Large cost gaps and waiting list back-logs are forcing almost half a million Australians to delay or skip vital health checks, such as specialist appointments, a new Grattan Institute report shows.
The report found bulk bill rates were too low and out-of-pocket expenses were too high for many specialist appointments. Among the Institute's calls for Medicare reform, it suggests that government should cover out-of-pocket diagnostic services and fund bulk-bill specialist services in private clinics.
Victorian Council of Social Service chief executive Emma King supported the need for change.
Ms King said there were already plenty of compounding factors creating barriers to healthcare for the most vulnerable people, let alone large gaps in specialist health services that were often beyond reach for low-income earners and pensioners.
"There is a line in the report saying you can shop around specialists, assuming you can get in somewhere," Ms King said. "Some medical specialists are not in a category of offering the best deal and can charge what they like when a low-income person cannot afford it or get into a doctor easily that bulk bills."
Sovereign Radiology co-principal Alicia Wang Sheludko, who also works in the public healthcare system, said the pandemic had created a back-log of people who deferred specialist appointments or screenings due to COVID-19 uncertainty.
Dr Wang Sheludko said adding to this was a lot of Melbourne-based specialists who, particularly amid lockdowns, were referring people to screenings in or closer to their regional home towns. This had added to demand on Ballarat healthcare.
Her private clinic makes clear to people their out-of-pocket expenses when making appointments.
VCOSS found the choice often became food or under-using electricity, against healthcare.
"If you think about Ballarat in winter, it's freezing, and there are people who are really worried about turning their heaters on too hot because they can't afford the electricity bills. There are ongoing health implications with that," Ms King said.
"It can be a vicious cycle: you get sick; see a doctor or specialist; can't afford the medication or health plan...It all compounds, especially for people already at a health risk."
It can be a vicious cycle: you get sick; see a doctor or specialist; you can't afford medication or health plan.- Emma King, Victorian Council of Social Service
Ms King said while there were some travel rebates, travel costs were still an added deterrent for people the further they lived from regional centres. Or, there was the cost of running a car or navigating public transport.
She said the gaps in healthcare became more profound during the pandemic with reports some people chose forgo showers in a bid to save money when community wash facilities were unavailable.
In heatwaves, places that were normally cool refuges, such as libraries, had limited access and Ms King said the result had been significant extra pressure on health frontlines, such as paramedics or nurse-on-call.
Grattan Institute's report shows should governments invest an extra $710 million per year in bridging Medicare gaps, Australians could save about $1 billion in out-of-pocket payments, and more people could access care when they need it.
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