Image Source: The New Daily
By Ashleigh Piles, Christopher Dastoor, Emily Downs, Irini Kourakis, and Shamsiya Mohammadi
Despite government funding, many patients pay significant out-of-pocket costs to cover medical expenses.
According to The Australian Institute of Health and Welfare, government spending accounts for more than 67 per cent of total health expenditure.
In 2014-15, funding from non-government sources—mostly out-of-pocket costs—increased four-and-a-half times faster than government funding.
The Australian Medical Association’s (AMA) federal budget statement shows private health insurance premiums continue to rise each year beyond the Consumer Price Index (CPI).
Women’s health specialist at the University of South Australia Medical Centre, Dr Brenton Martin said despite the increase in government funding, lower gaps are unreachable.
“It’s because the Medicare rebate on everything hasn’t gone up with the CPI,” Dr Martin said. “That’s the problem: it won’t ever catch up.”
The proportion of expenditure by the Government has remained relatively stable over recent years because the Medicare rebate has been frozen.
The freeze is increasing the gap between Medicare rebates and medical fees, with out-of-pocket costs doubling in the past 10 years.
Dr Amy Moten, Shine SA’s— South Australia’s leading sexual health agency—Medical Education Coordinator, said the increase in funds will encourage more GPs to provide alternative payment methods.
“I think if the Medicare rebate would increase at the same rate as the normal inflation indexation prices then a lot more doctors would bulk bill or charge less of a gap,” Dr Moten said.
If the outcome of a pathology test result is abnormal, the patient is required to revisit their GP for a second consultation.
A patient may or may not be charged by the pathology clinic, but they will be charged the gap for the second consultation.
“Medicare rebates exist and should cover some of the cost of medical consultations, but they actually aren’t enough to cover the expenses for a lot of GPs to run their own practice,” Dr Moten said.
“If we want universal free health care then the Medicare rebate probably needs to increase for a lot of health services.”
The lack of subsidies is further magnified with the disproportionate amount of clinical pathology tests required to ensure a healthy and functional female reproductive system.
Government rebates for pathology services have not been indexed in more than two decades, and bulk billing incentives that help the pathology sector minimise costs for patients are being removed.
Dr Martin said Medicare will fund the new cervical screening test for women who meet the criteria or are over the age of 25.
“If you were 14 when you first started sexual activity, if you have pelvic symptoms like bleeding in between your periods or bleeding after sexual activity, or any undiagnosed pelvic pain, they will fund it,” Dr Martin said.
“Under the age of 25, it is not covered—regardless if abnormal results are found.”
Lack of government planning means changes to the national cervical screening program will impact the pathology sector’s ability to retain skilled professionals needed to produce accurate and timely test results.
Dr Moten said the new cervical screening test is completely covered by Medicare, just as the previous pap smear test was.
“People who don’t have Medicare have always had to pay for the test,” Dr Moten said.
“There may be a fee charged by the health professional, just as any other GP visit and that won’t change.”
Increasing government funding would not only reduce the cost of consultations and pathology tests, but would produce quicker diagnoses and recovery time for chronic conditions like endometriosis.
Dr Martin said to be diagnosed with endometriosis, you may have to wait eight to 15 months to have a laparoscopy in the public system.
“It would be good for every girl with endometriosis to have an operation in two months, but we don’t have the funding for that,” she said.
Advisor to the Federal Health Minister on the national action plan for endometriosis, Libby Parker, said the lack of proper diagnosis, paying for specialist doctors, pain killers, scans, and other surgical procedures created significant costs.
“My lack of diagnosis for 19 years cost me my self-esteem at times, because doctors told me the pain and symptoms were in my head,” Ms Parker said.
“[It] cost me my chance at motherhood and has caused permanent damage, which has left me in chronic pain.
“The price of going from GP to GP, specialist to specialist hoping someone, some day, will believe you and help you is quite high.”
Ms Parker is also a member of the board of directors at the Pelvic Pain Foundation Australia (PPFA), which raises awareness of endometriosis and pelvic pain through health practitioner seminars, information sessions for women.
“I know my life would be very different if I’d been diagnosed earlier, and I will keep working until we can make a real difference to women and girls living with endometriosis, so they have a real chance to live to their full potential,” Ms Parker said.
Women are also charged for contraceptive requirements: getting a script for the pill, contraceptive injection, implant or intra-uterine devices.
“If they have a contraceptive implant or an intra-uterine device, they often have to pay a fee and those need to be replaced every three to five years,” Dr Moten said
Contraceptive pills are costing women about $240 a year, and other methods face similar price obstacles.
“Merinas [a contraceptive coil] are subsidised $220 by the government, the actual device is $270, and then you have to pay for insertion as well,” Dr Martin said.
Although the Medicare rebate indexation is not in-line with Australia’s CPI, the public still has an option to force action on the issue.
“People who feel medical treatment should be free should lobby their local MP, because it is actually up to the members of parliament to set the fees health professionals get paid,” Dr Moten said.
“It needs to be sustainable for people to be able to run a business just like any other—as much as we’re all compassionate people and want to help.”