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15 Jan 2016

The Federal Government is coming under pressure over concerns its cuts to bulk billing incentives will leave patients needing x-rays, ultrasounds, MRIs and other diagnostic imaging services hundreds of dollars out-of-pocket.

Estimates by the Australian Diagnostic Imaging Association (ADIA) suggest general patients who are currently bulk billed will face significant up-front costs, from up to $101 for an x-ray to as much as $532 for an MRI, if the Government’s plan to wind back bulk billing incentives for diagnostic imaging and axe them for pathology services is approved.

When the changes were unveiled in the Mid-Year Economic and Fiscal Outlook in December, AMA President Professor Brian Owler condemned them as “a co-payment by stealth”.

“Cutting Medicare patient rebates for important pathology and imaging services is another example of putting the Budget bottom line ahead of good health policy,” Professor Owler said. “These services are critical to early diagnosis and management of health conditions to allow people to remain productive in their jobs for the good of the economy.”

His concerns have been borne out by the ADIA’s analysis, which shows the Medicare rebate for an x-ray will be cut by $6 under the changes, while the rebate for an ultrasound will be $12 less, that for a CT scan will be $34 lower, $43 less for a nuclear medicine service, and $62 less for an MRI.

The Association said the effect of these cuts would be amplified by the fact that, under Medicare, patients have to pay the full cost of the service upfront before being able to claim the rebate.

In practice, this will mean that a general patient having an x-ray will be required to pay between $54 and $101 before being able to claim their Medicare rebate.

Patients requiring an MRI will face the biggest upfront charge, ranging from $422 to $532.

Even after receiving their rebate, patients will still be left out-of-pocket. The ADIA calculates that, for an x-ray, patients will ultimately lose between $6 and $56, while those needing an MRI will take a financial hit of between $62 and $173.

General patient diagnostic imaging expenses as a result of bulk billing incentive cuts




CT scan

Nuclear Medicine


Rebate cut






Upfront costs






Out-of-pocket costs






Source: Australian Diagnostic Imaging Association

ADIA President Dr Christian Wriedt said the changes were introduced without consultation and, by potentially deterring people from seeking early diagnosis and treatment, represented “bad policy”.

“This will make it much more difficult for many patients to receive the life-saving level of care they need,” Dr Wriedt said. “We are talking about services that are absolutely essential to diagnosing and treating many conditions, and we’re making it harder for people to get. More people, especially those with chronic, serious conditions, will not be properly assessed.”

Shadow Health Minister Catherine King said patients with serious, ongoing conditions such as cancer and heart complaints would be hardest hit.

“Patients with serious conditions never need just one scan,” Ms King said, citing the example of someone with thyroid cancer.

She said a confirmed diagnosis involved having an ultrasound and thyroid function test, a follow-up ultrasound and pathology tests, and a final round of head or body scans.

“All up, that comes to around $1000 in upfront charges,” Ms King. “Patients will eventually get much of this back from Medicare, but they will still be left with hundreds of dollars in out-of-pocket expenses.”

Health Minister Sussan Ley has so far pushed back against such concerns, pointing out that the Government has not touched Medicare rebates and arguing that bulk billing incentives – introduced by Labor in 2009 – were an unjustified handout to providers.

But Dr Wriedt said Medicare rebates for diagnostic imaging services had not been indexed for 17 years, ratcheting up the financial pressure on providers and leaving them with little choice but to pass the bulk billing incentive cuts through to patients.

He said the Government’s strategy was to push more costs on to consumers.

“Let’s not kid ourselves. This is a cash grab and a co-payment by stealth,” he said. “They [the Government] know that this will hurt people, and particularly the most vulnerable in our communities, and yet they’re pushing ahead.”

But the Government’s plan might yet fall afoul of the Senate, where it will have to rely on the support of cross-bench senators to get the measure passed.

At least one has flagged she will join Labor in opposing the changes.

Independent Tasmanian Senator Jacqui Lambie has threatened to vote against all Government legislation in order to prevent cuts to bulk billing incentives for pathology and diagnostic imaging services.

Realisation that the cuts could result in women being charged for pap smear tests provoked widespread outrage, and almost 190,000 have signed a petition protesting the measure.

Senator Lambie said it was time the Government stopped its “sneaky attacks on Medicare”.

“Australian women should not have to pay more for vital cancer health checks,” she said. “Over my dead body will I allow the Liberals to try and sneak through more changes and cuts to our Medicare system. I will vote to block all their legislation in the Senate until they stop playing with our Medicare system.”

Adrian Rollins


Published: 15 Jan 2016