Radio Interview Dr. Mukesh Haikerwal with Madonna King, ABC Brisbane - Medical Fees

MUKESH HAIKERWAL: The main discussion here is about the cost of medical fees, which we believe, wholeheartedly, need to be discussed at the time of consultation prior to surgery. That should be for the surgeon, the surgeon's assistant, the anaesthetist and also if there's a chance that someone might need an x-ray during the course of their hospital stay, or something sent off to a lab to be looked at. All these things need to be talked about up front. The problem is about disclosing gaps. Doctors don't create gaps, they just have a fee. The gaps are created by the medical health funds and the rebates that they provide for those services and each fund has a different rebate, so it's very difficult to actually pin down just what the gap is going to be.

MADONNA KING: But a person wouldn't buy a car or a lounge suite without knowing the total cost. People have family budgets to manage. Aren't they entitled to know how far out of pocket they'll be?

MUKESH HAIKERWAL: Yes, absolutely they're entitled to know that and that's something that we are pushing very hard with a hard-hitting educational campaign, to make people talk about the 'elephant in the room'. We have 19 per cent of consultations or procedures that may have no consent around them so, absolutely right, we need to make sure the patients know what the costs are going to be. The problem is that the insurers are not clear about the rebates that are available. There are also insurers that have no deals with certain large hospitals and therefore patients going to those hospitals end up carrying an additional cost.

MADONNA KING: So, are you saying that often the doctors don't know what the gap will be, it's up to the patients to find out from their insurers what it will be?

MUKESH HAIKERWAL: The doctors can give a very clear account of what it is they themselves will charge. They can also talk about the other people involved in the care and the fact there may be charges coming from there as well but the actual charge that they ... the actual out-of-pocket that they'll pay, the gap, varies with the Medicare rebate and the way Medicare interprets the account when they receive it. It also varies with the health insurer, the table the person is with the insurer and even the way in which the insurer deals with that particular claim. These variables are out of control.

MADONNA KING: So, whose responsibility is it to know what the gap payment will be? You're saying it's not the doctor's responsibility to tell patients. Are you saying it's the patient's responsibility to find that out?

MUKESH HAIKERWAL: It's the doctor's responsibility to be clear about what their fee is and who else will be involved in the cost of that procedure and the rest of that procedure. The actual gap is based on what the insurers will pay. Insurers need to provide that sort of information to patients and also the way Medicare deals with the situation is also important, too.

MADONNA KING: But how does a patient do that? If I go to the doctor for a procedure and they say, this will be my cost before the treatment, then I would need to take his number and go to my insurer, ring Medicare, minus that what I'll get back from the doctor's fee, before I know what the gap will be, won't I?

MUKESH HAIKERWAL: Well, that's absolutely right. I mean, the doctor only has control over the fee that they have and will do the best they can to provide information about what the Medicare rebate should be, but then it all depends on what the fund itself is charging, whether the fund has a deal with the hospital so that there's no out-of-pocket going into the hospital and so on.

MADONNA KING: So what is the solution to the problem?

MUKESH HAIKERWAL: The solution that we have put forward is this very hard-hitting campaign. This campaign will make sure doctors do the right thing and tell patients, the 19 per cent of patients that currently may not get informed consent about treatment, exactly what their costs are going to be. Also, we would ask at every opportunity, that that discussion happens in the doctor's surgery, at the private hospital, at the Medicare office and also at the private health fund.

MADONNA KING: I understand it was a $500 gap payment for an operation last year that prompted the minister, Tony Abbott, to have a look at this and that the average gap payment is something in the order of $700. That's a lot of money. Are some doctors charging too much?

MUKESH HAIKERWAL: The vast majority of doctors will be charging less than the AMA recommended schedule of fees and, basically, they are in a consumer industry and have to be competitive. Otherwise, people won't take the services from them in particular and, indeed, could ... would opt for the public system which, of course, would be something that we're trying to avoid because the balance we have in Australia of private health insurance that's accessible and affordable, together with the public system makes our system work very well.

…ends