Rheumatologist fees cause financial distress for patients

For people with arthritis the cost of seeing a rheumatologist is the main driver of financial distress, an Australian study has found.

An investigation into the personal financial burden of arthritis on working-age people conducted by Monash University researchers found that the greatest expenditure incurred by patients was for specialist rheumatologist consultations.

Although some patients were able to get rheumatologist appointments that incurred no out-of-pocket costs through the public hospital system, some reported paying fees of $AUD500 for an initial consultation and most reported paying approximately $AUD200 per appointment.

The findings from a qualitative study based on interviews with 21 patients under 50 with doctor-diagnosed arthritic conditions such as RA or psoriatic arthritis,  found that the direct and indirect costs of medical care were reducing people to lives below the poverty line.

And the fact that arthritis was a chronic disabling condition that rendered many patients unable to work and gain a regular income led to comments such as: “It’s the rest of your life you’re paying for this stuff”.

And while 70% of the patients surveyed had private health insurance, many said this did not cover the cost of seeing specialists  on a regular basis, not to mention the additional costs incurred for GP appointments and treatment from allied health workers such as physiotherapists to manage their condition.

In addition to the direct healthcare costs of medications, diagnostic investigations and treatment programs, people with arthritis reported facing many unexpected indirect financial costs for things such as transport, home modifications and products to assist with daily activities such as bending down.

Only one third of the patients were working full time, while one third were working part time or in casual work and 15% were unable to work because of their condition.

The low income from a disability allowance or pension meant that many had to rely on family members  – either parents or children – for accommodation, financial assistance with medical costs and with many also acting as unpaid carers.

One respondent said he felt guilt and shame at the burden he imposed on ageing parents who “try and pitch in with costs where they can, but I don’t like it because they should enjoy their retirement without worrying about my financial state”.

Writing in Arthritis Care and Research, the study authors said their findings confirmed previous reports showing that the inability to work and high cost of medical care for arthritis resulted in many patients experiencing financial hardship, and many living below the poverty line despite access to a public-funded healthcare system.

“Clinicians need to be cognisant that their patients may be experiencing financial distress, and that identifying these concerns as part of routine clinical care can help inform shared decision making, “ they wrote.

They suggested that clinician should be particularly aware of financial distress when referring patients for interventions or services that are high-value, and to identify available services that may be feasible “such as referring a patient to a community physiotherapy program, versus a private practice”.

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