Cost of diagnostic testing is a barrier for some patients

“About 12 months ago I felt something, but it wasn’t anything to concern me really,” Ms Whitfield said.

The following months were busy; the Mooroopna resident welcomed a new grandchild and had an unrelated surgery.

Then, a couple of months ago, she did another self-exam while in the shower.

“I noticed that it (the lump) had grown significantly larger, and I got out and made an appointment straight away to see the GP.”

With her history, Ms Whitfield was advised to get a diagnostic mammogram and ultrasound as quickly as possible.

Finding that the lump had grown was scary, she said, but she was trying not to panic, and she was pleased with how quickly things were moving.

Just days after discovering the lump was enlarged, she had a referral for diagnostic testing.

Then she called to set up the appointment at a local private clinic and was told she would need to pay an upfront cost of $570.

“I was angry,” Ms Whitfield said.

She was so angry, she took to social media to vent.

“How do women receiving (government) payments or minimum wage come up with the money for upfront costs? This is why so many are skipping or being diagnosed in late stages of cancer,” her post said.

“I have to decide to pay for a very necessary scan or pay the electricity bill. Choose the scan, I risk disconnection, pay the power bill, risk missing early detection.

“It is a disgrace.”

Ms Whitfield said she received an influx of responses from people of all ages with similar experiences.

Breast cancer screening is free in Victoria for women aged 40 and older, such as Ms Whitfield.

However, screening and diagnostic testing are different, and with Ms Whitfield’s lump indicating a possible issue she needed diagnostic testing, which meant out-of-pocket costs.

Ms Whitfield knew she would receive a rebate for some of the cost of the tests, roughly half, but the upfront costs due on the day of testing were still high.

For her, that initial $570 bill meant she needed to delay getting the tests done, at least temporarily.

During an interview in early March, Ms Whitfield said she and her husband were saving up for the tests, and the possibility that there would be additional costs if more tests were needed.

“It’ll take a couple of weeks to make sure we’ve got it all there, in case there’s more to come,” she said.

“I’m luckier than a lot of people.”

Ms Whitfield is concerned about people who are unable to put together that kind of money for tests.

“I’m concerned that they make that decision to feed their kids, pay their bills, keep the roof over their head, rather than check their health,” she said.

“Their health then deteriorates to a point where it’s too late, and you’re going through the whole cancer thing.”

According to the Cancer Council, early detection is the best way to improve survival for those with breast cancer, which is the second most commonly diagnosed cancer in Australia.

“They keep telling you to check, and it’s not going to help if you can’t afford to pay for the test,” Ms Whitfield said.

Unfortunately, situations like the one Ms Whitfield found herself in are not rare.

Another local woman, who asked not to be named, said she had also experienced the shock of having to pay hundreds of dollars for diagnostic tests.

“All up in 2023, medical imaging and blood tests cost me approximately $2500,” the woman said.

“It defies the theory behind early intervention in disease management.

“Yes, we can intervene early.

“But no, we can’t do that, unless you can pay. Unless you live in Melbourne where there are more specialist hospitals, and potentially more services that can, and will, bulk bill an MRI.”

Jessica Hetherington is a GP at the Shepparton Women’s Clinic, and she said the cost of diagnostic testing was a huge barrier for some patients.

“It’s really difficult, and sometimes you have to send them for tests that aren’t the best ones for them because it’s cheaper, and that’s really sad,” Dr Hetherington said.

She said one of the biggest issues was the low Medicare reimbursement rates for diagnostic tests, making the gap between the cost and what patients receive back larger.

“The government just needs to increase Medicare rebates across the board,” she said.

“That’s where patients will see more money in their pockets.”

Dr Hetherington said physicians felt for patients who struggled to pay for tests they needed, and wished they could do more.

She said she also understood that imaging companies had to keep their clinics running and couldn’t cover expenses by only charging the level covered by government rebates.

“I hate having to consider finances in how I treat people, because rich people shouldn’t get better healthcare than poor people,” Dr Hetherington said.

When she refers people for breast cancer diagnostic testing, Dr Hetherington said she advised patients to call around and compare prices and wait times for appointments at private imaging practices and at Goulburn Valley Health, a public hospital.

The Australian Diagnostic Imaging Association, the industry body for practices that provide services such as diagnostic breast scans, has also taken aim at low government rebates.

“Medicare rebates fall well short of the cost of providing breast imaging services, primarily because of a 22-year rebate freeze that only ended in 2020,” ADIA president Ron Shnier said.

“Practices have many costs to account for, such as paying for highly specialised radiologists and imaging professionals.”

Dr Shnier said costs were even higher in regional areas, exacerbated by issues such as a radiologist workforce shortage.

“ADIA has been calling on both the Federal Government and Opposition to commit to a patient bill relief scheme for some time, allowing patients to only pay the gap on the day of their scan,” Dr Shnier said.

He urged both major parties to commit to addressing the high cost of scans as the election approaches.

A spokesperson for the federal Department of Health and Aged Care said the government recognised breast imaging was an important tool in the investigation of breast cancer symptoms.

“The department is currently reviewing breast imaging diagnostic imaging services as part of the Gender Review of Medicare Funded Diagnostic Imaging Services,” the spokesperson said.

“The aim of the review is to determine whether current items reflect best practices and evidence-based guidelines, align with the time, complexity and costs associated with providing the services and support patient access while ensuring the quality and safety of imaging services.”

The spokesperson also said patients had the option of choosing to have diagnostic testing done in a public hospital, free of charge.

GV Health confirmed the hospital offered bulk billing for the kinds of scans needed to determine whether breast cancer may be present.

However, the wait time for those services is up to six to eight weeks, according to a spokesperson.

“When people are told ‘there is a risk you have cancer’ your life flashes in front of your eyes. You don’t know who to say what to, and just want to know,” the local woman who wished not to be named said.

For some, she said, the option to wait did not feel reasonable and for some services the wait time could be lengthy.

Ms Whitfield said she was never told she could access bulk billed diagnostic tests through the hospital.

So she and her partner saved and, in late March, Ms Whitfield was finally able to schedule and pay for her tests.

She paid $570.90 upfront and received $290 back.

The results were a relief.

While she does need to go back in three months for another round of testing — which will involve paying the upfront costs and out-of-pocket expenses for a second time if she opts for a private imaging clinic — she is not facing a cancer diagnosis.

Still, she wants to see change when it comes to the costs of the kinds of tests she required.

“I don’t want my daughter-in-law, my daughter, my granddaughter having to deal with this.”

Ms Whitfield wants to see more independents in parliament, and more pressure on the government to ensure people are not facing a choice between necessary testing and paying their bills or simply giving up on getting tests done after hearing the high costs.

“They say we’ve got the best health system in the world,” she said.

“Prove it.”