For privately insured healthcare patients attempting to calculate out-of-pocket costs for surgeries and compare them against other providers can be extremely difficult to search for and identify, let alone review.

In Australia, a government Senate inquiry has gone to the extent of delivering a report on the actual value of private health insurance, addressing the huge variations in surgeon fees, and with recommendations for the insured public to compare the market and evaluate other providers. A large consumer group has called on surgeons and private healthcare funds to increase transparency and publish the average prices for common surgeries.

Importantly, a blind assessment (or mystery shop) of sixty surgeons’ offices throughout Australia found more than a third of surgeons offices (twenty two to be exact) refused to provide any information about clinical fees. Tellingly, either specific price point information or even approximate information. As consumer group Choice has stated, the ease of access to price for healthcare has become critical.

As an example, an average gap payment for knee surgery varies from AUD$397/USD$300 for one states patients (SA) to AUD$2600/USD$1960 for another states patients (ACT). So one state was 15% of the cost of another, for the exact same service.

For another example, out-of-pocket costs for a radical prostatectomy ranged from AUD$2800/USD$2112 to AUD$10,700/USD$8073.

The Chief Executive of a peak industry body named Private Healthcare Australia has stated that feedback on dedicated research reflected out-of-pocket costs for medical specialist services was becoming a significant consumer issue. Notable was that with services that attract a gap, the charges were rising at 4 per cent a year (well above inflation).

She stated “the issue of consumer transparency of medical out-of-pocket costs must be addressed as this sector is out of step with the level of disclosure required in the rest of the economy, including financial services, and it is a key factor reducing consumer confidence in the private health sector.”

She also stated that the industry supported the use of online medical directory services to provide information to consumers and their GPs about the location and qualifications of medical specialists as well as the cost of treatment or the ability to find out.

“We believe this should be done on a national basis, to give patients the option of travelling to find more cost-effective options,” she said.

“We also believe the federal government and its agencies need to explore sanctions against health professionals who fail to provide patients with a reasonable quote for treatment in advance, and who are found to be charging excessive fees.”

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