Increased transparency around medical fees

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AMA (NSW) has developed resources to help doctors explain medical fees to patients. Our poster ‘Why is there a gap?’ and ‘How much will it cost?’ are free for AMA members to download from our website.

The Federal Government’s proposal for a website that allows people to search specialists’ fees has put out-of- pocket costs back in the spotlight.

The ABC Four Corners’ Mind the Gap special in May last year highlighted the issue of medical fees and was quickly followed by a Senate Committee recommendation to develop a government-funded website listing specialists’ fees.

Federal AMA cautiously backed the idea, saying patients had a “strong desire” for more transparency.

“We welcome the announcement that the Government will fund an education campaign about health financial literacy and informed financial consent. This is critically important to navigating Australia’s complex health system.”

However, AMA President, Dr Tony Bartone stressed that the website must equip consumers to make informed choices about their health insurance products, as well as their choice of doctors.

The AMA also insists the government website list what the patient can expect back from Medicare and their insurance fund. The AMA has been working with the Minister’s advisory committee and continues to push for greater transparency on out-of-pocket costs.

Whilst it appears that this website will include information about MBS rebates, the AMA has questioned whether it will breakdown the specific rebate for a given procedure, or just the average out-of-pocket cost in tiers.

“Will it also inform patients that MBS rebates for specialist services – paid for by their taxes – have failed to keep pace with inflation for more than three decades?” Dr Bartone said.

“Most importantly, will it show what health funds are prepared to refund to their customers for years of premium payments?”

Health insurance providers argue the complexity and breadth of the thousands of insurance policies makes it unworkable for them to provide their rebates for a comparison website.

The AMA agrees health cover is unnecessarily complicated and opaque.

“Even when a doctor charges the same fee every time, and even when the patient has good private health coverage, out-of-pocket costs can vary by thousands of dollars because of the variation in what the insurer chooses to pay as a rebate,” Dr Bartone said.

The AMA argues the website must have total transparency.

“While the Government is saving money with the continuing freeze on MBS rebates for specialist procedures, allied health consultations, and diagnostic imaging, the growing gap between rebates and the cost of providing care is passed on to the patient.”

The AMA remains fiercely opposed to exorbitant fees but points out 95% of medical procedures are performed at no gap or known gap.

In the December 2018 quarter, Australian Institute of Health and Welfare (AIHW) figures found:

• 87.7% of services were provided with no medical gap;
• 7.4% of services were provided with a known medical gap; and
• 95.1% of services were provided under a no or known gap arrangement.

According to the AIHW report on patients’ out-of-pocket spending on Medicare services 2016-17:

• 21% of out-of-pocket expenditure for individuals is on total medical costs, which includes hospital and non-hospital services;
• 37% is on prescription and non-prescription medicines; and
• 19% is on dental services.