Non-PBS medicines increasing patient out-of-pocket health spending

26 Sep 2019

New data from the Australian Institute of Health and Welfare (AIHW) has revealed that in 2017-18, Australian’s spent $30.6 billion on out-of-pocket health-related expenses.

$9.4 billion (30.8 per cent) of this spending was on medications that are not subsidised by the PBS.

AMA President, Dr Tony Bartone, said that the greatest contributor to patient out-of-pocket costs continues to be non-PBS medications, which includes vitamins and minerals and complementary therapies that are purchased over the counter at pharmacies – many of which have no proven efficacy.

This is compared with medical costs (referred and unreferred) accounting for just 13.1 per cent of out-of-pocket expenditure over the same period.

Dr Bartone said that APRA statistics show that the medical profession has shown remarkable restraint providing hospital services under private health insurance policies and minimising out-of-pockets for patients.

“The overwhelming majority of medical practitioners (95 per cent) bill their patients under a no gap or known gap billing arrangement,” Dr Bartone said.

 “This is compelling evidence that the overwhelming majority of doctors continue to assist patients in limiting their out-of-pocket costs – in an environment of years of frozen or inadequately indexed rebates.”

Dr Bartone emphasised that doctors are limiting out-of-pocket costs for patients despite MBS fees and Private Health Insurance rebates falling well behind the true cost of providing health care to the Australian community.

“The AMA will continue to advocate on behalf of doctors and their patients for fairer, clearer, and better value system that balances the interests of all stakeholders,” Dr Bartone said.

Read the full media release here.

The AMA’s Informed Financial Consent (IFC) Guide is the first step in addressing inappropriate egregious billing, to make health services more affordable and accessible for the community. Download a copy of the IFC Guide here.