Private insurers have wide variations in chemo fees
The benefits paid by different private health insurers for chemotherapy services – and likely out of pocket expenses – vary by as much as 18% between companies, the AMA has shown.
In its latest Private Health Insurance Report Card for 2021 the AMA notes that each insurer has its own schedule of benefits that it pays for admitted medical services – and the different amounts paid by insurers for the same procedure can vary significantly.
It provides examples of the different fees paid by insurers for selected MBS-rebated services, with variations as great as 46% ($301.30 ) in fees for procedures for femoral or inguinal hernia or infantile hydrocele, or as small as 9% (40.25) for colonoscopy.
For cytotoxic chemotherapy the report shows that the MBS fee is $112.40 and the fees paid by different insurers are: BUPA $134.50; HCF no gaps rate $142.75; AHM/Medibank Private $132.65; nib $127.85; AHSA $123.60 and HBF no gap rate $145.55. Therefore the benefit variation (highest to lowest) for chemotherapy was $21.95 (18%).
The report authors said the level of benefits paid will depend on the particular insurance policy and the insurer’s arrangements with the treating doctor and the treating hospital.
“When there is a difference between the doctor’s fee and the insurance benefit, out-of-pocket costs can occur. It is a common misunderstanding that the doctor’s fee is the reason for an out-of-pocket cost,” it says. “There can be a large difference in the amount an insurer will pay towards a medical service, and it varies from fund to fund and procedure to procedure.”
“These differences contribute to the out-of-pocket expenses patients incur and are also a good reason to look beyond just the price of the annual premium levels of an insurer to ensure that you get value for your insurance policy,” the report concludes.
Single dose IVIg for ITP
A single 1g/kg infusion of intravenous immunoglobulin (IVIg) is likely to be as effective as two consecutive 1g/kg doses for treating immune thrombocytopenia (ITP), as recommended by NHS England (NHSE) Specialised Commissioning guidelines, according to a new study published in the British Journal of Haematology.
For the study, a team from HaemSTAR, a UK wide network of trainee haematologists working to promote non-malignant haematology research, evaluated data from 961 patients with ITP who received a total of 961 initial and 416 subsequent IVIg treatments.
They found that achieving platelet counts of at least of ≥30 × 109/l was not affected by whether patients were treated with 1g/kg on one or two consecutive days.
Despite 2016 NHSE guidelines advocating a single 1g/kg infusion for ITP patients, the research showed that adherence to this dosing strategy in England remains poor, with just 35.8% of treatment episodes following the recommendation.
This reluctance from haematologists to treat with a single dose could be because alternate guidelines endorse the use of 1-2 g/kg IVIg and/or the lack of data at the time at which the NHSE recommendations were made, the authors said.
“We hope our data will reassure clinicians that the single 1 g/kg dosing regimen is effective, less expensive, rations a scarce resource and reduces side-effect risks,” they concluded.
Espionage claims for hospital PET scanner
A Sydney hospital’s acquisition of a cancer PET scanner is facing opposition in NewsCorp media campaign that claims the $14m deal will allow the Chinese government to steal confidential medical data.
In an editorial published on December The Australian newspaper called for the Royal North Shore Hospital’s purchase of the scanner from Australian-based United Imaging Healthcare to be blocked under the Foreign Relation Act to prevent China stealing research data and patients’ personal medical information.
The editorial quoted un-named ‘intelligence sources’ claiming that the scanner would operate within the NSW Health system’s firewall and this would potentially allow healthcare data to be acquired by the parent company United Imaging Healthcare UK, which in turn is owned by Shanghai United Imaging Healthcare. The intelligence source said this company’s shareholders might have links to the Chinese government, and thus there was a potential risk of data espionage.
The article suggested that the hospital consider alternative PET scanner vendors. The scanner industry has traditionally been dominated by US companies such as General Electric.
In a statement, the University of Sydney, which is responsible for Royal North Shore Hospital, said its contract to buy a PET scanner had not yet been awarded and did not breach any regulations, including DFAT obligations.
“We have rigorous and clear processes to ensure all relevant checks and balances are completed; this includes an external independent assessment. We are jointly working with the Northern Sydney Local Health District on this tender for an important piece of medical technology equipment that will provide benefits for patients and researchers,” it said.
Australian webinar to host international cardio-oncology experts
Australian clinicians with an interest in cardio-oncology are hosting a webinar on Friday 17 December with international experts to discuss how to manage the cardiovascular toxicities of new cancer therapies that have delivered impressive improvements in survival and yet may create issues around quality of life.
The webinar is hosted by Associate Professor Aaron Sverdlov, Director of Heart Failure and Clinical Lead, Cardio-Oncology Program, University of Newcastle, NSW, and Associate Professor Doan Ngo, Co-Director of Cardio-Oncology research program, University of Newcastle.
The first webinar will feature Dr Bonnie Ky, Director, Penn Center for Quantitative Echocardiography, Philadelphia, USA, discussing “Advancing Cardio-Oncology Clinical Care & Biomarker Science’. It will also feature Dr Darryl Leong, Director, Cardio-Oncology Program, McMaster University and Hamilton Health Sciences, Canada, discussing cardio-oncology in prostate and breast cancer.
“Cardiovascular disease is now the leading cause of morbidity and mortality among cancer survivors,” says Associate Professor Sverdlov.
“Throughout these webinars we will hear from experts on how we can potentially improve cardiovascular health outcomes for people living with and beyond cancer through better management and mitigation of cardiotoxicity risk while maintaining effective cancer therapies, emerging diagnostic and risk stratification tools and enhanced models of care.”