Helping patients understand fees and charges is key to avoiding bill shock
BY ASSOCIATE PROFESSOR JULIAN RAIT OAM, CHAIR, AMA COUNCIL OF PRIVATE SPECIALIST PRACTICE
On August 21, 2019, Australia’s largest health insurer Medibank Private announced that it’s full-year net profit rose three per cent to $458 million. Medibank also added a net of 15,000 new customers over the year, despite the downward trend of private health insurance (PHI) membership.
However, in every newspaper now, you can’t help but hear about the plight of PHI, the increasing cost of health care and the impact of out-of-pocket medical expenses. Doctors are being blamed for rising insurance premiums and for the falling numbers of people taking out insurance. Consequently, the Commonwealth Health Minister has responded by launching a national strategy to tackle excessive out-of-pocket costs charged by medical specialists by developing a website, a website designed to inform patients and help combat ‘bill shock’.
While the AMA does not support egregious billing, known out-of-pocket medical costs are not the major cause of discontent with health insurance – premium pricing (mainly driven by for-profit insurers), and a lack of coverage with unexpected gaps are the real problems. The AMA continues to advocate for consumers having access to an affordable, value-based product, while recognising changes to the current policy settings will need to be made. But the AMA has also been working to help medical practitioners reduce bill shock and increase health financial literacy of patients more directly.
For many patients and for some doctors, talking about charges and bills can be an uncomfortable conversation. But as medical practitioners we understand that patients have the right to be fully informed about all their medical costs before they make their decisions.
That surprise – that bill shock – is a difficult challenge. So, the AMA has been working to create a better Informed Financial Consent (IFC) guide that aims at empowering patients, increasing their knowledge and transparency about the options they have in choosing a doctor, specialist, or pathway for their treatment, and helping them to make sure there are no financial surprises.
This new IFC guide provides people with clear, easy-to-understand information to help them navigate the health system. It helps patients in their conversations with doctors and practice managers about fees for their medical procedures. It’s why we have called this guide a collaboration – we are working with patients to try and end the uncertainty where possible. The guide also provides patients with suggested questions – the right questions that they need to be asking to get the information they need.
It is up to the medical profession to take the lead in the health debate hence the unprecedented support the AMA received for this valuable resource. This the guide has been developed with, and is co-badged by, more than a dozen leading medical Colleges, Associations, and Societies. Finally, the guide was endorsed and launched by the Health Minister at Parliament House, Canberra.
The IFC guide includes:
- an Informed Financial Consent Form for doctors and patients to use together;
- information on fees and medical gaps; and
- questions for patients to ask their doctors about costs.
The guide is also accompanied by an updated webpage (https://ama.com.au/article/ama-informed-financial-consent) that includes a range of material you can use in your practice or provide to your patients. This includes:
- AMA Informed Financial Consent Form Template;
- "let's talk about fees..." brochures, pads and posters;
- What is a medical gap?;
- Gaps Poster;
- Questions to ask your doctor about costs before you go to hospital;
- AMA Position Statement on Informed Financial Consent 2015; and
- AMA Position Statement on Setting Medical Fees and Billing Practices 2017.
But this guide is only as good as we as practitioners make it. The next step is ours – we need to provide patients with the weblink, help them to use it, assist them in working out their health finance journey, as we do with their health care.
The final page of the guide is a form that the practitioner or patient can print out and use in their appointments. This form will assist in establishing a clear estimate of the out-of-pocket fees which may arise across a whole episode of care. This form is how we can help our patients achieve more transparency over the costs they face, reducing their bill shock and helping them maintain their trust in the health system.
Published: 09 Sep 2019