In August last year I found myself facing the prospect of needing to undergo thyroid surgery. I had two options: either I could get it done for free through Medicare or get it done privately at a cost of $11,000. If I opted for Medicare, I would have to be on call for three months and my surgery would be done by a trainee or registrar surgeon. If I did it privately, I could get it done within a week at a time of my choosing, and I would have an experienced oncologist performing the delicate procedure.
Like most people I weighed the pros and cons. $11,000 is a lot of money, but no one wants to gamble with their health. Given the choice, most people would want an experienced surgeon operating on them. I also needed to factor in the urgency of the procedure and the time off from work I would need to organise. All these considerations led me to get it done privately at a significant financial cost to myself.
The disparity between the private and public healthcare systems has recently come under scrutiny in light of the criticism aimed at Charlie Teo, a renowned brain surgeon whose operations are estimated to cost up to $120,000. As was pointed out by the University of Sydney's Professor Woo, many patients were resorting to crowd funding to cover their medical costs.
What followed was a media frenzy, with Teo claiming he would quit if the criticism were to continue and pointing out that his fee was only $8000-$15,000 of the $120,000 medical bill. Some complained, while others defended the 'celebrity' doctor, with Health Minister Greg Hunt warning medical professionals against excessive fees.
According to the Australian Institute of Health and Welfare, expenditure on health for 2016-2017 came in at $180.7 billion which is $7400 per person. Two thirds of that expenditure is funded by the government, with the rest either coming from health insurance providers or private funding. Like many Australians I struggled to afford private health insurance and never took out a policy. I didn't think I would face the prospect of going under the knife any time soon, let alone be weighing up my health prospects in terms of value for money.
If I had insurance, my health bill would have been reduced to about $4000, as health insurers generally only cover your hospital bed, not the surgeon's fees, which are rarely if ever the same as the scheduled fee the government recommends. For example, the scheduled fee for a partial thyroidectomy is just under $800, but my surgeon charged me almost $3000 and on top of that I had to pay the anaesthetist as well as other costs. These are referred to as 'gaps', costs that medical insurers don't cover. Even with insurance my surgery would have come with a hefty price tag.
My 'out-of-pocket-costs' would have been lower if I was living in Canada, New Zealand or the UK. According to the Australian Healthcare and Hospitals Association out-of-pocket costs in Australia account for 20 per cent of healthcare expenditure, which is higher than the OECD average. In comparison, out-of-pocket costs account for 14 per cent of Canada's health spending, 13 per cent of New Zealand's and ten per cent of the UK's.
"Money shouldn't dictate access to faster interventions and medical expertise."
In its submission on healthcare affordability to the Australian Senate Standing Committee in 2017 the AHHA notes that such out-of-pocket-costs stop people from seeking healthcare services, especially those who are on low incomes.
According the Australian Bureau of Statistics, eight per cent of people who needed to see a specialist delayed or did not see a specialist due to cost, while seven per cent of those who needed medicine either delayed or did not purchase the medicine due to costs. Younger people, those from low socio-economic areas and remote Australians were generally more affected than others. When it comes to dental healthcare, the statistics are higher, with almost one out of five Australians not seeing or delaying seeing a dental professional due to costs.
With out-of-pocket costs rising, the outlook is not great for many Australians, especially those who are unemployed or are on low incomes. Despite our universal healthcare, Australians struggle to pay for medical fees, and as we have seen are resorting to crowd funding platforms to access medical expertise. Often time is crucial when patients are dealing with cancers and other chronic diseases.
In one of the first comparative studies of healthcare systems globally, the World Health Organisation placed Australia 32nd in the world, behind countries like Columbia, Greece and Morocco — all less wealthy countries. What the recent media spat should do is highlight that Australia's healthcare system is not as egalitarian as we think it is. Money shouldn't dictate access to faster interventions and medical expertise.
Daniel Sleiman is a freelance writer and journalist based in Canberra.
Main image: Prime Minister Scott Morrison speaks to Health Minister Greg Hunt during Question Time in Canberra on 4 April 2019. (Photo by Tracey Nearmy/Getty Images)