Cancer patients face $12,000 treatment bills after budget cuts to Medicare

Cancer patients will have their out of pocket costs for life saving radiotherapy treble to up to $12,000 under a budget cut that reduces the amount they get from the Medicare Safety Net.

In last year’s budget the government capped the amount the safety net will pay patients at 150 per cent of the Medicare fee from January 2016 to save $267 million over five years.

“There was a furore over a $5 GP copayment but these patients are already contributing $2,000 to their treatment and now they will be slugged twice that,” said Melbourne radiation oncologist Dr Michael Guiney.

“Once you get over $4,000 in out of pockets that is the tipping point even for well heeled patients and we’ll see patients of lesser means having to access the public system.”

This will mean many hours of travel for rural patients to public hospitals that already have waiting lists of a month for access to radiotherapy.

The Extended Medicare Safety Net was set up by Tony Abbott when he was health minister in 2004 to cover 80 per cent of a patients out of pocket expenses when their doctors charged more than the Medicare fee.

Private patients undergoing a typical six to seven week course of radiation treatment currently have $12,000 in out of pocket expenses but $10,000 of this is covered by the Medicare Safety Net, Dr Guiney said.

When the 150 per cent fee cap is introduced in January the Medicare Safety Net will cover only $8,000 of these bills leaving the patient $4,000 out of pocket.

John Boyages, Professor of Breast Oncology at Macquarie University at the Faculty of Medicine and Health Sciences, says from January 1 patients will be out of pocket by up to $10,000.

“Patients will be queuing up into often-inefficient public hospitals where waiting lists are long and will increase with this new initiative,” he said.

Health Minister Sussan Ley said Legislation to streamline the Medicare safety net arrangements had not yet been introduced to Parliament.

“I have been travelling the country speaking with health professionals and consumers about a broad range of Medicare issues including radiation oncology,” Ms Ley said.

Private radiotherapy clinics deliver 40 per cent of radiotherapy provided to 50,000 cancer patients in Australia each year and private health funds don’t cover the treatment.

Doctors say they treat half their private patients at the Medicare schedule fee and cross subsidise their care by charging wealthier patients more.

It’s these wealthier patients who will be hardest hit by the safety net changes but even low income patients will be slugged by the safety net revamp.

Patients charged the Medicare schedule fee currently have their out of pocket expenses capped at $440 a year but this cap will be removed under the budget changes.

These patients will now have to spend $1,000 out of their pocket on out of pocket expenses before qualifying for the safety net and getting back 80 per cent of any out of pocket costs over this amount.

Radiation oncologists say their Medicare rebatable fees have not been reviewed for 25 years, have not been adjusted for inflation for years and have now been frozen.

Medicare rebates for radiotherapy are 50 per cent lower than the cost of providing the service and some modern targeted treatments have rebates ten times lower than the cost of delivery, Genesis care executive manager Keith Hansen says.

Melbourne mum Ros Parry has just a 60 per cent chance of surviving her breast cancer and will have both her breasts and her ovaries removed in May.

Her out of pocket expenses for radiotherapy were capped at $440 under the current safety net but if she had her treatment after January next year they would have totalled over $1,100.

She also faces bills of $8,000 for upcoming reconstructive surgery, $4,000 for an anaesthetist and has had to pay for numerous cancer scans.

“My parents are helping me out, my friends are organising a fundraiser to help pay for the surgery,” she said.

“If I don’t raise enough funds I’ll have to use the money set aside to buy a house,” she said.

She described safety net changes that would add to her out of pocket expenses as “ridiculous”.

“I’ve got enough to worry about,” she said.

“I’m trying to save for a mortgage, this is another stress when I’m trying to fight for my life,” she said.

Retired electrical engineer Ashley Webster who lives in Adelaide has spent $18,500 on cutting edge radiotherapy to shrink two tumours in his brain and received $13,000 back from Medicare.

He’s also spent $4,000 on scans and been left $1,000 out of pocket.

“We were planning a holiday of a lifetime in South America but this holiday in hospital has cost more,” he said.

Mr Webster said while he was fortunate that he could afford to pay increased medical bills after changes to the Medicare Safety Net after January.

“The issue is not us paying, it’s how much can others afford to pay,” he said.

“I think the majority of people can’t afford it, and I think it would be a mistake if people missed out on their treatment,” he said.

“Many women are dismayed to learn that despite paying years of private health insurance premiums, they cannot claim for radiotherapy costs from their private health fund unless they are in hospital during their treatment,” Breast Cancer Network Australia chief Christine Nolan said.

“These women must rely on the Medicare Safety Net to maintain their costs for radiotherapy at a reasonable level. Breast Cancer Network Australia is concerned about any proposed changes to the Safety Net that may increase treatment costs and add to the financial burden of a breast cancer diagnosis,” she said.