Higher fees and out-of-pocket costs in radiotherapy point to a need for funding reform

• Published in: Australian health review 2023-06, Vol.47 (3), p.301-306
• Main Authors: van Gool, Kees, Hall, Jane, Haywood, Philip, Liu, Dan, Yu, Serena, Webster, Samuel B. G., Moradi, Bahare, Aranda, Sanchia
• Format: Article
• Language: English
• Subjects: Cancer therapies; Costs; Ethics; Expenditures; Fees & charges; Funding; Hospitals; Medicare; Nuclear medicine; Oncology; Patients; Protons; Radiation therapy; Rebates; Trends
• ISSN: 0156-5788; 1449-8944
• DOI: 10.1071/AH22293

Objective To elucidate the policy implications of recent trends in the funding of radiotherapy services between 2009–10 and 2021–22. Method We use national aggregate claims data to determine time trends in the fees, benefits and out-of-pocket (OOP) costs of radiotherapy and nuclear therapeutic medicine claims funded through the Medicare Benefits Schedule (MBS) program. All dollar figures are expressed in constant 2021 Australian dollars. Results Radiotherapy and nuclear therapeutic medicine MBS claims increased by 78% whereas MBS funding increased by 137% between 2009–10 and 2021–22. The main driver of Medicare funding growth has been the Extended Medicare Safety Net, which has increased by 404%. Over the 13 year observation period, the percentage of bulk-billed claims peaked in 2017–18 at 76.1% but fell to 69.8% in 2021–22. For non-bulk billed services, average OOP costs per claim increased from $20.40 in 2009–10 to $69.78 in 2021–22. Conclusion Despite increased Medicare funding, patients face increasing financial barriers to access radiation oncology services. Policies with regard to funding radiotherapy services should be reviewed to ensure that services are easily accessible and affordable for all those needing treatment and at a reasonable cost to Government.