Medical imaging such as X-rays, ultrasounds and CTs can help with diagnosis, treatment, and monitoring of many medical conditions, from bone fractures to cancer, but they do carry radiation risks and patients are expected to pay excess fees, which can vary widely. CHOICE looks into the risks and fees, and busts some myths about medical imaging along the way.
For more information on Health practitioners, see General health.
Fees and rebates
Medical imaging is done by a radiographer, or a sonographer for an ultrasound. Evaluation of the image for clinical purposes is done by a radiologist, a specialty that requires a medical degree and further study. GP-referred imaging is largely paid for by Medicare, which has a scheduled fee for imaging services and provides a payment for each one. Patients may also need to contribute directly when there is a gap between the Medicare rebate and the amount charged by the provider, or in rare instances, where no Medicare rebate exists. If a provider is prepared to accept the rebate as full payment, they can bulk bill Medicare, cutting the patient out of the payment process and reducing both administration and accounting costs.
Choosing a provider
Discuss public and private options with your GP, but remember, regardless of the name on the referral, you can go to any imaging provider you choose. Public providers (and some private ones) don’t charge a gap; however, out-of-pocket costs can be high, so shop around, and don’t forget to check waiting times. A gap payment can be the trade-off if you want the convenience of a specific local private provider, with easy parking and no waiting. You can also ask your GP to request bulk billing, but be aware that many GPs will not.
AMA out on a limb?
The Australian Medical Association (AMA)'s suggested fees are substantial, with big gap payments to match. By contrast, the private providers’ Australian Diagnostic Imaging Association does not make fee recommendations. CHOICE’s provider survey for Adelaide and Sydney, using a CT chest scan as an example, found charges were nowhere near the AMA suggested fees. The AMA claims increases in its recommended fees keep pace with average weekly earnings and that the gap sizes are a result of Medicare rebates going down since 1998. However, we believe that other factors, such as efficiency from improved technology and economies of scale in a growing market, are also factors. We asked the AMA to justify their suggested fees in terms of changes over time in radiologist incomes, but it was not willing to provide this information. However, several industry commentators told CHOICE that radiologist incomes are “OK” – neither at the top or bottom of the list of medical specialties.
Squeezing the privates
Around Australia, public providers are offering imaging services, providing bulk billing and generating income from Medicare. However, private providers say that hospital inpatient work gives public providers competitive advantages in economies of scale, while Medicare payments add a further squeeze, having stayed relatively static for a long time. CHOICE believes increased competition drives down price for consumers – as it does in many other areas – but acknowledges that Medicare bulk billing rates should be enough to fund on-site senior radiologists and a complete range of quality services. The federal government must consider whether current rates can do this.
[insert med rebates & AMA fees chart]
The MRI Myth
An imaging provider must have a federal licence and conform to rules if Medicare rebates are to apply to magnetic resonance imaging (MRI). These licences are restricted, but there are plans to almost double the number by 2015. Typical rules require a specialist referral and certain clinical criteria. Changes were flagged in the 2011 federal budget allowing staged introduction of GP referrals, starting with children under 16.
So why ration this imaging, which could replace up to one-third of CTs?
(MRI is best for bones, joints, tendons, the spine and brain tumours, while CT is best for the lungs and chest cavity in general.) Conventional wisdom has it that MRIs are rationed because they are extremely expensive. This is not true – the cost is 15%-20% more than CTs to a high-volume public facility (up to 50% more for private). The likely reasoning is that if, say, 25% of CT work went to MRI, the CT “shortfall” would soon be filled with “new” screening services, such as CT cardiac angiogram screening. The government is concerned about limiting health budget blow-outs.