Higher fees and out-of-pocket costs in radiotherapy point to a need for funding reform
Kees van Gool
A B * , Jane Hall A , Philip Haywood A C , Dan Liu A , Serena Yu A , Samuel B. G. Webster B , Bahare Moradi D and Sanchia Aranda A E F
A University of Technology Sydney, Faculty of Health, Centre for Health Economics Research and Evaluation, Level 5, UTS Building 20, 100 Broadway, Chippendale, NSW 2008, Australia.
B Independent Health and Aged Care Pricing Authority, Level 12, 1 Oxford Street, Darlinghurst, NSW 2010, Australia.
C Health Division, Organisation for Economic Co-operation and Development, Paris, France.
D Northern Sydney Local Health District, Royal North Shore Hospital Reserve Road, St Leonards, NSW 2065, Australia.
E Department of Nursing, School of Health Sciences, University of Melbourne, Grattan Street, Parkville, Vic. 3010, Australia.
F Department of Health Services Research, Peter MacCallum Cancer Centre, Grattan Street, Parkville, Vic. 3010, Australia.
Australian Health Review 47(3) 301-306 https://doi.org/10.1071/AH22293
Submitted: 22 December 2022 Accepted: 12 April 2023 Published: 4 May 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective To elucidate the policy implications of recent trends in the funding of radiotherapy services between 2009–10 and 2021–22.
Method We use national aggregate claims data to determine time trends in the fees, benefits and out-of-pocket (OOP) costs of radiotherapy and nuclear therapeutic medicine claims funded through the Medicare Benefits Schedule (MBS) program. All dollar figures are expressed in constant 2021 Australian dollars.
Results Radiotherapy and nuclear therapeutic medicine MBS claims increased by 78% whereas MBS funding increased by 137% between 2009–10 and 2021–22. The main driver of Medicare funding growth has been the Extended Medicare Safety Net, which has increased by 404%. Over the 13 year observation period, the percentage of bulk-billed claims peaked in 2017–18 at 76.1% but fell to 69.8% in 2021–22. For non-bulk billed services, average OOP costs per claim increased from $20.40 in 2009–10 to $69.78 in 2021–22.
Conclusion Despite increased Medicare funding, patients face increasing financial barriers to access radiation oncology services. Policies with regard to funding radiotherapy services should be reviewed to ensure that services are easily accessible and affordable for all those needing treatment and at a reasonable cost to Government.
Keywords: cancer care, health funding and financing, health policy, Medicare, bulk-billing, radiotherapy.
References
[1] Valentini V, Boldrini L, Mariani S, Massaccesi M. Role of radiation oncology in modern multidisciplinary cancer treatment. Mol Oncol 2020; 14 1431–1441.| Role of radiation oncology in modern multidisciplinary cancer treatment.Crossref | GoogleScholarGoogle Scholar |
[2] Merie R, Gabriel G, Shafiq J, Vinod S, Barton M, Delaney GP. Radiotherapy underutilisation and its impact on local control and survival in New South Wales, Australia. Radiother Oncol 2019; 141 41–47.
| Radiotherapy underutilisation and its impact on local control and survival in New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar |
[3] Batumalai V, Shafiq J, Gabriel G, Hanna TP, Delaney GP, Barton M. Impact of radiotherapy underutilisation measured by survival shortfall, years of potential life lost and disability-adjusted life years lost in New South Wales, Australia. Radiother Oncol 2018; 129 191–195.
| Impact of radiotherapy underutilisation measured by survival shortfall, years of potential life lost and disability-adjusted life years lost in New South Wales, Australia.Crossref | GoogleScholarGoogle Scholar |
[4] The Senate. Health Insurance Amendment (Safety Net) Bill 2015 [Provisions]. 2015. Available at https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Safety_Net/~/media/Committees/clac_ctte/Safety_Net/report.pdf
[5] Department of Health and Ageing. Medicare Statistics. 2022. Available at https://www.health.gov.au/resources/publications/medicare-annual-statistics-state-and-territory-2009-10-to-2021-22?language=en
[6] Department of Health and Ageing. Review of the Radiation Oncology Health Program Grant Scheme. 2020. Available at https://www.health.gov.au/sites/default/files/documents/2021/05/radiation-oncology-health-program-grants-rohpg-scheme-2020-review-report-rohpg-scheme-2020-review-report.pdf
[7] Australian Bureau of Statistics. Consumer Price Index, Australia. 2022. Available at https://www.abs.gov.au/statistics/economy/price-indexes-and-inflation/consumer-price-index-australia/sep-quarter-2022
[8] Gordon LG, Elliott TM, Olsen CM, Pandeya N, Whiteman DC. Patient out-of-pocket medical expenses over 2 years among Queenslanders with and without a major cancer. Aust J Prim Health 2018; 24 530–536.
| Patient out-of-pocket medical expenses over 2 years among Queenslanders with and without a major cancer.Crossref | GoogleScholarGoogle Scholar |
[9] Gordon LG, Walker SM, Mervin MC, Lowe A, Smith DP, Gardiner RA, Chambers SK. Financial toxicity: a potential side effect of prostate cancer treatment among Australian men. Eur J Cancer Care 2017; 26 e12392
| Financial toxicity: a potential side effect of prostate cancer treatment among Australian men.Crossref | GoogleScholarGoogle Scholar |
[10] Bates N, Callander E, Lindsay D, Watt K. CancerCostMod: a model of the healthcare expenditure, patient resource use, and patient co-payment costs for Australian cancer patients. Health Econ Rev 2018; 8 28
| CancerCostMod: a model of the healthcare expenditure, patient resource use, and patient co-payment costs for Australian cancer patients.Crossref | GoogleScholarGoogle Scholar |
[11] Slavova‐Azmanova NS, Newton JC, Saunders CM. Marked variation in out-of-pocket costs for cancer care in Western Australia. Med J Aust 2020; 212 525–526.
| Marked variation in out-of-pocket costs for cancer care in Western Australia.Crossref | GoogleScholarGoogle Scholar |
[12] Rodriguez-Acevedo AJ, Chan RJ, Olsen CM, Pandeya N, Whiteman DC, Gordon LG. Out-of-pocket medical expenses compared across five years for patients with one of five common cancers in Australia. BMC Cancer 2021; 21 1055
| Out-of-pocket medical expenses compared across five years for patients with one of five common cancers in Australia.Crossref | GoogleScholarGoogle Scholar |
[13] Van Gool K, Savage E, Viney R, et al. Who’s getting caught? An analysis of the Australian Medicare Safety Net. Aust Econ Rev 2009; 42 143–154.
| Who’s getting caught? An analysis of the Australian Medicare Safety Net.Crossref | GoogleScholarGoogle Scholar |
[14] Van Gool K, Savage EJ, Johar M, et al. Review of Extended Medicare Safety Net Capping Arrangements Report: a report by CHERE prepared for the Australian Government Department of Health & Ageing. Canberra: Department of Health & Ageing; 2011.
[15] Yu S, van Gool K, Hall J, Fiebig DG. Physician pricing behavior: Evidence from an Australian experiment. J Econ Behav Organ 2019; 161 20–34.
| Physician pricing behavior: Evidence from an Australian experiment.Crossref | GoogleScholarGoogle Scholar |
[16] Sloan FA. Effects of health insurance on physicians’ fees. J Hum Resour 1982; 17 533–557.
| Effects of health insurance on physicians’ fees.Crossref | GoogleScholarGoogle Scholar |
[17] Dormont B, Péron M. Does health insurance encourage the rise in medical prices? A test on balance billing in France. Health Econ 2016; 25 1073–1089.
| Does health insurance encourage the rise in medical prices? A test on balance billing in France.Crossref | GoogleScholarGoogle Scholar |
[18] Deeble J, Scotton R. Compulsory health insurance for Australia. Aust Econ Rev 1968; 4 9–16.
[19] Yap ML, O’Connell DL, Goldsbury D, Weber M, Barton M. Factors associated with radiotherapy utilisation in New South Wales, Australia: results from the 45 and Up Study. Clin Oncol 2020; 32 282–291.
| Factors associated with radiotherapy utilisation in New South Wales, Australia: results from the 45 and Up Study.Crossref | GoogleScholarGoogle Scholar |
[20] Radiation Oncology Inquiry Committee. A vision for Radiotherapy (the Baume Inquiry). Canberra: Department of Health & Ageing; 2002.
