A Patient Perspective of Diagnostic Imaging: Challenges for Patients

Indexation and the Patient Gap

The freeze on diagnostic imaging Medicare rebates has had a significant impact on the affordability of diagnostic imaging for patients. Currently in its 17th year, the freeze on indexation has resulted in the real value of diagnostic imaging Medicare rebates falling, in some cases, by almost 50 per cent. This has resulted in patients paying consistently higher gaps each year, making diagnostic imaging service costs increasingly prohibitive.  Figure 4 reveals the rise in patient gaps for each modality, with the average patient gap rising by over 50% in the last six years.
Figure 4: Average gaps by modality: 2007-08 to 2013-14
 

Ultrasound
CT
X-Ray
Nuclear Medicine
MRI
Total

Average gap2007-08

$69.17
$102.19
$33.80
$93.79
$126.17
$61.09

Average gap2013-14

$98.61
$137.75
$52.43
$99.45
$164.45
$92.00

Growth from 2007-08 to 2013-14
42.6% ?

34.8% ?

55.1% ?

6.0% ?

30.3% ?

50.6% ?

*Average patient contributions for out of hospital services. Source: Department of Health
Of the additional comments made by respondents, almost 17% expressed a concern or inability to afford diagnostic imaging services, with some delaying or foregoing treatment due to the prohibitive cost.
The current gap crisis is also amplified by the current Medicare rules which require all patients who are paying a gap to pay the full cost of a service before receiving the Medicare rebate. This means that patients may be required to pay hundreds of dollars upfront, even where the gap is only $5-10. This policy disadvantages patients facing financial hardship who cannot afford the full cost of the service outright, and in some cases poses a barrier to patients accessing vital diagnostic imaging services.
No Private Health Insurance support
Understanding the role of private health insurance when accessing diagnostic imaging services is often a major challenge for patients. While private health insurance will generally cover diagnostic imaging services for patients who have been admitted to hospital, there is no private health cover available for out-patients accessing diagnostic imaging services. Many patients are unaware of this and mistakenly assume that gaps incurred from diagnostic imaging services will be covered by private health insurance.
A number of respondents highlighted this as a challenge, with respondents highlighting that they are having to pay significant gap fees that they thought would be covered by Medicare in addition to private health insurance cover.
The ongoing costs
For a large number of patients accessing diagnostic imaging services is an ongoing process, with patients receiving diagnosis, monitoring and treatment for multiple conditions (see Figure 3) or due to an ongoing condition, such as cancer, which requires regular diagnostic imaging services for the remainder of their lifetime. A number of respondents advised that regular, on-going monitoring and treatment was required, often more than twice a year, for the rest of their lives. A number of respondents highlighted the need for services over a decade due to the nature of their illness.
Furthermore, there are a number of services which are not covered by Medicare, such as an MRI of the breast, which means patients pay the full cost of the service without any rebate. This can lead to great financial hardship, with some respondents disclosing that medical costs had led to the sale of assets, such as the family home, in order to meet medical costs associated with their illness. While diagnostic imaging alone is not responsible for the significant financial difficulties patients face, it does highlight that diagnostic imaging patients are often some of the sickest patients who require extensive medical care. The addition of non-rebateable diagnostic imaging services is an added deterrent to already vulnerable patients who are having to choose between adequate healthcare and financial hardship.
These are issues that face patients in every part of the country and highlights the importance of addressing barriers to the affordability and accessibility of diagnostic imaging in order to ensure quality, affordable care for all Australians who need to access diagnostic imaging services.
‘As I am on a very low income, I sometimes refuse treatment as the gap is huge’ – Lynette
Where to from here?
It is clear that patients are facing a number of difficulties when accessing diagnostic imaging services. Growing patient gaps, uncertainties surrounding the role of private health insurance and Medicare with regard to rebates and the on-going costs associated with the monitoring and treatment of multiple conditions are heavily impacting the ability of Australians to access diagnostic imaging services. These factors, while significant issues in their own right, are symptoms of a far greater problem: a lack of appropriate funding to support diagnostic imaging services.
While Medicare affords Australians an unparalleled opportunity to access necessary medical services, the lack of adequate funding has put significant pressure on patients and the diagnostic imaging practices who service them. This is particularly disturbing given their overwhelming value and necessity in the prevention and early detection of a myriad of serious illnesses.
In order to ensure appropriate and affordable access to diagnostic imaging, the current funding model must be changed. Prioritising quality services and patients who are most in need is essential to restoring the balance as it is often the sickest patients that face the greatest challenges in accessing services. There must also be a focus on ensuring quality care, which is best achieved by supporting the role of the radiologist as an essential part of the clinical team. Radiologists are crucial to the diagnostic process and having a radiologist available to attend the patient if patients are to be assured quality imaging services.
ADIA’s 2013 HELP Campaign revealed the importance to patients of having affordable access to quality diagnostic imaging services. The role it plays in the patient journey and the challenges that threaten to undermine its long-term viability were also highlighted. Adequate funding is essential to ensure that patients receive proper clinical care and to ensure that important healthcare services are accessible and affordable for every Australian.

This concludes our Two-Part series by Pattie Beerens, CEO of the Australian Diagnostic Imaging Association.