Out-of-pocket payments: impacts on healthcare decision-making and system and individual level measures to minimise the burden

Abstract

Out-of-pocket healthcare payments are a concern for all, particularly those least able to afford them, a situation only being exacerbated by the current cost-of-living crisis. This article aims to provide an overview of out-of-pocket payments and their impacts on decision-making: whether, or not to delay care or seek care at all. The impact of average out-of-pocket payments on demand for mental healthcare services is provided as a specific example. The available data indicate a positive linear relationship between the average out-of-pocket payments for Medicare services by type of provider, and the proportion of patients who decide not to obtain care from a given type provider. This article also poses that current safety net processes are not consumer centric, the Pharmaceutical Benefits Scheme (PBS) Safety Net particularly so, and that change is required. It is recommended that a consumer-centric approach should be adopted with everyone listed on a Medicare card automatically included in the assessment of the Medicare and PBS Safety Nets and for the PBS Safety Net to be automatically assessed through Services Australia. Links to websites are provided to support individual decision-making and registering for available safety nets. Finally, supply side considerations and their implications for market equilibrium and the economy are briefly overviewed.