The out-of-pocket cost of a first visit to a private medical specialist in Australia can vary by more than $200, according to a new study that analyses, for the first time, variations in specialist fees.
The authors of the study, published in The Medical Journal of Australia, say it may be time to reconsider the policy that prohibits health insurers from covering these out-of-pocket expenses.
The scheduled Medicare fee for a first visit to a specialist – item number 110 – is $150.90 of which $128.30 is rebated.
While standard Medicare rebates have been frozen since 2014, specialists' own expenses have increased and this variation is probably the profession's way of making up income.
But as there are no quality measures for these visits, there is no way of people knowing if a greater fee is justified or is what the market can bear.
Not time limited
These visits are not time limited and the study shows that such a visit to a neurologist can be the most expensive of all. At the top end, it may cost $340, leaving the patient $211.70 out of pocket.
The cheapest visit occurs when the specialist bulk-bills and the patient pays nothing. The lowest rates were in geriatric medicine where only 17 per cent of visits were bulk-billed.
Most bulk-billing occurred in haematology at 60 per cent and in medical oncology at 53 per cent.
For the study, Medicare data from 2015 was analysed for first appointments with physicians in 11 frequently used non-surgical specialties. The others were: cardiology, endocrinology, gastroenterology, immunology-allergy, nephrology, respiratory medicine and rheumatology.
While on average, a first visit left patients $71.90 out of pocket, geographical differences were pronounced.
Private specialists in the Northern Territory bulk-billed 76 per cent of visits compared with 20 per cent in Western Australia.
"It's surprising that this is the first time we have looked at this. Now we need start utilising data to make better decisions rather than relying on anecdotes to drive policy," says Gary Freed, Professor at the Centre for Health Policy, University of Melbourne.
He says the failure of state governments to fund outpatient speciality care has created more demand in the private sector.
An editorial in the same journal argues that self-regulation or increasing MBS rebates will have little effect on fee variation.
Increasing numbers of specialists should put downward pressure on prices but the scale is difficult to predict, write Dr Ian McRae of Australian National University, and Associate Professor Kees van Gool of The Centre for Health Economics Research and Evaluation at the University of Technology Sydney.
While direct government regulation is an option, it is likely to generate considerable debate.
They suggest improving the transparency of pricing could increase competition and place downward pressure on unreasonable fee setting and may provide the most affordable and fair approach to the problem.
Sourced from Australian Financial Review
07 Mar 2017