Researchers from University of Sydney Provide Details of New Studies and Findings in the Area of Insurance (Patterns of Specialist Out-of-pocket Costs for Australian Medicare Services: Implications for Price Transparency): Insurance

Health Policy and Law Daily

2022 MAY 16 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Fresh data on Insurance are presented in a new report. According to news reporting out of Sydney, Australia, by NewsRx editors, research stated, “To explore out-of-pocket (OOP) costs within specialties and individual specialists, and use of Medicare Benefits Schedule (MBS) data for potential price transparency initiatives. We conducted a cross-sectional descriptive study of claims for a 10% random sample of Medicare enrolees for out-of-hospital MBS-billed subsequent and initial consultations between 1 January 2014 and 31 December 2014, specific to cardiologist, oncologist and ophthalmologists (with at least 10 patient visits in 2014).”

Our news journalists obtained a quote from the research from the University of Sydney, “Our main outcomes were the number of locations per provider, number of unique OOP consultation costs per provider and provider-location, and the proportion of bulk-billed visits for these visits. We studied 970 cardiologists, 913 ophthalmologists and 376 oncologists. At least 67% of specialists across each specialty had at least two practice locations: cardiologists had a median of three (interquartile range [IQR]: 2-4) and ophthalmologists and oncologists both had a median of two (IQR: 1-3). For subsequent consultations, cardiologists had a median of three unique costs per location (IQR: 2-3), whereas ophthalmologists had a median of four unique costs per location (IQR: 3-5). In contrast, oncologists had a median of one unique cost per location (IQR: 1-2) (57.6% of oncologists’ provider-locations charged only the bulk-billing amount). Specialists have distinct fee lists that can vary based on location.”

According to the news editors, the research concluded: “Summary statistics on price transparency websites based on a single amount (like a median or mean OOP charge) might mask substantial variation in costs and lead to bill shock for individual patients.”

This research has been peer-reviewed.

For more information on this research see: Patterns of Specialist Out-of-pocket Costs for Australian Medicare Services: Implications for Price Transparency. Australian Health Review, 2022. Australian Health Review can be contacted at: Csiro Publishing, Unipark, Bldg 1, Level 1, 195 Wellington Rd, Locked Bag 10, Clayton, Vic 3168, Australia. (CSIRO Publishing - www.publish.csiro.au; Australian Health Review - http://www.publish.csiro.au/nid/270.htm)

Our news journalists report that additional information may be obtained by contacting Kelsey Chalmers, University of Sydney, School of Public Health, Menzies Ctr Hlth Policy & Econ, Sydney, Nsw 2000, Australia. Additional authors for this research include Adam G. Elshaug, Sallie-Anne Pearson and Bruce E. Landon.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1071/ah21316. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.