Push for specialist fee transparency may backfire


By Andrew Bracey

2 Dec 2020

The government’s push to publish individual specialists’ fees could lead to some patients making poorly informed decisions based purely on worries about costs, a leading clinician has warned.

Professor Ian Olver, an oncologist and former head of Cancer Council Australia, said the recent flagging by Health department officials that specialists may be forced to disclose their fees for the government’s Medical Costs Finder website may have unintended consequences.

The site went live late last year and currently allows patients to search and view average out-of-pocket expenses for private medical services based on their location.

But the proposed extended model that would allow patients to compare individual clinicians’ prices would make it difficult for patients to know if they were ‘comparing apples with oranges,’ said Professor Olver, a researcher at the University of Adelaide.

He told the limbic the complexity involved in determining how specialists set their fees for various procedures and care meant cost alone was a “blunt tool” that failed to take into account important factors such as expertise and the likelihood of quality patient outcomes.

“If you’re providing additional services to patients in terms of their supported care [for example], it may be costing someone more to deliver that treatment in the private sector,” Professor Olver said.

“The government website, as it is at the moment, is informing people about when they’ll be gaps and what the extent of the gap is… [which] might be very useful.

“But once you start getting into individuals, it could be easily misused and it could actually not be interpreted as it should be which would be a shame really.”

Disclosure delays

Last month, Health Department secretary Professor Brendan Murphy told Senate estimates that there had already been “great buy-in from most of the medical profession” with regard to voluntarily disclosing their fees.

However, he warned that if insufficient numbers of specialists opted into the scheme, the government would effectively attempt to shame doctors into taking part or, ultimately, explore “potential ways to make it mandatory in the future”.

The individualised specialist fee data element of the government’s Medical Costs Finder was due to have gone live earlier this year. However, Professor Murphy said this had been delayed due to COVID-19.

“We think there will be a tipping point,” he told Senate Estimates. “As we eventually get enough of a critical mass of specialists to put their fees on there compared to those that aren’t on there, we will make it very clear in our communications that a good doctor shouldn’t hide their fees and that we would like to communicate to the public that this is an expectation.”

Professor Olver said it was vital to take steps to reduce patient bill shock by informing patients about the likely costs of their treatment. However, he felt uncomfortable with what he described as a “Big Brother” approach that risked “interfering with what is perfectly legal and acceptable trade.”

“Unless [doctors] are … making false claims and charging for them, which is something that the government should regulate, then the rest of it should be allowed to function as the rest of society functions,” he suggested.

He noted that previous research indicated that patients often felt that it was inappropriate to ask their doctors about fees or costs, and that this was a key factor in bill shock.

Instead it may be better to encourage specialists to instigate conversations about the gap fees their patients were likely to encounter in the course of their treatments, said Professor Olver, and direct them to available resources that could assist them in making better informed decisions.

In a statement, AMA president Dr Omar Khorshid said he actively encouraged full transparency of doctors’ fees. But without data around the level of benefits paid by insurers, he said the government’s proposed Medical Costs Finder model was an incomplete resource that “is not in anyone’s interests.”

“The AMA believes that a complete resource, which provides transparency all around, while assisting the consumer to understand the health system, would go a long way to exposing where excessive or egregious out of pockets occur and assist consumers to purchase better value products,” he said.

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