid by Queenslanders with cancer.

Looking at what 452 people diagnosed with a range of cancers in the 12 months from November 2010 paid for treatments and were left with in out-of-pocket costs, the study, among other worrying issues, shows wild differences in what providers charge.

For example, the median of provider fees (the numerical middle value) over two years for those with lung cancer, which had the highest total fees, was $22,011 but the interquartile range (the spread of charges in the middle range) was $8346 to $38,387. Breast cancer also figured among the highest provider fees, the median fee being $21,581, with an IQR spread of between $11,982 and an eye watering $40,350.

Those with lung cancer were offered some reprieve in the form of lower out-of-pocket expenses, while the gaps were larger for those with breast and prostate cancer, with the latter facing median out-of-pocket costs of $3175 and a middle range of gaps of between $971 and $8431.

Joint author of the paper, Associate Professor Louisa Gordon concluded in The Courier-Mailthat three-quarters of the 452 patients found themselves in the red by $4900, with the highest out-of-pocket costs paid being around $20,000.

This QIMR paper reminded me of another in the MJA last year looking at specialists’ charges for initial consultations for which the Medical Benefits Schedule rebate fee is $150.90.

That study threw up shameful evidence of how some of us end up hundreds of dollars out of pocket from the get go.

The gap for people visiting specialists was found to be particularly high. (Pic: supplied)

Among the worst offenders were immunologists the average charge by whom was $257, with the most greedy 10 per cent billing more than $305 leaving a gap of $177; and neurologists averaging $252 with the top 10 per cent charging more than $340 leaving those patients at least $211 the poorer.

I’ve previously been circumspect in my criticism of the medical profession. After all, mostly the blame for the mess can be levelled at the revolving chumps in Canberra. They’re supposed to be running the country and therefore the health system in our best interests. But they do stupid things like apply MBS rebate indexation freezes and nasty, punitive “lifetime health cover” penalties of up to 70 per cent of premiums that last 10 years; while not doing very important things like ensuring regular reviews of the MBS so the rebates bear a closer resemblance to a fair and reasonable fee for services and procedures which would eliminate any justification for vast gaps, and not raising the Medicare levy (stagnant for 23 years and counting) to help pay for these recalibrated MBS fees.

However, I think it’s becoming clearer not all medicos are ethically equal when it comes to charging and the profession is going to have to grasp this nettle itself or face pricing regulation.

There’s a push on for transparency so prospective patients are presented with full information about fees and any resultant gaps prior to any initial consultation.

This seems to be the direction in which a ministerial committee aimed at tackling out-of-pocket costs is heading.

But while that committee grinds on, I recommend heeding the hot tip from Royal Australasian College of Surgeons president Dr John Batten, who firmly says size doesn’t matter.

Now, I wouldn’t always agree with that sentiment, except he’s talking about very big fees bearing no relationship to the quality of a medical practitioner and so we need to shop around.

And I reckon that’s some dead set quality medical advice we all need to be taking.