Scan rebate freeze huge pocket pain
PATIENTS are facing an average $100 hit to the hip pocket for X-rays and other scans because Medicare rebates have been frozen since 1998.
A Deloitte Access Economics report, commissioned by the Federal Government, has found Medicare rebates for scans are set at 20 per cent below the cost of the service.
The report calls for rebates to be increased to slash out-ofpocket expenses faced by patients.
And bulk billing rates for common procedures have crashed, with 51 per cent of pregnancy ultrasounds, 17 per cent of prostate cancer ultrasounds and only 45 per cent of breast cancer biopsy ultrasounds now bulk billed.
There is a Medicare funding shortfall of $711 million a year, and scans have the lowest bulk billing rate of any primary medical service (77 per cent compared with GPs at 85 per cent).
One in five patients pay the bill (up to $575 in some cases) up front and then claim back the Medicare rebate.
“Paying the full cost up front [and then receiving the rebate, as required under legislation] places a significant cost burden on patients,” it said.
Some people who cannot afford the money up front do not have the scan and illnesses can go undiagnosed.
ABS data shows 300,000 Australians chose not have a scan because of the cost.
A breast-cancer patient can face out of pocket expenses ranging between $3000 and more than $5000 for scans.
The underfunding is most severe for fluoroscopy gastrointestinal studies and mammography forcing providers to cut the number of services they provide.
To stay in business, operators are making up for lost Medicare funding by charging one in five patients gap fees averaging $97.
General patients are being overcharged for scans to cross subsidise services for pensioners and welfare recipients the report finds.
The report says Medicare rebates have to be increased.
And it says Medicare rules should be changed so providers can bill Medicare direct and charge the patients only the gap amount upfront.
Medicare rules prevent this because it undermines bulk billing. It is less likely providers will bulk bill if they can charge every patient a small amount instead of the bill upfront.
The Government commissioned the report to honour a pledge for evaluation of the diagnostic imaging sector.