A survey of Royal Australasian College of Surgeons (RACS) Fellows has identified pressures across Medicare, private health insurance, public hospital capacity, and the distribution of the surgical workforce as barriers to Australians accessing affordable surgical care.
RACS is the peak body for surgical education, training, standards and professionalism in Australia and Aotearoa New Zealand, representing around 9,000 surgeons, together with 1,300 surgical trainees and specialist international medical graduates across nine surgical specialties.
More than 700 surgeons from across Australia responded to the survey, which informed the College’s submission to the House of Representatives Inquiry into Access to and Affordability of Medical Specialists.
genuine transparency means understanding the whole equation – the specialist’s fee, the Medicare rebate and what the insurer will actually contribute
Focus on What Creates the Gap
Welcoming the opportunity to look comprehensively at all factors contributing to access and affordability, RACS President Dr Philip Morreau said the focus needs to be on what creates the patient gap.
“When a patient faces out-of-pocket costs, we need to understand what has created that gap.
“A specialist sets their professional fee, but they don’t set the Medicare rebate or the benefit a patient’s private health insurer will pay.
“When Medicare and insurer contributions don’t keep pace with the cost and complexity of delivering care, more of that cost can fall to the patient.
“Focusing only on the most visible part of the patient’s bill risks treating the symptom rather than the underlying problem.”
More than 70% of Fellows identified inadequate public hospital funding as a major barrier to accessing surgical services. Theatre closures, limited operating lists and private health insurance settings were each identified by 50.9% of Fellows, while 46.5% identified a lack of hospital beds.
The survey also highlights the increasing cost of providing surgical care. Medical indemnity insurance was identified by 65.9% of Fellows as a major contributor to private practice costs, followed by administrative staffing at 63.9% and practice infrastructure and consulting rooms at 60%. These costs form part of the underlying cost of delivering private surgical care and have increased over time.
When asked which reform would most improve access to surgical care, 67% of Fellows nominated modernising Medicare rebates so they better reflect the time, complexity, expertise and resources required to provide contemporary surgical services.
Dr Morreau said Australia’s public and private surgical systems are interdependent.
“If capacity is lost from the private system, the need for surgery doesn’t disappear. It moves elsewhere, including into already stretched public hospitals.”
Reforms Needed
RACS is calling for reforms across the health system, including:
- Modernising Medicare patient rebates so they better reflect the cost and complexity of contemporary surgical care, with appropriate ongoing indexation.
- Reforming private health insurance settings to improve affordability and transparency, including reviewing and appropriately indexing the $500 known-gap threshold, ensuring insurer benefits and gap arrangements keep pace with the cost of care, and clearer disclosure of what insurers will contribute.
- Increasing public hospital surgical capacity, including outpatient services, operating theatres, theatre utilisation, beds and workforce, with better reporting of waiting times across the patient journey and theatre utilisation.
- Strengthening national workforce planning, with specialty- and region-specific planning informed by specialist medical colleges and health services, and targeted support for training and services in areas of greatest need.
RACS said it supports informed financial consent and appropriate transparency so patients have clear information about the expected costs of their care.
“But genuine transparency means understanding the whole equation – the specialist’s fee, the Medicare rebate and what the insurer will actually contribute,” Dr Morreau said.
“Transparency alone won’t increase a Medicare rebate, improve an insurance benefit or create additional hospital capacity.
“If we want to make surgical care more affordable and accessible, we need to address the system that sits behind the patient’s bill.”
RACS has offered its workforce data, analysis, and surgical expertise to support the Inquiry and assist governments and health services to develop practical reforms to improve access to surgical care.
