Australia's Not-So-Universal Healthcare System Makes Living With Chronic Illness Hell

Some of Australia’s poorest become the nation’s sickest as a result of gaps in Medicare, experts say.

Australians like to think of Medicare as a bulletproof on-ramp to world-leading medical treatment for anyone, regardless of their income, or where they’re from. And the nation’s leaders like to think of it as the world’s best. But for years, according to research from the Grattan Institute, it has been making poor people sicker and those living with chronic illness poor.

The Grattan Institute, one of a small number of Australian think-tanks, found in a new report that Australians are currently spending about $7 billion a year out of their own pockets on out-of-hospital medical services and medications. This is the case even if they’re listed on the Pharmaceutical Benefits Scheme (PBS), which was established to shield patients of vulnerable backgrounds from the expense of costly treatments. 


As a result of Medicare’s coverage holes, nearly half a million Australians missed out on seeing a specialist because of cost, and more than half a million either put off or skipped out on getting a prescription filled altogether during the 2020-21 financial year.

The report’s author, health economist Stephen Duckett, suggested on Monday that all Australian taxpayers will wear the cost, as those who can’t afford the care they need only get sicker. 

Of course, when the sick get sicker, they only place more strain on a public health system that’s already letting them down.

“Bulk-billing rates are too low and out-of-pocket payments are too high for some services. It’s a catch-22: the people who need the most healthcare – the poor and the chronically ill – miss out on care the most,” Duckett said. 

“That’s bad for those people, but it’s also bad for taxpayers, because when people skip or defer recommended treatment they often get sicker and end up in hospital,” they said. 

The cause: Treatment waiting periods are so long that patients have no choice but to turn to private treatment providers, who are charging exorbitant fees way above Medicare’s scheduled rates. In practice, all of this means that living with a chronic health condition in Australia can cost a fortune. 

For those living with obstructive pulmonary disease and chronic kidney disease, for example, the out-of-pocket expense can set a patient back as much as $5,600 a year. 


And more than half of the nation’s cancer patients end up about $5,000 out of pocket each year – for both hospital and non-hospital care. 

When compared to other nations, out-of-pocket expenses in Australia are still quite low. In the US, cancer is a disease survived only by those who can afford to. For those without $150,000 a year to shell out on out-of-pocket treatment expenses, a cancer diagnosis might as well be a death sentence.

But Australian legislators have long held themselves to a higher standard. Or, at least they’ve promised one. 

What’s more is that people living with these chronic health conditions are less likely to have all of their services bulk-billed. Australia’s much-lauded public healthcare system only manages to fully serve 30 percent of people living with chronic conditions like these.

According to analysis of 2019 data from the Australian Bureau of Statistics, half a million Australians spent about $450 on specialist services alone. Those who couldn’t afford to explore the option were, in some cases, left to wait up to two years for treatment in the public system. 

It’s a wide-reaching schism the Morrison government has been quick to deny. In one recent report, federal Health Minister, Greg Hunt, said the Coalition’s commitment to Medicare is “rock solid”, and the number of bulk-billed services across the public health system was, in fact, increasing.


Without surprise, Labor’s opposition health spokesman, Mark Butler, said the public wait times and rising fees have only worsened under the Morrison government, without addressing how, or even if, an Albanese would do any better. Opposition leader Anthony Albanese has yet to announce a single health policy ahead of May’s federal election. 

Until either party does, the Grattan Institute has called for state governments to expand outpatient services to reduce wait times so that fewer patients are put in a position where they need to seek private treatment, and for the federal government to bulk bill the instances when they do. 

To cut pharmaceutical costs, Duckett also suggested the government do away with charging fees altogether for services like scans and blood tests. Combined, their recommendations are estimated to save Australians about $1 billion every year – and countless lives. 

Follow John on Twitter.

Read more from VICE Australia.


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