Out-of-pocket medical costs: out of control for Lyme patients

by Grace Riley

The Australian Institute of Health and Welfare (AIHW) released a report last week on Patients’ out-of-pocket spending on Medicare services, 2016–17. It was quickly followed up by media reports that Australians are paying more than $30B in out-of-pocket costs for health-related services in Australia.

The report noted that half of all Australians (10.9 million people) incur out-of-pocket costs for non-hospital Medicare services. It stated the average cost of out-of-pocket costs for these people is around $142 per year, but it varied from area to area, with affluent areas paying higher out-of-pocket costs for health services. The 10% of patients in the “high” out-of-pocket cost group reported average out-of-pocket costs of $601 or more in a year.

AIHW also found that patients are more likely to pay higher out-of-pocket costs for specialist services. And that patients are putting off attending medical services, especially specialist appointments, due to affordability.

There is a distinction to be made between health-related services and Medicare rebatable services. The report notes that Australians spent $29.4 billion out-of-pocket on all their health-related expenses in 2015–16; which averages around $1,195 per person.

If those data are reported for the average healthy Australian, its incomprehensible when we consider the significant out-of-pocket health-related costs that occur for patients with chronic illnesses, especially Lyme-like illness.

According to the AIHW report, the highest out-of-pocket costs occur in relation to specialist services (34%). We know from our early patient surveys that it takes people with a Lyme-like illness an average of 10 years from acquisition to diagnosis; and most patients see between four and ten doctors or specialists in their search for a diagnosis.

As part of the Senate Inquiry, in 2016, we analysed 349 public patient submissions and were able to get an understanding of the health-related costs of those who suffer a Lyme-like illness. In those 349 submissions, we found the out-of-pocket health-related costs amounted to $2.7m which equates to $42, 561 per person; that’s a long way from $142 in Medicare rebatable out-of-pocket costs and the average of $1,192 per person total health-related expenses. In fact, its 3570% higher!

Clearly, there is complete disparity here and people suffering from chronic illnesses, who are already struggling to maintain any income at all are not supported financially or equitably within our medical system. With an estimated 22,000 people suffering from a Lyme-like illness in Australia the total health-related costs being shifted onto the patient community is more likely to be somewhere near $964m.

And it is just not good enough.