Marked variations in medical provider and out-of-pocket costs for radical prostatectomy procedures in Australia

Ramya Walsan; Rebecca J. Mitchell; Jeffrey Braithwaite; Johanna Westbrook; Peter Hibbert; Virginia Mumford; Reema Harrison

doi:10.1071/AH24020

RESEARCH ARTICLE (Open Access)

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Marked variations in medical provider and out-of-pocket costs for radical prostatectomy procedures in Australia

Ramya Walsan

^A ^* , Rebecca J. Mitchell ^A , Jeffrey Braithwaite ^A , Johanna Westbrook ^A , Peter Hibbert ^A ^B , Virginia Mumford ^A and Reema Harrison

^A

+ Author Affiliations

- Author Affiliations

^A Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Road, North Ryde, Sydney, NSW 2113, Australia.

^B IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.

^* Correspondence to: ramya.walsan@mq.edu.au

Australian Health Review 48(2) 167-171 https://doi.org/10.1071/AH24020

Submitted: 19 January 2024 Accepted: 25 February 2024 Published: 14 March 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Objectives

Unwarranted clinical variations in radical prostatectomy (RP) procedures are frequently reported, yet less attention is given to the variations in associated costs. This issue can further widen disparities in access to care and provoke questions about the overall value of the procedure. The present paper aimed to delve into the disparities in hospital, medical provider and out-of-pocket costs for RP procedures in Australia, discussing plausible causes and potential policy opportunities.

Methods

A retrospective cohort study using Medibank Private claims data for RP procedures conducted in Australian hospitals between 1 January 2015 and 31 December 2020 was undertaken.

Results

Considerable variations in both medical provider and out-of-pocket costs were observed across the country, with variations evident between different states or territories. Particularly striking were the discrepancies in the costs charged by medical providers, with a notable contrast between the 10th and 90th percentiles revealing a substantial difference of A$9925. Hospitals in Australia exhibited relatively comparable charges for RP procedures.

Conclusions

Initiatives such as enhancing transparency regarding individual medical provider costs and implementing fee regulations with healthcare providers may be useful in curbing the variations in RP procedure costs.

Keywords: hospital costs, medical costs, out-of-pocket costs, prostrate cancer, radical prostatectomy, surgical cost variations, specialist costs, unwarranted variations.

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