New report reveals out-of-pocket costs for Medicare services in your local community

Half of Australian patients pay a contribution towards their non-hospital Medicare services, according to a new report released today by the Australian Institute of Health and Welfare (AIHW). However, the proportion of patients that are out-of-pocket and the amount they pay varies greatly across Australia depending on where they live.

The report, Patients’ out-of-pocket spending on Medicare services looks at health services that were delivered outside of hospitals and subsidised by Medicare, including GP, specialist, imaging and obstetric services. While governments contributed $19 billion towards these services in 2016–17, $3 billion was paid for by patients. Services that were paid for completely by the patient or subsidised by private health insurance are not included in the report.

The report shows that nationally in 2016‒17, half of patients (10.9 million patients) paid something from their own pockets toward their services. The remaining half had the full cost for all of their non-hospital Medicare services covered by the government.

This is different from the usually reported bulk-billing rate for GP services that were completely paid for by the government. In 2016–17, 86% of GP services were bulk-billed while 66% of patients had all of their GP services bulk-billed.

The proportion of patients with out-of-pocket costs for non-hospital Medicare services varied considerably across Australia’s 31 Primary Health Network areas, from 31% of patients paying something out-of-pocket in the Northern Territory PHN, up to 69% in the Australian Capital Territory PHN.

Overall, patients living in metropolitan PHN areas were less likely to have out-of-pocket costs than patients in regional PHN areas.

‘For patients who incurred out-of-pocket costs, the median amount each patient spent in the year was $142—but patients living in some PHN areas paid almost double that of others’, AIHW spokesperson Michael Frost said.

The median out-of-pocket cost per patient during 2016-17 ranged from $104 in Western Queensland to $206 in Northern Sydney.

For the 10% of patients with the highest costs, there was also substantial variation across similar socioeconomic areas. For example, among patients living in lower socioeconomic areas in the major cities, the top 10% in Playford (SA) were out-of-pocket at least $372 during 2016‒17, while those in Botany (NSW) were out-of-pocket at least $682.

The report also highlights variation in how much patients pay out-of-pocket per service. More than 7 in 10 people who had specialist consultations had out-of-pocket costs, and for these people the median ‘gap’ per specialist visit was $64. Across local areas, the median out-of-pocket cost ranged from $36 to $97 per specialist service.

‘A range of factors can influence out-of-pocket costs. These can include the types of services the patient requires, the availability of bulk billing and the cost of services in their area,’ Mr Frost said.

The report provides important insights into the way Australians use health services and the barriers to accessing services that may exist in some areas. The findings will help inform policymakers and health service providers to better understand the needs of their local area.


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