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Standards for general practices (4th edition)

including Interpretive guide for Aboriginal and Torres Strait Islander health services

Standard 1.2 Information about the practice

Our practice provides sufficient information to enable our patients to make informed decisions regarding their care.

Criterion 1.2.4

Costs associated with care initiated by the practice

Our practice informs patients about the potential for out-of- pocket expenses for health care provided within our practice and for referred services.

Explanation

Key points

  • Cost can be a barrier to care
  • Patients need to know in advance about the potential for out-of-pocket expenses
  • Patients need to know in advance about consultations that do not attract a government subsidy
  • This criterion cross references to Criterion 1.2.2 Informed patient decisions.

Costs and informed decision making

Patients and advocacy groups have indicated to the RACGP that the cost of treatment or investigations can pose a barrier to care.

Information provided in advance about the costs of healthcare is an important component of informed decision making by patients. It is important for patients to know in advance whether the healthcare services they may require from the practice will attract costs over and above consultation fees so they can make an informed decision about their own healthcare.

Clear communication about unexpected developments can assist the patient to understand the need for additional costs. While it is not practical to stop in the middle of a procedure and inform patients that it will cost more than originally thought, effort to inform patients of the possible cost of additional treatments or procedures is needed before proceeding.

Special care should be taken to advise patients of the costs of consultations that do not attract a government subsidy (eg. cost of telephone and electronic consultations and diving or commercial driving licence medical examinations).

Components of health costs

Costs can include:

  • brief, standard and longer consultations
  • additional costs for late or missed appointments
  • telephone and electronic communication
  • nursing consultations
  • home/other visits or care outside the practice’s normal opening hours
  • medicines (where the medicine is not subsidised or where the brand name prescribed is more expensive than a generic version).

Costs of other services

The practice should advise patients of the potential for out-of-pocket costs related to services such as pathology, imaging, specialist or allied health. It is not necessary for the practice to provide more detailed information.

If the patient indicates that such costs pose a barrier to the suggested referral, alternatives may need to be discussed (eg. referral to public services).

Standard 1.2 Information about the practice

Our practice provides sufficient information to enable our patients to make informed decisions regarding their care.

Criterion 1.2.4

Costs associated with care initiated by the practice

Our practice informs patients about the potential for out-of- pocket expenses for health care provided within our practice and for referred services.

In a nutshell

Costs can be a major barrier to care, especially for many Aboriginal and Torres Strait Islander communities. Your service needs to inform patients about potential out-of-pocket costs before they make the decision to proceed with care. Although it may be difficult to accurately predict the cost of care, you can help your patients make informed decisions by letting them know of any possible costs over and above consultation fees, and answering their questions. Clear communication will help patients plan and prepare for any unexpected eventualities.

Key team members

  • Practice manager
  • Health service doctors

Key organisational functions

  • Billing policies and function
  • Patient communications

Indicators and what they mean

There are no indicators for this criterion. Refer to Criterion 1.2.4 Costs associated with care initiated by the practice of the Standards for general practices for a listing of the components of health costs.

Case study

Below is a description of the ways in which an Aboriginal community controlled health service can ensure it tells patients about any out-of-pocket expenses. Not all of these good practices are required by the Standards, but they illustrate the many practical and creative things that ACCHSs can do to ensure they deliver services of high safety and quality to their community.

All services and consultations provided at the service are bulk-billed and additional costs for patients are kept to a minimum.

The service participates in as many Close the Gap campaign initiatives as it can, and explains to patients any of the financial aspects that may be related to the care they receive. This includes medicines and other pharmacy services, referrals to specialists, and health assessment and prevention programs.

Reception staff have a list of available external health service providers. When making appointments with these providers on behalf of the patients, staff phone to check for any out-of-pocket costs patients are likely to receive.

The service has negotiated for local pathology and radiology providers to bulk-bill patients it refers to them. It also has a list of external specialists, pathology or radiology providers and advises patients if those providers will bulk-bill or charge a fee that must be paid at the time of service.

The service makes available to patients a list of services it provides, such as:

  • pathology
  • radiology
  • dressings
  • electrocardiogram (ECG)
  • spirometry
  • consultations (short, standard, long)
  • diabetes education classes
  • care plans for chronic disease management
  • 
travel, accommodation and other costs for patients – including, if it is offered, an escort from a remote community to accompany patients to a regional or city hospital and other available assistance (for example, contacting the Aboriginal liaison officer at the hospital and requesting for patients to be met when they disembark from transport and escorted to the hospital or accommodation).

The list states if these are bulk-billed or if they may incur out-of-pocket costs that must be paid at the time of service.

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