Mind the Gap: Part 3 - Estimates of Costs

This is Part 3 of a series outlining the Australian Health Insurance industry from the perspective of a health provider. Dr Dork has prompted me to add an extra section to my series.

3. Estimates of Costs

Dr Dork said:

What disturbs me is when there is not financial disclosure prior to a procedure. I personally outline costs with every patient, and believe this is always necessary.

As a patient, I've also had some surgeons send me large unexpected bills. The bills don't piss me off. The fact that it is unexpected does.

Precedents demonstrate that lack of financial consent excuses the patient from paying, if they so choose.

Of course patients should expect an indication of the costs involved in their care - but just like when you contract a builder or any other tradesperson, the initial quote can balloon out if there are unexpected issues that need to be addressed.

As the "point man" (or "woman", or "person" etc...) the surgeon is often put under the spot to supply quotes or cost estimates from the private hospital, the assistant, the anaesthetist, the visiting physician, orthotics, physiotherapy etc. As things stand today, it is impossible for one doctor to presume to know what everyone else will charge.

Ultimately, such cost estimates are only indications of likely cost, and the failure is in the practitioner's ability to explain that to the patient. Usually this is because the patient is so worried about what the "gap fee" will be!

Things are somewhat easier for a physician (for the benefit of our US readers, internist) treating a patient as an outpatient - a set fee is charged per visit. Imagine giving the patient a quote for their hospital admission for, say, community acquired pneumonia? Who is to say how long they will be in hospital and how many inpatient visits or procedures you may be involved with? Should the patient refuse to pay anything beyond the first week because you said they would probably only be in hospital for that long?

Obviously the patient has the right to walk out of the hospital after a week, just as you have the right to fire your builder - but that's not very productive when you've got a half-built house. At the end of the day, if the builder fixed an unexpected major problem that had you been there you would have agreed to anyway (possibly because there is little or no choice) then would you deny payment just because they didn't talk to you first? Perhaps that is an issue of principle over pragmatism.

More on this series next week.