Medical care should be affordable for all – and there’s lots we can do about it
There are many ways we can improve access to cheaper specialist services for all Australians right now. We just need to act.
Two issues are front of mind for many Australians at the moment – the cost of living, and the cost of doctors’ appointments. Both are intertwined for a huge number of people.
Our population is ageing, and chronic health conditions are affecting more and more people, so demands that the government take action to make specialist care accessible and affordable are reaching fever pitch.
In the heated discussions about medical fees there has been a great deal of finger pointing and blame shifting. Yet what Australians actually want is access to care, not talk, and there is plenty that can be done to improve the situation right now. What is required is some creative thinking and an appetite to take action.
Yes, in some cases the cost of seeing specialists in private settings can involve out-of-pocket costs that are difficult to meet for people. This can leave people suffering in silence, unable to access the care they need. That is terrible in modern Australia but it doesn’t need to be this way.
Being able to access specialist medical care when it is needed is about things other than the out-of-pocket cost too. It is about not having to travel, and not having to wait for long periods.
It wasn’t always this way. Public hospital outpatient clinics had provided accessible care for people for decades. The fact that so many people feel driven to seek medical care in private health settings is a demonstration of failures in our public system.
When I was training as a specialist in the 1990s, public hospitals offered outpatient clinics of which we all could be proud. Many of the foremost doctors in the country worked both in public and private hospitals. I learned my craft working with extraordinary specialists at public hospitals.
In those days state and territory governments put considerable resources into flagship clinics, and the booking of surgery was left in the hands of surgeons themselves. We were able to deal with the differing priorities for patients needing surgery and assign their operations on our own operating lists. Long waits for surgery were almost unheard of.
Fast forward 25 years and the situation is almost unrecognisable to older specialists like me. Data show that some patients wait years for appointments at clinics, meaning that their conditions often have changed completely by the time they are seen.
Australians without the means to afford private care should not be in that situation. Yet resource cuts, staffing shortages, and restricted investment in infrastructure have stripped public outpatient clinics – where specialist care should be available to everyone who needs it – beyond breaking point.
Australia’s National Health Reform Agreement negotiations are the ideal place for governments to work together to fund and build great outpatient clinics that serve every patient who needs them, leaving nobody with their only option as private care.
The problems are particularly acute for patients in regional and rural Australia. Hundreds of thousands of people have no option but to travel to major cities for specialist care, often paid for by state and territory travel schemes.
What about flipping the situation and funding specialists such as psychiatrists, physicians and surgeons to travel out to the regions? Stumping up to fly doctors to see patients, rather than the other way around, and setting up dedicated clinics for them to work in makes good economic sense. Cheaper to fund travel and accommodation for one doctor than dozens of patients.
To ensure that these trip are productive, specialist doctors could be offered incentives for seeing certain numbers of patients or performing a minimum number of procedures locally.
Such schemes would also ensure that nurses and other health professionals who live regionally and make up treatment teams can maintain their skills and do the valuable work they thrive on.
Making it financially viable for city-based medical specialists to leave their practices and provide clinical care for Australians outside of our urban areas would make healthcare much more affordable for millions of people at a stroke.
Australians living in our large cities may also face challenges in seeing specialist doctors, but there are creative solutions that can help with costs and improve access. The use of vouchers for care, especially for people living with multiple chronic medical conditions, is something the government could initiate.
Independent economic analysis conducted by Australian researchers suggests that, when appropriately structured, voucher systems can support patients to choose services that will meet their healthcare needs and encourage competition among doctors. Those can only be good things and make economic sense.
There’s no doubt that out-of-pocket costs for seeing doctors in private settings have increased and when the cost of living is high, that can be a problem for many Australians. So, too, have the costs of running a medical practice.
I ran my own private practice for more than 20 years. When first I opened the doors
the cost of running my practice represented 37c for every dollar I billed a patient. By the end of 2023 it had increased to 61c for every dollar, an increase of 65 per cent over the period.
While little can be done about increases in the costs to doctors of running their private practices, it does demonstrate that specialists also are dealing with rising costs for providing their services. Nobody is immune.
With pressures on public hospital surgery resources, two thirds of all planned procedures take place in Australian private hospitals and day surgery centres. The good news is that for those patients the total proportion of in-hospital procedures undertaken with no out-of-pocket at all was over 88 per cent. A further 9 per cent were performed with a known gap, with the average gap at $130.
Indeed, that private surgery is relatively affordable is remarkable considering the inflation-based erosion in Medicare rebates. For example, the Medicare rebate for removal of the gall bladder in 2005 was $640. Twenty years later, the patient rebate is only $732. In real terms, because of inflation, the rebate to patients now is actually 55 per cent lower.
As I see it, there is plenty that governments can do to help patients get the care they need and reduce the pressure that is put on the private system. The most important step of all is restoring the health and vitality of public hospital outpatient clinics, giving patients a real choice.
It is no wonder that exasperated patients opt to seek care in private settings when they know that efficiencies will allow them to be seen much more quickly. Waits for surgery in private settings are commonly measured in weeks, not years.
Making care affordable for every Australian will involve governments building a partnership with doctors, a partnership that puts patients as its focus. Starting a war between the groups won’t help anyone.
While such partnerships are being built, there are actions that could be put in train immediately that could ease the crisis. Let’s hope we see some action.
This column is the opinion of Professor Steve Robson and does not necessarily represent the views of any organisation he works for or belongs to. Professor Robson is one of Australia’s most highly qualified surgical specialists, researchers and teachers.
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