Prostate Cancer Treatment Costs Explained
A prostate cancer diagnosis can be stressful, let alone thinking about treatment costs and the potential hit to your wallet. Here we provide an overview of out-of-pocket costs for localised, low-risk prostate cancer (which is early stage and slow growing) and provide some useful Australian resources on where to get financial help and support.
How much will my treatment cost?
In short, it depends…
Whilst some men have virtually no expenses, others will be out-of-pocket in excess of $10,000. Unfortunately, it’s not a straightforward answer because there are many factors to consider and everyone’s situation is different. For example, it depends on whether you are a public or private patient and what treatment you end up having. Let me explain further:
Public or Private patient?
As a public patient, we are fortunate to receive free or low cost treatment, tests and consultations in Australian public hospitals, with a valid Medicare card. However, you won’t have the freedom to choose your own treating doctor and facilities will vary between hospitals. Treatment waiting times are usually longer for public patients compared to private.
As a private patient, you have choice about the doctor that treats you, the hospital you are treated in and a time for treatment that suits you. Private health insurance can give you a sense of control and peace of mind. However, there is usually an out-of-pocket expense or ‘gap’ you will need to pay for medical costs (i.e. doctor and hospitals fees). This is additional to your insurance premiums and sometimes these costs are unexpected.
Private doctors set their own fees for some services so it’s important to ask for a breakdown of costs. This is called Informed Financial Consent and if in doubt, consider getting a second opinion. Consultations with specialist doctors in private practice (e.g. urologist, radiation oncologist) are not covered by private health insurance. Medicare may partly cover these fees, but you will need to pay the gap. Prof Jeremy Millar, Radiation Oncologist, said it’s important for patients to enquire about the costs very early in the process.
Specialist doctor consultations are covered by Medicare in public hospitals, however you won’t necessarily have choice about the doctor you see or how long you need to wait for the appointment.
Ultimately, you have the choice whether to be seen as a public or private patient; there are pros and cons to consider in terms of financial implications and choosing one over the other doesn’t necessarily mean you will receive better care.
Do I need Private Health Insurance?
The decision to purchase private health insurance is a personal choice. Private Healthcare Australia (PHA) cites that over 13.5 million Australians have private health insurance (54% of the Australian population) and it pays for close to two-thirds of non-emergency surgeries in hospitals. Those who cannot afford the premiums for private health insurance or do not wish to take out private health insurance, continue to have the right to access the public hospital system through Medicare. However, those considered ‘high income earner’ and ‘above the base income threshold’ incur the Medicare Levy Surcharge which is an extra 1% to 1.5% levy paid by Australian taxpayers who don’t have private hospital cover. The surcharge aims to encourage individuals to take out private hospital cover, and where possible, to use the private system to reduce the demand on the public system.
Lastly, you can still elect to be seen privately without health insurance; however it can be costly. Or you can choose to be seen privately at first, but then move into the public system if your circumstances change.
Help! What does my policy cover?
It can be frustrating trying to compare private hospital insurance products and work out what is best for you. It can also be difficult understanding what services different products do, and do not, cover. This is why it’s essential to check what policy you have and what medical treatment is covered so there are no unexpected surprises along the way.
Generally, the more extensive the health cover, the greater the premium you pay. For example, surgical removal of the prostate (i.e. radical prostatectomy) won’t necessarily be covered on a basic insurance package. However, Mr Kevin Chu, Consultant Urologist, says that policies differ widely between insurance providers. There are common misconceptions by patients about what their health insurance covers, but the truth is:
Doctor fee rebates are fixed for each insurer and vary from insurer to insurer. This may mean a bronze policy for one insurer may pay more than a gold policy for another insurer. This may affect the out of pocket fee you pay.
Inpatient blood tests and radiology scans (e.g. CT/X-ray) may be covered on the basic hospital cover for one insurer, yet they aren’t covered on the top cover of another insurer.
Hospital excess fees range anywhere between $0 and $1,000 and are only payable if you are admitted to hospital. You can pay a higher premium to lower your excess, but it is not necessarily related to the level of cover.
Private Health Insurance Reforms
Reassuringly, the Australian Government has introduced reforms this year to make private health insurance simpler and help people choose the hospital cover best suited to their needs. Health insurers have until 1 April 2020 to classify their private hospital cover into four tiers: Gold, Silver, Bronze or Basic (see Table 1). These tiers seem to indicate that prostate is covered in all but the basic tier under the clinical category ‘male reproductive system’ and ‘chemotherapy, radiotherapy & immunotherapy for cancer’. However, it is essential to check your policy with your health care provider, as each situation is different.
Table 1: Hospital Treatment Private Health Insurance Tiers – Gold, Silver Bronze and Basic (2019)
What is your Treatment Choice?
Deciding which treatment you should have (or not have) for low-risk prostate cancer is a personal choice and should be made in consultation with your doctor. It becomes challenging when treatment options are comparable in terms of survival outcomes but the side-effects differ significantly. Prostate cancer treatments may damage nerves and muscles near the prostate, bladder and bowel which can cause erection problems, urinary incontinence, a lowered sex drive and infertility. Whilst some side-effects are only short-term, others can be more long-lasting.
You may need to weigh up the practicalities of treatment options: travelling to daily treatment over many weeks (radiotherapy); hospitalisation and taking time off work to recover (surgery); or being closely monitored over potentially years and delaying treatment until it is necessary (active surveillance).
As of last year, Medicare introduced a new $400 Medicare rebate for prostate MRI scans which makes these scans more financially accessible to patients. These scans help to highlight suspicious cancer areas in the prostate and to better target a biopsy if required. It is important to note that the prostate MRI rebate can only be requested by a specialist (e.g. urologist, oncologist), and that GPs are not eligible to request this rebate.
If you elect to go on active surveillance, there is no ‘treatment’ as such however you will need to have follow-up appointments, blood tests, biopsies and scans so your doctor can closely monitor you for any signs of cancer progression. These costs will be mostly covered as a public patient, and partially as a private patient.
Radiotherapy or Brachytherapy
If you decide to be treated with radiotherapy or brachytherapy, the out-of-pocket expenses are minimal in the public hospital system, but vary considerably in the private setting. Public and private radiotherapy centres are available in each State, but there are differences for brachytherapy.
Dr John Yaxley, Prostate Cancer Specialist, explained there are two main types of brachytherapy – either low dose rate (LDR) or a high dose rate (HDR). It is his understanding that all States have HDR programs, but the availability is limited in the public sector. While all States have private LDR programs, it appears that only NSW, South Australia and Victoria have public LDR brachytherapy facilities.
If you decide surgery is right for you, the out-of-pocket costs will differ depending on your surgeon, where you have surgery (private or public hospital) and the type of surgery. For example, robotic prostatectomy will cost more than open surgery. If you have surgery as a private patient, there will be additional costs to cover such as hospital and anaesthetic fees. The average out-of pocket expense for prostatectomies is $5,116 for private patients, according to a joint report by the Royal Australasian College of Surgeons’ (RACS) and Medicare (2016). The out-of-pocket fees ranged from $0 (no charges) to $10,810 and patient costs increased for robot-assisted surgery
Where can I get financial help and support?
Associated costs for cancer treatment are often unavoidable, so it’s good to know what resources you can access and where to get financial help. Depending on your circumstances, you may need to consider travel, accommodation and parking costs; time off work; scans and blood tests; post-operative rehabilitation; physiotherapy; medications; dressings; incontinence pads; erectile devices or needing extra support with your family and the household.
Medicare provides additional financial aid to seniors, pensioners, health card holders and veterans where they can access cheaper health services and medicines. The Department of Veteran’s Affairs provides former serving members and their families a range of healthcare benefits.
The Cancer Council offers a comprehensive range of practical and financial assistance including pro bono legal and financial advice; they can assist with transport and accommodation costs and put people undergoing treatment in touch with organisations that provide financial counselling. They can also link patients with utility providers and telecoms that may be able to offer bill payment assistance programs.
Travel, Accommodation and Parking costs
Parking costs can sometimes be partially reimbursed in public hospitals, so check with your healthcare provider. If you end up travelling long distances for treatment, you might also need to consider additional accommodation and living costs. Patient Accommodation and Travel Schemes (PATS) are available to cover some of your travel costs for patients and carers. PATS are managed each State/Territory, so check if you are eligible using the relevant link below.
If you need accommodation near your treatment centre, the MediStays website helps find nearby accommodation at a discounted rate. It also includes some useful information about receiving financial support and travelling for treatment.
Time off work
You may need to have time off work to attend appointments, procedures and for recovery which may lead to a loss of income or the use of sick or annual leave. If you have a partner or carer, they may also need to take time off work to support you during this time. The Fair Work Ombudsman has more information about taking sick and carer’s leave.
Tips on being Financially Informed
Have an up-to-date GP referral letter for private specialists so you can claim any Medicare rebates.
Ask your doctor about any financial assistance available to you.
If Private – ask your specialist doctor for a breakdown of out-of-pocket costs. If in doubt, consider getting a second opinion.
If Private – check with your insurance provider about what your policy covers and what is excluded.
We’d love to hear from you
We hope you find this information useful to help understand the financial considerations of prostate cancer treatment and we’d love to hear your thoughts or feedback at [email protected]
Following on from an article by the Chief Health Officer in the Veterans Affairs newsletter, we received an influx of readers contacting us who wanted to better understand the costs involved around treatment. Following this feedback, we are incorporating a more comprehensive financial section in the Navigate DA trial website.
If you are reading this article before June 2020 and have recently been diagnosed with early-stage, low-risk prostate cancer, please consider joining our research trial www.navigateprostate.com.au to help navigate your treatment options.
We’d love to hear from you!
[email protected] | (03) 8559 7453
Need questions answered now?
Call Cancer Council 13 11 20 Information and Support line from anywhere in Australia.