Leonie Haven is a breast cancer patient who is $30,000 out of pocket for medical expenses since being diagnosed last year. Picture: Kristi Miller Source: The Daily Telegraph
FAMILIES are being forced to sell their homes or raid their superannuation to pay medical bills, with some going bankrupt as Medicare rebates fail to keep pace with inflation and health funds fail to cover all medical charges.
The financial nightmare has exposed the growing inadequacy of Medicare and health fund rebates and the crippling health costs to those with multiple or serious illnesses.
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Battling breast cancer, chemotherapy and a life-threatening infection, Leonie Havnen's biggest challenge was not her health but the $31,300 in medical bills not covered by Medicare.
This year the 52-year-old Sydney mother of two was forced to raid her superannuation nest egg to cover her treatment costs.
"As a taxpayer for the past 36 years who pays around $30,000.00 a year in tax, $2,500 health insurance and the Medicare levy, to have to pay out of pocket for life saving medical treatment, just screams to me the 'the system is broken'," she said.
"Why did I have to access my superannuation to pay for my life saving medical treatment? we aren't a third world country."
Since being diagnosed with breast cancer a year ago Ms Havnen has had surgery six times, first to remove both breasts and then to deal with the consequences of a golden staph infection. She spent time in hospital when one of her kidneys collapsed. A statement from her health fund for the 2011-2012 financial year shows her private hospital treatment cost $77,732 and she received rebates of just $59,400 from Medicare and her health fund? leaving her $18,331 out of pocket.
On top of these hospital expenses, Ms Havnen had another $12,000 in bills for specialist appointments, scans, health fund excess payment, and medication.
Her health fund reviewed her case after being contacted by The Sunday Telegraph and have since refunded her a further $6000.
While our Medicare and health fund systems are praised as among the best in the world, there is emerging evidence they are leaving hundreds of thousands of Australians in poverty.
A Menzies Centre for Health Policy study has found 250,000 Australians spend more than 20 per cent of their income on health costs. Doctors and anaesthetists who charge large out-of-pocket gap fees, poor health insurance cover, Medicare rebates that haven't kept pace with inflation and the $35.40 copayment for medicines are at fault. As well, many treatments and medicines are not covered by either subsidy schemes.
A recent Health Consumers NSW survey has found families were being forced to sell their homes or skip doctors' appointments or medicines because of the cost.
"Due to the combination of suddenly not being able to work, and the high out of pocket costs of my illness, we had to sell our family home," one respondent told the survey.
"Have not attended a cardiologist since February 2011. Cannot afford to," another said.
The government's Private Health Insurance Administration Council said health fund members paid $4.3 billion in out of pocket expenses last financial year.
Research by the George Institute found 11 per cent or 28, 665 bankruptcies in 2009 cited ill health or absence of health insurance as the primary reason.
A recent survey of 3000 National Seniors members found one in five Australians aged 50 to 64 are skipping doses of their prescription medicines because of cost.
Gaps fees for plastic and reconstructive surgeons averaged $1588, for orthopaedic surgery $1485, the gap for scans averaged $88 and for specialists $56.
A spokesman for Health Minister Tanya Plibersek said gaps came about when doctors charged more than the scheduled fee.
Australian Institute of Health and Welfare figures show Australians spend an average $1075 a year in out-of-pocket health expenses.
"The issue is whilst we say we have a universal system, the reality is many people are struggling," Consumers Health Forum chief Carol Bennett said. "The cumulative costs of a chronic illness mean you have multiple scripts and scans and appointments and you've got to make the difficult choice of whether you see your doctor or put food on the table."
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$500 a month to ease pain?
MULTIPLE sclerosis sufferer Robert Pask lives in a world of constant pain. Like many ravaged by the debilitating disease, he requires daily medication to get through.
But it comes at a cost.
He spends $519 a month on his own care, highlighting the failure of the health system to subsidise vital treatments for the chronically ill.
His plight backs research by academic Beverley Essue and Health Consumers NSW that shows patients are being forced to choose between their medication or food to make ends meet. Others rely on handouts from their relatives.
Even though we have a taxpayer-subsidised Medicare and Pharmaceutical Benefits Scheme Mr Pask's experience shows many patients still fall through the cracks.
Mr Pask spends $120 a month on anticonvulsant medication gabapentin to control pain; botox injections to stop muscle spasms to relieve pain cost $500 every three to six months; sleep relaxants are $38 a month; and vitamins his doctor recommends, including cranberry tablets, vitamin C, vitamin D and calcium add another $40-$50.To top it off, his health insurance costs $362 a month.
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I had to move back in with mum?
YVONNE Appleby had to borrow $600 from her pensioner mum to pay for an MRI scan to test whether she had a brain tumour.
The single mum from Sydney has spent more than $4000 in out-of-pocket medical expenses in the past four years as she battles a range of illnesses, including diabetes and glaucoma.
In one week in 2008, Ms Appleby, who works six days a week as a receptionist, had to find $625 to pay for an MRI - not covered by Medicare - $250 to see an ophthalmologist and $422 for an ear nose and throat specialist.
Six months later she paid $90 to the ophthalmologist and $320 for an endocrinologist.
"Some was refunded by Medicare, but you have to have the money (or credit card) to pay the bill in the first place," she said. "It's very difficult when I had fixed weekly expenses, like rent, food, petrol."
Ms Appleby who had two breast lumps removed in July, said her car was a "bomb" and because she didn't qualify for a health care card she had to spend $30 a month on her diabetes and blood pressure medication.
Ms Appleby has since moved to live with her mother.
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