Respiratory patients forced to pay thousands for ‘standard of care’ scans

Thursday, 1 Feb 2018

Shrinking or non-existent Medicare rebates mean respiratory patients are now having to pay hundreds and sometimes thousands of dollars for standard radiology tests, advocacy groups say.

Patients with lung cancer are left $258 out of pocket for a PET scans for staging because the imaging is not covered by Medicare, a Senate inquiry has been told.the Senate’s Community Affairs Reference Committee was told at a public hearing in Brisbane on 13 December.

Gap fees also affect patients with COPD and upper respiratory tracts infections, the inquiry has been told by the Australian Diagnostic Imaging Association.

Radiology tests for COPD such as chest X-ray and CT scans or lung perfusion and ventilation studies required patients to pay upfront fees of  $1,096 and left them with gap fees of $337, ADIA figures show.

For patients with upper respiratory tract infections, imaging tests such as chest CT with contrast will cost patients $566 in upfront fees and leave them $184 put of pocket, the ADIA said.

Patients faced high gap costs for “standard of care” imaging tests because Medicare rebates have been frozen since 1998, the ADIA representative told the inquiry into the availability and accessibility of diagnostic imaging equipment around Australia.

High out of pocket costs also arose because the Medicare system wasn’t keeping pace with imaging technology and rebates had not been approved for many tests that are now considered the basic standard of care, the Association said.

“[Cancers]  often require more than one radiology service for diagnosis, treatment and monitoring, meaning that patients pay thousands of dollars upfront and are left hundreds of dollars out of pocket,” the ADIA said in its submission to the inquiry

The claims were backed up by patient advocacy groups, who told the hearing that imaging gap fees were now the major financial burden for cancer patients.

Cancer patients can expect gap fees for scans to double in costs over the next decade unless action is taken to unfreeze the Medicare rebates for imaging, the hearing was told.

There was also a need to reform the slow and outdated system of approvals for Medicare rebates, with the Medicare Services Advisory Committee, taking three or more years to consider applications.

By the time the MSAC rulings come out, technology had often moved on to better tests that were adopted as standard practice overseas, the committee was advised.

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