Opinion

Transparency and out-of-pocket specialist fees


Evelyn Lewin


17/06/2019 3:43:15 PM

Patients’ out-of-pocket fees are again in the spotlight, prompting Dr Evelyn Lewin to explore the surrounding issues.

Calculating costs
One in three respondents to a survey said out-of-pocket were not explained to them before treatment.

Out-of-pocket expenses charged by specialists have again come under the microscope, with concerns about fees charged by high-profile Sydney neurosurgeon Dr Charlie Teo.
 
The debate was ignited when oncology surgeon Professor Henry Woo recently criticised Dr Teo’s fees on Twitter.
 
‘Something is seriously wrong if a terminally ill girl with a brain tumour has to raise $120K to have surgery …’ Professor Woo wrote.
 
Dr Teo defended himself by explaining that in cases where a surgery costs $120,000, about $80,000 goes to the private hospital, while the remaining $40,000 is shared between himself, a radiologist, an anaesthetist and others, meaning he receives around $8000–15,000 personally.
 
Federal Health Minister Greg Hunt responded to the issue.
 
‘It is my expectation, and the expectation of the leaders of the medical profession, that out-of-pocket costs incurred during private hospital treatment are modest, justifiable and proportionate to the circumstances of the patient,’ he said.
 
Minister Hunt said he shared the concerns of medical colleges about the ‘small minority’ of specialists overcharging and causing ‘material financial harm to patients’ through out-of-pocket fees.
 
In such cases, patients may be told upfront of expected costs, but may be forced to rely on mechanisms such as crowdfunding to cover such expenses.
 
Professor Woo took to Twitter to write that, ‘on a search on GoFundMe for Charlie Teo, there are 113 campaigns listed that mention him as the surgeon for which donations are sought to pay for his services’.
 
While this case illustrates what is often referred to as ‘overcharging’, it ties in with the other issue with specialists’ fees – namely that patients don’t always know their out-of-pocket costs in advance, raising the question of informed financial consent.
 
This can then leave patients with unexpected ‘bill shock’, which can be of significant concern.
 
The Department of Health’s Report: Ministerial Advisory Committee on out-of-pocket costs, released in November last year, noted that a survey on this issue found more than a quarter of the 1200 respondents treated for breast cancer incurred an out-of-pocket cost of more than $10,000.
 
Furthermore, one in six respondents said that out-of-pocket costs had a significant impact on their lives, while a third of respondents said such costs were not explained to them before treatment.
 
The report notes there is evidence of financial hardship caused by such out-of-pocket medical costs.
 
‘A number of patients have reported the need to take out a loan or an additional mortgage and others have made special applications for early access to superannuation,’ the report stated.
 
It seems, however, that transparency of out-of-pocket costs is about to change, with the Federal Government pledging earlier this year to build a searchable website that will list individual specialists’ fees for specific services.
 
This will help patients avoid bill shock, Minister Hunt said, which is a move many patients will be keen to embrace. It will also crack down on doctors charging exorbitant out-of-pocket specialist fees.
 
Minister Hunt said the website will allow patients to make informed choices about their care.
 
‘In many cases, patients may feel committed to a particular specialist after the first consultations,’ he said. ‘I am confident this website will improve transparency and choice for patients and families.
 
‘Our Government will also make available existing de-identified data, showing the range of fees and related out-of-pocket costs charged by specialists for the same treatments. The data will be aggregated to show the range of the costs charged within a geographic area.
 
‘We will also fund an education initiative to increase the understanding of medical out-of-pocket costs among consumers, their families and GPs.’
 
Given informed consent is pivotal for patients when considering medical options for treatment, it makes sense that the same should apply in a financial sense.
 
Of course, financial considerations are not always top of mind when referring patients to a specialist, as quality of care (rightly) remains the most important consideration when referring.
 
But it must be noted that, according to the Department of Human Services, referrals do not need to be made out to a specific specialist or consultant physician. This can allow patients with financial concerns to find an appropriately priced specialist – when such data is made publicly available, of course.
 
Even with such a website and transparency of out-of-pocket specialist fees, there will still be specialists who charge as they see fit, and patients who elect to see them, for a variety of reasons.
 
But I am glad to see the Government taking a stance to addressing these issues by launching a website that I believe is a step in the right direction towards transparency and informed consent.



out-of-pocket fees specialist fees



Michael Brown   24/06/2019 9:45:45 AM

This debate is not just about fees. It is also about whether treatments have evidence base to justify them being performed in the public system. I never cease to be amazed that nobody is challenging Dr Teo about outcomes for his surgery. He is yet to convince his neurosurgical colleagues that operating on terminally ill brain cancer patients offers a greater life expectancy than palliative measures alone. The anecdotal stories do not constitute evidenvce. Until he can demonstrate this, then surgery in this setting is no different to other alternative interventions such as thermotherapy treatments that are ubiquitous in Germany.


Dr Van Son Nguyen   24/06/2019 4:18:13 PM

I understand that when someone enrolled into a medical school or entered a training program, he or she did not do that for charity. However, the process of training includes subsidy from tax, goodwill from public patients, and most importantly the negative experiences comes from in-training-junior doctors. How could a doctor,after completion of training, tell a patient that if you do not pay my gap fee then I will not treat you. I know that not many medical graduates in the world took the Hipocratic oath nowadays but that refusal is immoral anyway.


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