Latest news with #healthcareCosts
The Guardian
6 days ago
- Business
- The Guardian
More Australians can't afford specialist fees. Experts say it's ‘not in the spirit of Medicare'
The cost of an initial dermatology appointment is now up to nearly $300 on average, new data shows. It reflects a broader problem: that Medicare rebates are not keeping up with the pace specialist fees are rising. Online healthcare directory Cleanbill, which has tracked bulk billing rates among GPs, is expanding to provide data on out-of-pocket costs to see other health professionals, starting with dermatology. The report, released on Thursday, found the Medicare rebate in March 2017 for an initial appointment with a dermatologist was $72.75, while the out-of-pocket cost was $148.73. By March 2025, the rebate had risen by $11.40, to $84.15, while the average out-of-pocket costs, at $210.18, were $61.45 more expensive. Over eight years, average out-of-pocket costs for an initial consultation had increased by over 40%, and average follow-up consultation costs had increased by over 55%. The rebate rose by less than 16%. Cleanbill compared the 2017 data collected by predecessor MindTheGap for 165 dermatology clinics still currently operating, with its own data collected in October. Sign up for Guardian Australia's breaking news email Based on all 280 dermatology clinics Cleanbill identified currently operating, the average upfront cost of an appointment was $296.71 – more than 3.5 times the Medicare rebate. Cleanbill's report highlighted that as private health insurance does not cover out-of-hospital consultations, these out-of-pockets costs are being borne entirely by patients. Private health insurance mainly covers the cost of private hospital treatment, and may also cover non-Medicare subsidised services such as physiotherapy, psychology and dental services – but not GP or specialist consultations. 'These out-of-pocket costs far exceed the increases that we've seen to the Medicare rebate,' Cleanbill's chief executive, James Gillespie, said. 'In these circumstances, it's easy to see why the number of Australians putting off specialist care due to cost has risen from 176,000 in 2016-17 to 900,000 in 2023-24,' he wrote in the report, citing Australian Bureau of Statistics data. Many specialist services are available to patients for free in public outpatient clinics, but patients need a referral from their GP to qualify, and each hospital or specialist clinic has its own process for assessing urgency, accepting referral letters and making appointments. A GP referral is needed to claim the Medicare rebate at a specialist appointment, meaning a second round of out-of-pocket costs that 'stacks one on top of the other', Gillespie said. Gillespie said it was reasonable to extrapolate similar price increases across other medical specialists than dermatologists. The latest government data on medical specialist consultations showed patient out-of-pocket costs in non-hospital settings increased in real terms (adjusting for inflation) from $1.1bn in 2012-13 to $1.9bn in 2022-23 – or 'from $213 per patient to $294 (38%)'. In the same period, Medicare benefits paid by the government increased in real terms from $2.5bn to $2.9bn – or 16%. The government this year promised $7m to expand the much-derided Medical Costs Finder website, which the former Coalition government spent $24m setting up to see only 70 specialists – out of 11,000 registered to practice – choose to voluntarily display their fee information as of March 2025. Prof Yuting Zhang, an expert in health economics at the University of Melbourne, said providing cost information was only a first step – and the government had not outlined a policy to lower fees. Zhang and her colleagues at the Health Analytics, Leadership and Economics Hub mapped specialist fees in 2023 across different areas, finding on average that rheumatology had the highest fees, followed by neurology and immunology. Specialist fees have gone up 'a lot' but the Medicare schedule fee hasn't been properly indexed, Zhang said, remaining 'quite flat' for about the last 20 years, leaving patients to absorb the increasing gap. Sign up to Breaking News Australia Get the most important news as it breaks after newsletter promotion Some fees were 'super high' at about $1,200 but cost varied widely even within the same specialty for exactly the same services, she said. 'Some people might be willing to pay a lot more to see a specialist and thinking the price might be an indicator for quality – which I can assure you, it's never the case,' Zhang said. 'More expensive doesn't really mean better.' A third of people living with chronic diseases say they are not able to attend specialist appointments due to the cost, a study published in May in the journal Health Policy found, with both the upfront cost and out-of-pocket costs being a major barrier to care. Australian National University researchers analysed the experiences of more than 1,800 Australians living with a range of chronic conditions within 37 studies. Assoc prof Jane Desborough, the lead author of the study, said while GPs face 'consistent pressure' to bulk-bill, backed by policy initiatives, there is 'no similar conversation about non-GP specialists who are also trained in the public system, who are also remunerated through Medicare … yet from the evidence, it seems quite uncommon for them to bulk-bill'. Many Australians with multiple chronic conditions often need to see several different specialists; even a person with a single chronic condition such as psoriatic arthritis needs both a dermatologist and rheumatologist. Those who struggled to afford specialist appointments reported often choosing who they saw based on 'what's hurting most at the time', Desborough said. Chronic illness often impacts people's capacity to work. The frustration of not being able to afford specialist visits is compounded by the long wait list for public specialist clinics, she said, as well as an increased trend by specialists towards exclusive private practice. Those who had full access to the specialist clinics in the public system were 'very grateful for what Medicare does,' Desborough said. But as for others, having to forego important aspects of their life – like food choices, social activities, family holidays, children's sport, school excursions – to access healthcare: 'That's not in the spirit of Medicare,' she said. The health minister, Mark Butler, said the private health sector, including insurers and specialists, 'need[s] to do more to protect patients for exorbitant bills'. Zhang said specialist medical colleges could play a role, by developing codes of conduct around fee practices and scrutinising members who consistently charge high fees. The government could also open more public clinics offering free specialist care for those who cannot afford the gap fees in private clinics, Zhang said.
Independent Singapore
02-06-2025
- Business
- Independent Singapore
Singaporeans shocked by S$52K/month rental for Tampines clinic
SINGAPORE: On Sunday (Jun 1), a doctor shared on LinkedIn that a rental clinic in Tampines is going for a monthly rental rate of more than S$52,000 per month. Dr. Hisham Badaruddin posted a screenshot of the final result for the bid of S$52,188 for Block 954C, Tampines Street 96, indicating that Lum Sian Wei Shaun was the successful tenderer. Its closing date was Jan 14, 2025. 'This is obscene … S$52K per month rental for a clinic in a HDB area? Madness…,' wrote Dr Hisham, whose LinkedIn bio says he is a Longevity Medicine Physician, in the caption to his post, adding that he believes the Ministry of Health might say that rentals in the private sector are out of their purview. Screenshot His post has since garnered many reactions and shares, with some commenters expressing concern that the high rental rate could be passed on to patients, who might find themselves saddled with higher consultation fees. In response to a question about the clinic's size, Dr Hisham guessed that it's likely to be less than 1,000 square meters. 'That's crazy! Can't believe this is a HDB tender!!' a commenter wrote. 'Rent in Singapore is abhorrently high, especially when it comes to businesses, and let's not talk about renewal of leases once you have invested your hard-earned money in renovation. The landlord knows you are stuck between a rock and a hard place!' wrote another LinkedIn user. Over on Reddit, where the post was shared, the top comment pointed out that 'Caring Pte Ltd, who was second in this bid, won two other bids with a S$25K/mo rent. In the same doc, there are two clinics in the North that went for S$4.2K and S$5K each. If the outlets were listed at these rates, Hisham might have a point, but in a closed bidding system, if he's literally bidding twice the amount as the next person, then either he's spoiling the market, or there's something special about that location that guarantees crazy good business.' See also Has the Wage Gap in Singapore Really Been Closing? Another agreed saying, 'There will always be these opportunistic people who'll try to ruin the playing field for market share & supposedly future gains.' 'Location is at a new BTO estate that recently TOP-ed, winning bid is essentially paying over the top to get a first mover advantage by trying to lock their patients in,' a commenter pointed out. A Reddit user wrote, 'S$52k is absolutely insane. It is double or triple the current market rate to rent in a populated HDB area. How do they even sustain? It doesn't seem right unless they are open for long hours or 24/7.' Some commenters on LinkedIn and Facebook, however, wrote that the renter may be planning an aesthetic clinic instead of a GP clinic, a practice that can be very lucrative indeed. /TISG Read also: Resident tells Jamus Lim her industry is being killed by high rental costs
Yahoo
18-05-2025
- Business
- Yahoo
Long-term care costs can derail retirement plans. Here's how to manage them
Even the best-made retirement plans can fail, especially when unexpected health care costs crop up. A recent study by Morningstar found that costs for long-term services and supports (LTSS), including things like in-home care, assisted living and nursing home facilities, can have a dramatic impact on retirement plan failure rates. To understand the impact of long-term health care costs, Morningstar researchers used a proprietary model of U.S. retirement outcomes to simulate two different groups: a baseline group where LTSS costs were incurred and a group where LTSS costs were set to $0. In the first group, researchers found that 41% of households are projected to run out of money in retirement. That figure dropped dramatically in the second group, where there were no long-term care costs, to a 26% failure rate. The study found that long-term care costs can vary drastically between men and women, as women tend to live longer and are more likely to require long-term care. A majority of single women (52%) were projected to run out of money in retirement, due in part to long-term care costs. When those costs were removed, the retirement failure rate for single women dropped to 34%. READ MORE: Remote workers are delaying retirement. Is that a good thing? By comparison, roughly one in three single men were projected to run out of money, partially as a result of long-term care costs. In a group where no care costs were incurred, the rate of retirement failure dropped to 23%. Factors like gender and family history may lead some people to forgo planning for long-term care costs. Financial advisors say that's a mistake. "Although not all households will face a long-term care need, because we don't know who will need it, all must acknowledge it as a potential need and prepare accordingly," said Jessica McNamee, founder of Sirius Wealth Strategies in Bellefontaine, Ohio. As the share of Americans age 65 and older rises over the coming years, demand — and costs — for long-term care are expected to rise. Misunderstandings about the health care system have left many Americans unprepared to cover those costs, the Morningstar researchers wrote. Medicare does not cover long-term care costs, and while Medicaid does, individuals must meet strict financial and functional eligibility requirements to qualify. For baby boomers requiring long-term care, costs can average nearly $250,000 from retirement age through death, according to Morningstar's research. READ MORE: Financial advisors are divided over this RMD tax strategy "Given the high costs of LTSS and the strict eligibility requirements for Medicaid, private long-term-care insurance is an option for those looking to protect their assets," the researchers wrote. "However, the market is rather limited." A relatively small portion of Americans — some 7.5 million — have such policies, leaving many to depend on personal savings or reduce their assets to qualify for Medicaid when care becomes necessary, the researchers wrote. Michael Hausknost, secretary for the Orange County chapter of the Financial Planning Association, said that he recommends people purchase a long-term care (LTC) policy in their early 50s, when costs are lower. "Speaking from experience, where my late wife and I dealt with her aunt's care and where I now care for my own mother, who is in a memory care facility, the well-documented high cost of these facilities is something few can afford, particularly in high-priced states," Hausknost said. "So, having an LTC policy to offset all or much of the cost is critical." LTC plans are widely recommended by financial advisors to help protect against long-term care costs. But high premiums associated with these plans push many clients toward other solutions. For ultrahigh net worth clients, advisors say that self-insuring can be a viable option. This can be particularly appealing for clients who don't believe they will incur long-term care costs, since they won't have to pay any LTC insurance premiums. However, if a client decides to go this route, they should have at least $1 million set aside for care costs, Hausknost said. Unpaid caregiving provided by family members can also help mitigate long-term care costs, but advisors are typically skeptical of that as a solution on its own. "I insist every client of mine have a plan of how care would be provided," said John Power, a financial advisor at Power Plans in Walpole, Massachusetts. "And if the plan is 'my daughter,' I want them to have a documented agreement to that plan." READ MORE: How to plan ahead for diminished capacity and prevent elder abuse Advisors say that other instruments, like reverse mortgages and certain life insurance policies, can also help retirees without LTC insurance to cover costs. "The use-it or lose-it nature of most insurance policies has led us to implement permanent life insurance policies with long-term care riders — for the appropriate situation — over the past several years," said Tyson Sprick, a financial advisor at Caliber Wealth Management in Overland Park, Kansas. "For someone who is likely passing on assets to their heirs anyway, this strategy enables them to do so in a tax-efficient way while also being able to tap into that death benefit for long-term care needs during their life, if necessary." While insurance plans are common, long-term care planning can be achieved in several ways, said Kris Etter, founder of Beacon Financial Planners in Houston, Texas. "It is our job to educate our clients on each one that may be suitable for them," he said. "Just this week, we discussed reverse mortgages with two couples. Prior to 2012, if a client asked me about a reverse mortgage, I would have suggested they fire me. While they are not for everyone, they can be the Swiss Army knife in a retiree's toolbox. LTC is just one option they solve for. We don't ask clients, 'Do you have LTC insurance?' We ask 'What is your LTC plan?'"
Medscape
16-05-2025
- Health
- Medscape
Why Aren't More PCPs Ordering Allergen Tests?
Few primary care providers (PCPs) are testing patients with asthma who have suspected allergen triggers, which may delay treatment that could improve outcomes, new data suggested. Mridula Sree Naagendran, MBBS, internal medicine resident at UConn Health in Farmington, Connecticut, presented the information in a poster at the Society of General Internal Medicine 2025 Annual Meeting in Los Angeles, Florida. 'The absence of PCP-initiated allergen testing represents a critical missed opportunity for early identification and management of asthma triggers,' the authors wrote. 'As outlined in the Global Initiative for Asthma guidelines, prompt allergen identification could reduce exposure to known triggers and potentially prevent exacerbations.' Tests Relatively Inexpensive Testing may also lower healthcare costs, the authors noted. Given that allergen testing is relatively inexpensive ($200-$300) compared with the cost of asthma-related hospitalizations (upwards of $9000), implementing routine allergen testing in PCP offices for high-risk patients with asthma could significantly improve patient outcomes and reduce costs not only of hospitalizations but unnecessary medications and emergency department visits. Blood inhalant allergy testing is 'already available and can be seamlessly embedded into routine clinical practice,' Naagendran told Medscape Medical News . The researchers conducted a retrospective review of 151 patients with asthma treated at a medically underserved primary care clinic. Data collected included allergen testing rates, hospitalization rates for asthma flares, allergen sensitization profiles, referral patterns, and treatment delays. None of the Testing Was Initiated by PCPs They found that among 151 patients with asthma, only 15 (9.93%) underwent blood inhalant allergen testing. For these 15 patients, none of the testing was initiated by PCPs. Pulmonology referrals occurred for 53 (35.1%) of patients with asthma, and only three of those were referred to an allergist. Sensitization was found to common allergens: Dog dander (26.7%), cat dander (20%), dust mites (20%), oak pollen (13.3%), and cockroach (6.7%). There were 15 asthma-related hospitalizations over 2 years. 'The gap we identified is not necessarily in knowledge, but in awareness and workflow integration,' Naagendran said. 'Environmental or indoor allergen triggers are not often addressed in primary care settings, not because they are unimportant but because they are not part of a standardized process. By remembering risk factor screening and targeted blood IgE [immunoglobulin E] testing in routine asthma evaluations, we can shift from reactive care to proactive management.' Doctor Says Information Will Change His Practice Michael Antolini, DO, family medicine physician in Fayetteville, West Virginia, said the information presented will change practice for him. He told Medscape Medical News that he works in a federally qualified health center, and because there's an allergist in their provider community, the tests are ordered by the allergist. But he said this study has him wondering why he hasn't been ordering the tests himself. He said he took a straw poll in his practice and none of the PCPs were ordering the tests. He checked and found out they were readily available and could be ordered within seconds and results would take only 3-5 days. Additionally, the tests are typically well-covered by insurance, he said. He said he doesn't see the change resulting in more time for physicians. 'We're already having discussions on environmental triggers of asthma anyway. This would probably be a better utilization of time if we could get some answers on what, specifically, they should stay away from. I would make the time if I'm preventing a hospitalization.' Currently, in his practice, the patients are getting the tests, 'but we're waiting until the allergist does it,' he said. 'This is easy stuff we could be doing. Some people can't afford to go to the allergist, frankly, so it puts the tool in our hands. I can provide whole-person counseling on what things patients should avoid.' The results of the test, he noted, don't necessarily provide a cause-and-effect relationship with potential false-positive results that are not really related to a patient's asthma, but he added it's always a good idea to avoid possible triggers. 'This could help me in my practice by providing the care that some folks who are underserved need,' he said. Naagendran and Antolini reported no relevant financial relationships.
