Modern medicine and science is an incredible thing. Compared with even a few decades ago, the options available for Australians to manage their health is impressive. A simple blood or urine test can reveal medical issues and potential complications even before symptoms appear or physical health noticeably deteriorates. No longer is a cancer diagnosis a guaranteed death sentence. MRI and PET scans, x-rays and other diagnostic tools have proven crucial to the early detection and management of cancer, disease and infection. Routine blood and urine tests are vital to the health management of millions of Australians.
Up until now, nearly all Australians, young, old, rich and poor, have had access to, and the benefit of a health system where everyone is largely treated equally, and lives are valued. Every person, regardless of gender, socioeconomic status, education, or employment status has had the opportunity of being bulk-billed for pathology services.
But not anymore – at least not if Prime Minister Malcolm Turnbull and Health Minister Sussan Ley have their way.
From the 1 July 2016, the Commonwealth Government intends on cutting the bulk billing incentive for pathology services, putting the final nail in the coffin of affordable and accessible medical diagnostics for Australians.
And it will put the nail in the coffin for millions of Australians. Quite literally for some.
What Ley’s cuts will do is change how Australians seeking crucial testing and diagnosis are charged. Pathology industry representatives have warned that if the cuts go ahead, instead of being bulk-billed, patients will be forced to pay up front for services: Potentially thousands of dollars up front, leaving the most vulnerable and sickest patients hundreds of dollars out of pocket after the rebate has been claimed back from Medicare.
Fiercely defending the cuts, Minister Ley and her office have resorted to the most ludicrous claims to attempt to distract from her attempts to put a real dollar price on the health of Australians. In refuting the claim that pap smears, (a crucial tool to test for early signs of cervical cancer in women) will cost $30 if the incentive is removed, Ley asserted that the Medicare rebate has and will not change.
Of course she is right. The Medicare rebate for pathology services hasn’t changed in over 17 years. However costs to pathologists have continued to rise. Critics warn that the industry simply cannot absorb any more costs or government cuts. And Minister Ley intends to cut a massive $650 million from pathology services over four years.
That is a lot of money and it will affect millions of Australians who may be forced to pay up front for vital services.
According to the Australia Diagnostic Imaging Association patients may have to pay up to $93 upfront for an x-ray, $396 for a CAT scan, a minimum of $85 for a mammogram and up to $186 for an ultrasound. A PET scan could cost up to $1,000.
But patients rarely need just one test.
Each year over a million Australians present to doctors concerned about possible skin cancer. If detected early, skin cancer rarely kills. However early detection requires testing – tests that may now cost patients hundreds of dollars initially. And for the thousands of people diagnosed, upfront costs of around $1500 and out-of-pocket costs of up to $400 after receiving Medicare rebates. Over two years the costs could escalate to over $3000, with out-of-pocket expenses of up to $725.
In 2012, four people died every day from melanoma. This will certainly rise if Ley has her way.
Cervical cancer has no symptoms. The only way to detect it is by testing, and the routine pap smear is crucial for women’s health. In 2009, over 2 million routine tests were conducted, identifying 28,000 cases of high-grade abnormalities or cervical cancer. As a result of early testing, the vast majority of cases were treated successfully, leading to only 152 deaths. However, around the world, every 2 minutes a woman dies from cervical cancer, the vast majority of these in countries who do not offer routine testing.
If Ley’s cuts go ahead, the number of Australian women who die of cervical cancer will almost certainly rise as women on lower incomes forgo the vital test.
Approximately 1.7 million Australians have diabetes; they may now face up to $400 a year in upfront costs just for basic urine and blood tests which are vital to detect early signs of kidney disease or cardiovascular diseases. The cuts may see people forced to choose between medication and ongoing routine tests. Experts warn that some of the patients may go blind where complications have not been detected early enough.
In the indefensible move, Minister Ley’s proposed changes will almost certainly see millions of Australians suffering financially, or even worse, their health deteriorating as a result of declining a test or scan due to the cost. The sickest and most vulnerable patients will bear the brunt of the cuts.
Any Australian who relies on routine testing, who has concerns about their health, any person who panics at the sign of blood coming from somewhere it shouldn’t, any person stricken by lethargy, unexplained pain, or weird symptoms that they cannot quite identify, may have to choose between paying for food to put on the table and accessing tests for diagnosis and treatment.
Conditions, such as cervical cancer, bowel and prostate cancers, hepatitis C, and many sexually transmitted infections, have almost no early symptoms. These conditions may go undetected, leading to horrific outcomes for Australians who may otherwise have been able to be treated.
In one of her favourite excuses, Minister Ley erroneously claims that the introduction of the bulk billing incentive in 2009 only saw a rise of 1% in bulk billing rates. Minister Ley additionally claims that bulk billing rates are already so high, no incentive is required. With 98.7% of all out-patients bulk billed for pathology services in 2014-15, it is virtually impossible to imagine much more of an improvement. However it is entirely feasible to see a massive drop in bulk billing if the incentive is cut.
There is little to climb from 98.7% but a very long way to fall.
Each 1% fall in bulk billing rates represents over a million people now having to pay up front for vital services.
Cancer doesn’t discriminate. Neither does serious illness or disease.
Cancer won’t wait for a pensioner to save up thousands of dollars for crucial tests.
Cancer won’t wait for a young child to grow old enough to tell their parents that they are in pain and need urgent medical attention.
Cancer won’t wait for a young man or woman to spontaneously seek a prostate or cervical examination, ‘just on the off-chance’ there’s an abnormality.
There is an enormous and very real risk that many Australians, already struggling to make ends meet, will be dissuaded from undergoing essential tests, or forgo treatment altogether, if they have to pay upfront for pathology services.
If the Coalition has its way, one thing will be certain. Hundreds of thousands of Australians will suffer, and families will be wracked with grief as they watch their loved ones lose the battle against illness, which if detected and managed early enough, could have been successfully treated.
Unable to publicly justify the cuts, Minister Ley’s office has fallen back on the Coalition’s favourite excuse; apportioning the blame on Labor. However stripping funding from pathology services is not the same as arguing who is responsible for a budget deficit. A pathetic whine that “Labor did it first, so why shouldn’t the Coalition rip more money out of a vital industry, thus putting the health of millions of Australians at risk, and potentially resulting in people prematurely dying from treatable cancer and preventable illness?” has a hollow sound when the real life ramifications sink in.
In response to the initial backlash, Treasurer Scott Morrison said, ‘the government could not justify what amounted to “handing out large subsidies” to the pathology industry.’
If only pathology services tested for coal.