The poorest and sickest Australians are those who most need healthcare, yet they are missing out due to the combined forces of variable bulk-billing rates and high out-of-pocket costs according to a report from the Grattan Institute released this week.

Australia’s healthcare is designed to ensure no one misses out on access to healthcare, but mounting out-of-pocket costs are making specialist care and access to medications unaffordable for many people.

The Not so universal: How to reduce out-of-pocket healthcare payments report released by the Grattan team, led by Dr Stephen Duckett show that the people who need to most from health care – lower socioeconomic groups with high health care needs, those with chronic illness and young people are the worst affected by out-of-pocket costs.

“The extent to which out-of-pocket costs are a barrier to care is consistent with what we are being told by consumers in our own research and consultations, the CEO of Consumers Health Forum, Leanne Wells, said.

“A package of systemic and structural measures are urgently required to address the enduring challenge of out-of-pockets costs,“ said Ms Wells.

“It is an ongoing and pain point in our system that must be addressed if we are to achieve health equity.

Missing out on essential medicines, specialist care or being unable to afford treatment to unacceptable wait times on the public system is a growing concern for many Australians.

The report shows that younger people are more likely to skip necessary healthcare costs, and specialist treatment, especially mental health support.

“The cost of medicines, particularly for people with chronic conditions on multiple medications, such as cancer patients, can drive important prescribed medications out of reach for some people,” said Ms Wells.

“CHF supports the recommendations in the report which would target financial barriers for people with chronic illness on lower incomes and bring down costs of expensive services,” she said.

“The proposed national secondary consultation scheme to support GPs in reducing unnecessary referrals to specialists, reviewing the Medicare Safety Net and expanding public health services in low social economic areas to bring down wait times are important steps to rationalising our services and help those with high needs access more support”, said Ms Wells.

“The lack of transparency around fees and charges from some healthcare providers, particularly specialists, is a major concern for health consumers,” Ms Wells said.

“Consumers have expressed their dissatisfaction about the lack of transparency about costs of treatment and lack of itemised inclusions and exclusions”, said Ms Wells. 

“There are a range of measures that can improve the financial health literacy of consumers and encourage them to ask questions relating to fees.  CHF supports a proposal for a national standard for Informed Financial Consent, and we have participated in the design of the Australian Government’s Medical Cost Finder website.

“CHF calls on all political parties to commit to ambitious healthcare funding priorities to bring down costs for consumers and create a more fair and equitable system,” said Ms Wells.

Additional reading 

Specialist fees and performance transparency - potential for improvement
Position statement from CHF and the Centre for Health Policy, the University of Melbourne, informed by discussions at the Specialist Fee and Performance Transparency  Roundtable
Endorsed by 

• Melbourne Institute: Applied Economic and Social Research - University of Melbourne
• Australian Healthcare and Hospitals Association