Out-of-pocket spending on health care
Medicare does not always cover the full cost of medical services. Doctors and other health care providers are free to set their own fees for consultations and procedures and the patient may need to contribute to the cost of those services.
Nationally, it is estimated that Australians spent $29.4 billion out-of-pocket on all their health-related expenses in 2015–16—or about $1,195 per person. This compares with $141 billion spent on health by governments, private health insurers and accident compensation schemes (AIHW 2017).
Out-of-pocket costs in 2015–16 included spending on:
- prescription and non-prescription medicines ($10.8 billion)
- dental services ($5.7 billion)
- hospital services ($3.3 billion)
- non-hospital Medicare-subsidised services ($2.9 billion)
- aids and appliances, including glasses, wheelchairs and hearing aids ($2.8 billion)
- other expenses, including allied health services not subsidised by Medicare ($3.9 billion) (Figure 1).
Figure 1: Total patient out-of-pocket spending on health in Australia, 2015–16 ($ billions)The below figure is a bar graph showing the total out-of-pocket spending on health in Australia in 2015–16. The x-axis is the Out-of-pocket expenditure in billions of dollars. The y-axis is the Health service. In Medicines, the cost was $10.8 billion. In Dental, the cost was $5.7 billion. In Hospital, the cost was $3.3 billion. In Non-hospital medicare, the cost was $2.9 billion. In Aids and appliances, the cost was $2.8 billion. For all other areas, the cost was $3.9 billion.
|Health service||Out-of-pocket expenditure|
|Non-hospital medicare||$2.9 billion|
|Aids and appliances||$2.8 billion|
- AIHW 2017; AIHW analysis of MBS claims data, 2015–16.
Patients may also incur personal expenses which are not identified in the data, such as taxes, travel, and private health insurance premiums.
The out-of-pocket costs for patients can affect their ability to get the care they need, when they need it. Being able to get health care ‘at the right place and right time, taking account of different population needs and the affordability of care’ (NHIPPC 2017) is a cornerstone of a high quality health system.