Abstract
PurposeAmong Australian women, breast cancer is the most commonly diagnosed cancer. The out-of-pocket cost to the patient is substantial. This study estimates the total patient co-payments for Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) for women diagnosed with breast cancer and determined the distribution of these costs by Indigenous status, remoteness, and socioeconomic status.MethodsData on women diagnosed with breast cancer in Queensland between 01 July 2011 and 30 June 2012 were obtained from the Queensland Cancer Registry and linked with hospital and Emergency Department Admissions, and MBS and PBS records for the 3 years post-diagnosis. The data were then weighted to be representative of the Australian population. The co-payment charged for MBS services and PBS prescriptions was summed. We modelled the mean co-payment per patient during each 6-month time period for MBS services and PBS prescriptions.ResultsA total of 3079 women were diagnosed with breast cancer in Queensland during the 12-month study period, representing 15,335 Australian women after weighting. In the first 3 years post-diagnosis, the median co-payment for MBS services was AU$ 748 (IQR, AU$87–2121; maximum AU$32,249), and for PBS prescriptions was AU$ 835 (IQR, AU$480–1289; maximum AU$5390). There were significant differences in the co-payments for MBS services and PBS prescriptions by Indigenous status and socioeconomic disadvantage, but none for remoteness.ConclusionsWomen incur high patient co-payments in the first 3 years post-diagnosis. These costs vary greatly by patient. Potential costs should be discussed with women throughout their treatment, to allow women greater choice in the most appropriate care for their situation.
Highlights
In 2018, it was anticipated that an estimated 18,087 women would be diagnosed with breast cancer, which is the most commonly diagnosed cancer in women within Australia [1]
We report the total and average patient co-payment separately for Medicare Benefits Schedule (MBS) services and Pharmaceutical Benefits Scheme (PBS) prescriptions during each of the time periods analysed
The total patient co-payments for the first 3 years for women diagnosed with breast cancer was approximately $21.7 million for MBS services and $14.2 million for PBS prescriptions
Summary
In 2018, it was anticipated that an estimated 18,087 women would be diagnosed with breast cancer, which is the most commonly diagnosed cancer in women within Australia [1]. Australia has a universal healthcare system, Medicare, which has three parts: hospital, medical, and prescription pharmaceutical. Support Care Cancer (2020) 28:2217–2227 on the MBS, Medicare pays a rebate (proportion of the fee) to the service provider. If the fee charged is equal to the rebate, the patient incurs no co-payment (the service is ‘bulk-billed’); if the fee charged by the service provider is greater than the rebate, the patient will be charged an OOP copayment [9]. Medical service providers in Australia may set their own fees, resulting in unregulated OOP fees for patient [10]
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