It is Anzac Day 2017, and Blair Meldrum cannot get out of bed.

He never misses the service, but crippling back pain has made moving nearly impossible. And so he schedules an appointment with his doctor.

Less than two weeks later he gets the news: Cancer. Again.

He survived lung cancer in 2008 and then bowel cancer in 2011, but this time it has metastasised in his spine.

Mr Meldrum died on July 25, 2017, leaving behind a loving wife and kids — and an $8,000 bill for treatment his family thought was covered by their private health insurance.

Blair was a family man through and through. ( Supplied )

Angry and overwhelmed

There was nothing Lenore Meldrum would not do for her husband.

"You're between the devil and the deep blue sea," she said.

"Because, you know, you've got this person you love and care for and I've been married to for more than 50 years who's in incredible pain, and yes you'll do anything to relieve that pain."

"So you do it. You manage it somehow."

Ms Meldrum is referring to the bills that began to mount when her husband was diagnosed and started radiotherapy treatment near their home in the Sunshine Coast hinterland.

Lenore Meldrum stayed by her husband's side right to the end. ( Supplied )

She is not alone in her anxiety.

According to the Australia Talks National Survey, one in five Australians say they have little or no confidence they would be able to afford the care needed to get better if they were sick or injured.

Unsurprisingly, the concern is higher for those on lower incomes.

But it also consistently rises the further you go from the major cities, with only 33 per cent of Australians living in rural areas feeling very confident they could cover costs compared to 43 per cent from inner-metro areas.

Mr and Ms Meldrum had thought they were in a secure position.

Both had held private health insurance for more than 50 years and continued to pay the premium of about $280 a month.

When doctors advised Mr Meldrum was too sick to travel to the public hospital 100 kilometres away, they felt comfortable opting for the private clinic just down the road.

For the first time, Ms Meldrum took charge of the family finances and said she sought assurances from their insurer that her husband's radiotherapy was covered.

Lenore and Blair Meldrum paid for private health insurance for more than 50 years. ( Supplied )

As the out-of-pocket expenses started to add up, Ms Meldrum kept a brave face.

"It certainly did concern me. But that wasn't a concern I could take to my husband, who had always managed our finances, because he didn't need that worry," she said.

"You've got the added stress that you know in the back of your mind that he's dying, but you don't have time to plan for any of that because you're so busy concentrating on getting him treatment and relieving his pain.

"It took me managing the finances some six months to try and sort out what we are owed and things I had to cancel, and all the changes that no-one prepares you for when you're widowed suddenly."

In all, they paid $7,893 in out-of-pocket expenses for tests, appointments and treatment in the 12 weeks between Mr Meldrum's diagnosis and death.

Ms Meldrum estimates the treatment bought her an extra six weeks with her husband.

The costs included more than $6,000 for 19 bouts of radiotherapy treatment, which lasted only about five to 10 minutes each.

"It makes you very angry," she said.

"We had health insurance for more than 50 years … they got the money out of us, why can't we get some of that benefit back?"

Patients are skipping treatment

Mr Meldrum's case is not isolated.

In her research, Christine Paul from the Hunter Medical Research Centre found cancer patients with private health insurance faced double the out-of-pocket expenses as those without it.

The reason is these patients can pay not only the private health insurance excess and the gap between coverage and a surgeon's bill, but also costs associated with anaesthetic, diagnostic procedures or hospital stays that would often be covered under Medicare in the public system.

Rural patients often have to travel long distances for treatment. ( ABC News: Jane Cowan )

In a separate study, Professor Paul also found the financial toll on patients could be enormous, and in some extreme cases people were opting out of potentially lifesaving treatment due to the cost.

"Between 5-10 per cent of people say that it changed the decisions they made about the treatment," she said.

"So they might have cut treatment short, they might have chosen not to have a treatment that was recommended for them, or they're perhaps not taking the treatment."

More broadly, a 2018 report from the Australian Institute of Health and Welfare found 1.3 million Australians had put off seeing a doctor in one year because they could not afford it.

And Australians were paying $3 billion in out-of-pocket expenses each year, despite bulk-billing rates hitting a record high of 86 per cent.

Professor Paul said while there was a general expectation Australia had an equitable healthcare system and those who did pay for private health insurance would be covered if they became sick, the truth was a little more complex.

"There are some people for who it's true and others for whom it isn't, but it's very hard to figure that out at the outset with a disease like cancer," she said.

"While it's not universally terrible, there are substantial groups of people for whom it's a financially devastating disease."

'Doctors are taking a haircut'

The Australian Medical Association (AMA) has long argued for a change in the Medicare rebate to help ease the financial burden on patients.

So for AMA federal vice-president Chris Zappala the Australia Talks data showing anxiety about affording care is not surprising.

Dr Zappala says the Medicare rebate is not keeping up with costs. ( Supplied )

"In some respects, it's disappointing because I'd like to think that everyone feels that if they need health care, at least through the public system, that they're going to be able to get it," he said.

"And I do think that remains fundamentally true.

"So if the chips are really down and you're in an emergency situation, then the system will be there for you."

Yet Dr Zappala said things became complicated when elective surgery and care were factored in. And he pointed to the rising cost of medical care as an issue the nation needed to reckon with.

"Unfortunately, the rebates that patients have been provided from the government by way of Medicare have in no way kept pace with the cost of medicine and the cost of practice," he said.

"And so that gap has widened over time."

Dr Zappala sympathised with Ms and Mr Meldrum, and said in his experience the majority of out-of-pocket costs in cases like this would go to the hospitals — not a specialist doctor charging excessive fees.

"Private health insurance payments … the huge majority of that goes to private hospitals, and only about 16, 17 per cent is paid to doctors," he said.

"The doctors have taken a haircut over the last successive years.

"The number of specialists that have excessive fees is exceedingly small."

As for Ms Meldrum, she will continue with her private health insurance for fear of what might happen if she loses it.

And the cost is something she will just have to bear.

"I have a number of medical issues and I just cannot afford to be without it," she said.

"So, yes, I have to make sacrifices to keep it."

The Australia Talks National Survey asked 54,000 Australians about their lives and what keeps them up at night. Use our interactive tool to see the results and how their answers compare with yours.

Then, tune in at 8.30pm on November 18, as the ABC hosts a live TV event with some of Australia's best-loved celebrities exploring the key findings of the Australia Talks National Survey.