Australian specialists aim to maximise their profits in charging above MBS scheduled rates but are also fair in trying to accommodate patients with lower incomes, a health economics analysis has concluded.
Associate Professor Meliyanni Johar and colleagues at the University of Technology Sydney said that despite the presence of discounts to low-income patients, out-of-pocket expenses remain substantial when compared with other healthcare providers such as GPs.
“There might be a case for devising incentives for specialists to charge low-income patients lower fees, similar to those in the GP market, to help remove some of these barriers,” they said.
Their conclusions were based on data from the Sax Institute’s 45 and Up Study, the largest follow-up health study conducted in the Southern Hemisphere.
Between 2006 and 2010 it collected data on more than 267,000 randomly-selected adults in New South Wales aged 45 or more and living in the community, and is continuing to extract information from linkages with databases including Medicare. The data includes more than half a million specialist consultations every year.
Professor Johar’s team looked at initial specialist consultations – MBS Item 104 – for which the MBS rebate was $68.75 in 2010 but the average fee charged was $124.62.
However, the average gap payment ranged from $47 for low-income patients (household income <$20,000/year) to $74 for high-income patients (>$70,000/year).
“While this gap equates to a 19% lower fees for the poorest patients it is unlikely to remove the substantial financial barriers they face in accessing specialist care,” they said.