There are marked variations in the cost of cancer care and patients with private health insurance pay almost twice as much in out-of-pocket expenses than those with no insurance, according to new Australian research.

Published in the MJA, the findings come from a survey of more than 430 patients with colorectal, lung, prostate or breast cancer conducted by Professor Christobel Saunders and colleagues at the University of WA between 2014 and 2017.

Almost all patients incurred out‐of‐pocket expenses for their cancer care, chiefly for surgery, medical tests, and medical appointments. Costs ranged from as little as $13 to as much as $20,842.

Costs were higher for patients living in outer metropolitan areas than those in rural areas. For some patients the costs were considerable: one third of outer metropolitan participants (33%) and 17% of rural residents spent more than 10% of their household income on cancer care.

Mean out-of-pocket expenses were higher for people with private health insurance : $4670 v $2510 compared to uninsured patients in outer metropolitan areas and $2455 v $1103 for rural residents.

Expenses were also higher for men than women ($5217 v $2247) in metropolitan areas, as well as for those who had undergone surgery ($5434 v $2157), worked prior to being diagnosed with cancer ($5471 v $2143), resided in higher socioeconomic areas ($4299 v $1859), or were receiving chemotherapy ($4286 v $2735).

“The higher out-of-pocket expenses for people with private health insurance or undergoing surgery indicate the importance of health care funding arrangements and the magnitude of the costs borne by patients,” said the study investigators.

The wide variations in out-of-pocket expenses also highlighted the need for easily accessible information about services, medical costs, and gap payments for all health care services, they said.

“Problems that still need attention in the unregulated private fee-setting environment in Australia include price discrimination in some specialist sectors.”

“Bundles of care for cancer treatment that would allow patients and their families to better understand and plan for expenses should be explored,” they suggested.