The $4 billion question: why have specialist copayments risen by 35%?


Academics are questioning why specialists have increased their consultation fees to make out of pocket healthcare expenses for patients rise by 35% in recent years, ahead of other healthcare costs and the cost of living index.

Average out of pocket costs on specialist fees rose from $325 in 2009-2010 to $438 in 2015-16 according to Australian Bureau of Statistics surveys of more than 10,000 households.

The rise in specialist copayments was in contrast to other healthcare out of pocket costs which remained relatively stable for medications and dentist fees, and increased by a modest 11% for GP consultations from $86 to $96 per household, according to Sydney University researchers.

They said the increase in out of pocket expenditure on specialist copayments – equivalent to $4 billion in gap fees a year – was much greater than the rise in total household expenditure (up 15%) and expenses for healthcare overall (25% rise).

And yet there was no evidence that large out of pocket costs for specialists were related to better quality of care or increased access to care. Other areas of increased healthcare expenses were private health insurance premiums (51% rise) and co-payments to ‘other health professionals’ (42% rise).

The study authors said the upward drift in out of pocket expenses likely reflected a dismantling by stealth of the Medicare system of universal healthcare.

“The progressive movement of healthcare costs from public to person has occurred without policy debate, slowly and steadily with small steps, such as freezing Medicare rebates for various medical services, and so it may be imperative for practitioners to seek, beyond simple efficiency savings, an increasing copayment from patients,” they wrote in Australian Health Review.

“Practitioners should take account of the effect of increasing copayments for their services, especially on patients belonging to the lower socioeconomic categories …Increasing copayments may lead to people foregoing medical care,” they wrote.

Key findings:

  • Households OOP expenses on healthcare: $4,290, (5.8% of total household expenditure).
  • Private health insurance ($1744) accounted for 41% of household healthcare costs.
  • Households with private health insurance had fourfold higher OOP costs than those without insurance ($6295 vs $1457).
  • Richer households spent more on OOP costs than poorest ($7368 vs $2116)  but a smaller proportion of household budget (5.5% vs 6.4%).

Already a member?

Login to keep reading.

OR
Email me a login link
logo

© 2022 the limbic