Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694573622319.pdf (Australia)
12 May 2014 Committee Secretary Senate Standing Committees on Community Affairs PO Box 6100 Parliament House Canberra ACT 2600 Dear Sir/Madam Re: Inquiry into out-of-pocket costs in Australian healthcare The Australian Psychological Society (APS) welcomes the opportunity to provide input to the Senate inquiry into out-of-pocket costs in Australian healthcare.
The APS provides the following feedback to the Committee that broadly addresses the terms of reference for the Inquiry:  The World Health Organisation (WHO) constitution of 1948 declared health a fundamental human right and the Alma-Ata declaration of 1978 re-emphasised the principle of universal healthcare coverage.

This principle includes the ability for people to access healthcare when they need it without experiencing financial hardship1.

Equity of access to healthcare is paramount.


 Medicare was conceived in order to provide “equitable and efficient healthcare for all Australians”2.

The principle of universal healthcare and equity must underpin any discussion of out-of- pocket expenses.

 Under Medicare, providers such as psychologists can charge an out-of-pocket expense at their discretion.

That is, they have the potential to place an additional payment (or gap fee) between the Medicare scheduled payment and their professional fees.
The decision by a psychologist to charge a gap fee is often based on factors such as the consumer’s ability to pay and the nature and extent of the health service provided.

 The imposition of mandatory out-of-pocket expenses has the potential to be a barrier for consumers seeking professional services from their health care providers, especially for consumers with complex health issues/co-morbidities, those with reduced 1 World Health Organisation (2012).

What is universal healthcare coverage?


Accessed 7.5.14 from http://www.who.int/features/qa/universal_health_coverage/en/ 2 Parliament of Australia (2004).

Medicare – Background Brief.


Accessed 6.5.14 from http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_ Archive/archive/medicare Out-of-pocket costs in Australian healthcareSubmission 53 capacity to pay a gap fee, people of Aboriginal and/or Torres Strait Islander descent, and those living outside major population centres.
For these people, the existence of out-of-pocket expenses can result in individuals not accessing or delaying their access to critical health services, ultimately leading to poorer health outcomes.

In the medium to long term, not accessing or delaying access to healthcare will increase the overall costs associated with healthcare due to a failure of early intervention, increased chronicity and complexity.
 While the Medicare Safety Net exists for consumers, it only applies to those consumers who already have spent over the established Safety Net amount.

It provides no assistance to individuals who cannot afford the initial upfront health care.

 The APS urges the Australian Government to maintain the principle of universal healthcare in Australia.

Australians must be able to access healthcare when they need it without experiencing financial hardship.
For this to happen, it is critical that bulk billing be available to consumers experiencing financial hardship.

The availability of bulk billing is an important contributor to ensuring equitable access to healthcare.

 At a structural level, the Medicare Benefits Schedule (MBS) was built around a medical model and the average time taken to deliver a discrete service to a patient.
In general practice, for example, many appointments are brief and there is a substantial throughput of patients in any one day.

The delivery of psychological services differs from many medical services in that the conduct of psychological assessments and interventions cannot be undertaken in a brief appointment.

Consequently, psychologists can only see a limited number of clients in any one day.

It is therefore not financially viable for psychologists to bulk bill all their clients.
The majority of psychologists quarantine a percentage of their client load for situations where financial hardship prevents clients from paying a gap fee.

These patients are bulk billed.

It is unclear in the current financial environment the extent to which independently practising psychologists can continue to provide for such clients without adequate support and incentives from government.
In summary, the APS urges the Committee to reaffirm the principle of universal healthcare coverage incorporated within Medicare as it provides an equitable and efficient means of healthcare resourcing.

2 Out-of-pocket costs in Australian healthcareSubmission 53 Kind regards Dr Louise Roufeil Executive Manager - Professional Practice (Policy) About the APS The Australian Psychological Society (APS) is the national professional association for psychologists with over 21,000 members across Australia.
The APS has a proud history of working with all levels of government, consumer groups and other health profession peak bodies to improve the health and wellbeing of Australians.

3 Out-of-pocket costs in Australian healthcareSubmission 53