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A close encounter with our ill health system



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.

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)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 SleimanDaniel 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)

Topic tags: Daniel Sleiman, healthcare



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Existing comments

This country's leading surgeons all have appointments at public university teaching hospitals. They also have independent private practices. They thus have the facility to operate at both public and private hospitals - for no fee to the patient in public and for a fee in the private. Some 92% charge a fee in private covered by the private funds basic and gap cover plus Medicare. The 8% are not covered in full because they have seen a surgeon who either does not have a public hospital appointment or unlike the 92 % puts a premium on top of the usual fee determined by personal assessment of his/her worth, a recommendation that is not necessarily accurate, tainted by a certain bias and likely to be highly inflated. Those who do have public hospitals appointments prioritise patients with serious illness such as cancer. Those who do not prioritise serious illness and seduce the patient into "going private" so that a fee can be earned are not surgeons but businessmen. Should a patient find himself stuck with a businessman, he should seek out another opinion/surgeon and inform the medical registration board that he was denied treatment to which he was entitled under Medicare by a surgeon appointed to a public hospital who refused to do the work . Self-promoted or media-promoted surgical celebrity is not an indication of superior surgical ability or outcomes.

john frawley | 04 July 2019  

Extract from a letter I wrote to Mr. Greg Hunt MP, Minister for health in March this year. I write concerning a procedure to combat prostate cancer through a new wave in BPH treatment called REZUM. Prostrate Cancer Kills More Men than Brest Cancer in women. This treatment is not available in Public Hospitals and while I qualify as informed during a consultation with my Urologist, I could have the procedure performed at a cost of $5,000, in a private Hospital. Did I receive a response now some 4 months later? No it was in all probability filed in the trash can. If I could travel to the U.S.A. the procedure would be done for $200.00 USA currency. Out of pocket expenses are a simple form of extortion, but don’t knock the public health system. Our public hospitals do a great job but should be funded and operated under the federal government. Edward M

Edward M | 09 July 2019  

If everyone who wanted surgery was given the private Health Rolls Royce treatment in the public system there would be no Government money left for anything else. We have the best health system in the western world with the most reliable outcomes. And guess what it costs money. So you take out private health insurance and go business or you take your turn and go economy. If your surgery was life threatening and urgent you immediately get upgraded. I have several doctors in my family, their overheads are phenomenal. And trainees have to start somewhere and surely it should be on the more routine non urgent cases. If you want to complain about excessive salaries and wages try the CFMEU and the Transport unions.

Peter | 09 July 2019  

Australia's health care system is not egalitarian because Australian society is not egalitarian. It may be in principle, or before the law, but as was said of British Law - it is the best that money can buy. Here's the pub test question. What's Joe Bloggs worth? The answer you are most likely to get is in terms of dollars. Rarely would you get an answer that refers to Bloggs' class position, religious standing, military rank, knowledge, or political or social contributions. The egalitarian principle that all men, women and children are of equal value is challenged from the moment an individual draws breath. While we may not live in a society where only the fittest survive, the weak are dependent on the generosity or venality of others. So we have competition for limited resources in all areas of our lives, and, of course, in health care. And so we end up with the distinction between the vocational surgeon and the businessman. (cf John Frawley's comment above) Trying to manage this dichotomy in a democratic capitalist system results in adversarial politicking. The consequences of which we can see in David Sleiman's experience.

Uncle Pat | 09 July 2019  

Our experience with the health care system is more favorable as we come from the prospective of being whole of life wage earners who expected to pay for doctors of our choice in chosen hospitals. My wife and I as baby boomers have had health insurance our whole lives (40+years) and in the last 20 years had timely major back surgery, full breast cancer treatment and open heart surgery. There have been instances where contributions to treatment were required but both breast cancer treatment and major heart surgery was with little out of pocket due to chosen teams covering gaps and good health insurance being at the highest level. Generally due to our life circumstances we are of the view that if you can afford to pay you should, freeing up free health care to those who cannot. Making informed choices is critical and can start with a good family GP.

Lyle M | 09 July 2019  

Yes, private health insurance is very expensive but if you value your life and health, its worth sacrificing perhaps the smokes, the booze, the annual holidays, the overseas trips, the petrol guzzling SUV, to afford cover. Emergency care in the public system in my experience is excellent but specialist experience resides with them. Even vet fees are now more expensive than GP consultations but we need em when our fury family friends are sick. So its about personal priorities!.

Jane Jimboomba | 09 July 2019  

Jan Jimboola, your response seems to assume that those of us whom 'cannot afford to get sick', smoke drink, own cars etc. I am the recipient of a disability support benefit, and so appreciative of such. I need to see a specialist right now, but have absolutely no choice but to go on the public waiting list. If my situation worsens whilst l wait, it may be that the issue becomes much more dire than is currently is. I can't help but wonder how many people become quite ill because of such a situation. We can, and should do so much better. It's just not a priority for this government.

Julie Shannon | 10 July 2019  

If this had been me, I would have jumped at the opportunity for a junior doctor do the operation under observation. This junior doctor/surgeon will be the specialist of the future.

Gabrielle Jarvis | 12 July 2019  

Daniel you said you had the choice of an experienced surgeon or a learner. Personally I would have gone with the learner supervised by the specialist. If the learners do not have the opportunity to practice where do the next generations of specialists come from.

Gabrielle | 13 July 2019  

Like Lyle we have had health care for most of our lives 50+ years each. That is, apart from a short time when our children were young and money was scarce. We resumed Private Health cover as soon as we could possibly manage it. It does cost but we feel that it's not only security for ourselves but our part in helping others who absolutely cannot afford the large cost. Those such as our daughter and her husband and small child who refuse to allow us to help and have so far had excellent care when needed. How wonderful would it be if we were generous enough as a wealthy society to allow health care cover to be means tested. Then the 'greedy' doctors would be paying into the system as would all those who could easily afford to pay but who wait until they too need urgent or serious care and then pay for it from their ample finances. We have chosen a not for profit fund after watching the blatant money grabbing tactics of Medibank and hope that others who can afford it will one day see the need to do so. There's something akin to the way the way in which Eureka Street works which reminds me of what I am trying to say ! Marg Alice

Margaret Leahy | 14 July 2019  

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