Cuts to rebates and bulk billing incentives for CT scans, MRIs, ultrasounds and other imaging will cost patients hundreds more, say private radiology practices

Cancer patients could be left hundreds of dollars out of pocket by federal government cuts to the bulk billing incentive for diagnostic services, an organisation representing private radiology practices has warned.

The Australian Diagnostic Imaging Association (ADIA) said that patients required several different diagnostic services, like CT scans and magnetic resonance imaging (MRIs) before cancer was diagnosed, let alone treated.

Melanoma patients would fare the worst if they were made to pay a gap payment to cover reductions to the bulk billing incentive, ADIA said, pointing to the fact that up to seven services may be required to test for the harmful skin cancers. The group estimates that out-of-pocket costs could be up to $1,120 for previously bulk billed patients, depending on whether services introduced a gap fee or scrapped bulk billing altogether.

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Breast cancer patients could face out-of-pocket costs of $302, and thyroid cancer patients $492, the group said.

“These amounts are paid as part of the patient rebate and are significant amounts for patients to forego,” the chief executive of ADIA, Pattie Beerens, told Guardian Australia.

But a spokesman for the federal health minister, Sussan Ley, did not accept that, saying that patient Medicare rebates and the bulk billing incentive were two different things.

There would be no change to the amount of money patients received from their rebates under the bulk billing incentive changes, the spokesman said, adding that ADIA’s cost estimations were inaccurate because they included cost recovery from patients who were not currently bulk billed.

A spokeswoman for the federal Department of Health said the department could not verify the figures “as ADIA does not provide the number and type of services included”.

“These figures may not be representative of the average patient,” she said.

Service providers have warned that the federal government’s decision to reduce incentive payments for diagnostic companies to bulk bill from 15% to 10% would leave them with no choice but charge patients the shortfall.

“It is not realistic to expect that practices can absorb these most recent cuts, because their costs continue to increase year-on-year,” Beeren said. “Several diagnostic imaging groups have already indicated that they will consider introducing gaps for general patients in response to the patient rebate cuts.”



Medicare rebates for diagnostic services have been frozen for 17 years, since 1998.



The bulk billing incentive ranges from $6 for X-rays to $62 for MRIs, according to ADIA’s figures. Companies could choose to charge patients just the shortfall resulting from the reduction in the incentive, but the way Medicare is structured means that patients would have to pay the full cost of services upfront and then wait to be reimbursed for the remainder.

Labor’s health spokeswoman, Catherine King, said that the government’s cuts to the health budget “punish the most seriously ill, at every stage of illness and treatment”.

“For many of the patients who are now bulk billed, those sorts of costs will be unaffordable. We already know that upfront costs are a huge barrier to people on limited incomes and many patients will delay, or even skip crucial scans,” King said. “As pathologists have pointed out, such measures are not only bad for patients, but are short-sighted and will cost the health system more in the longer term.”

The government announced that it would reduce the bulk billing incentive for diagnostic imaging – and totally scrap it for pathology services – in its December budget update statement. The changes will net the government $650m over four years, and will come into effect on 1 July.

The changes have been criticised for adversely affecting women, after it was revealed that they would apply to services like pap smears and breast exams.

Independent senator Jacqui Lambie has vowed to vote against all government bills if the changes to bulk billing incentives, which do not require legislative change and therefore do not require a Senate vote, are instituted.

“Australian women should not have to pay more for vital cancer health checks. Over my dead body will I allow the Liberals to try and sneak through more changes and cuts to our Medicare system,” Lambie said. “I will do everything in my power to stop cancer health checks like pap smears from costing an extra $30, as predicted by the Royal College of Pathologists.”