Lexi Webster
Breast cancer is one of the most common cancers in Australia, and it can be very expensive to treat. While patients can receive free treatment in public hospitals, there are often hidden costs, such as tests, scans, and drug treatments not covered by Medicare, which can amount to thousands of dollars. Private health insurance can cover treatment in private hospitals, but this also comes with out-of-pocket expenses. Financial counselling services are available to help patients navigate these costs, but the financial burden of breast cancer treatment in Australia remains a significant issue.
| Characteristics | Values |
|---|---|
| Treatment cost covered by Medicare | Yes, but only in public hospitals and only for admitted patients. |
| Out-of-pocket costs | Yes, for outpatient services, tests, scans, and non-PBS medicines. |
| Average monthly out-of-pocket cost | $531 for women with secondary breast cancer treated in the public system. |
| Total out-of-pocket costs | $900 on surgery, $1500 on radiotherapy, and $922 on scans. |
| Private health insurance | Covers treatment as a private patient in a private hospital of choice, with the doctor of your choosing. |
| Financial support | National Debt Helpline, Financial Counselling Australia, Cancer Council's Pro Bono Program. |
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What You'll Learn
Breast cancer treatment costs in public hospitals
Every Australian who holds a valid Medicare card is entitled to free treatment in a public hospital. Many doctors who work in private practice also do sessions in public hospitals. If you choose to be a public patient, Medicare will cover the costs of your treatment in a public hospital at no charge to you. However, you cannot choose the particular doctor who will treat you. You will be treated by doctors nominated by the hospital and your operation may be partly or wholly performed by a trainee surgeon who will be under the supervision of a specialist consultant surgeon.
Breast cancer surgery is classified as "Category One" within the public sector and is performed as a high priority in an appropriate time frame, without long waiting times. However, breast cancer is one of the most common and expensive cancers for out-of-pocket expenses. A recent report from the Consumers Health Forum of Australia (CHF) found that half of Australians with cancer have out-of-pocket costs exceeding $5000. The ministerial advisory committee's report into out-of-pocket costs found that patients were charged up to $5000 for breast cancer surgery, $3000 for pathology, and $5000 for radiation treatment, all out-of-pocket. The average out-of-pocket costs reported by privately insured women with breast cancer were double that of uninsured women ($7000 compared to $3600), according to the Breast Cancer Network Australia’s financial impact report.
Cancer patients in Australia pay only a relatively small proportion of the total costs of their care, but their out-of-pocket costs can still range from a few hundred to tens of thousands of dollars. These costs can include scans such as MRIs, which can cost up to $1500, and PET scans, which can cost up to $1000. Patients with rarer cancers report paying more than $3000 for imaging scans just to establish a diagnosis. More than 300,000 Australians skip radiology each year because of the cost.
There are resources available to help patients with the financial burden of cancer treatment. The Cancer Council has developed a list of questions patients should ask their healthcare professional about the cost of their treatment and any out-of-pocket costs they may incur. The Cancer Council's Pro Bono Program can help people with legal issues, financial planning, small business accounting, and workplace advice. The National Debt Helpline is a not-for-profit service that helps people tackle their debt problems. Financial Counselling Australia is another not-for-profit organisation that provides resources and support for financial counsellors and links Australians to financial counsellors in their state or territory.
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Private health insurance coverage
Breast cancer treatment in Australia can be expensive, with breast cancer being one of the most common cancers for out-of-pocket expenses. While every Australian with a valid Medicare card is entitled to free treatment in a public hospital, wait times can be long and inconvenient, prompting some to opt for private treatment.
Private health insurance covers treatment as a private patient in the private hospital of your choice, with the doctor of your choosing. This can be particularly important for breast cancer patients who may wish to select a specialist breast surgeon with specific credentials and experience. Private patients are given greater flexibility when scheduling surgery and shorter waiting times.
However, it is important to note that private health insurance does not always cover all treatment costs. Patients with private health insurance should contact their insurer to discuss what their policy covers and what out-of-pocket expenses they may incur. The Cancer Council has developed a list of questions to help guide these discussions.
There are also other resources available to help patients understand and manage the financial aspects of their treatment. The Department of Health has a webpage for private health insurance that explains out-of-pocket costs in detail, and the National Debt Helpline offers free, independent, and confidential financial counselling services.
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Out-of-pocket expenses for breast cancer patients
Breast cancer treatment in Australia can vary in cost, and patients may face significant out-of-pocket expenses, depending on their choice of healthcare provider and treatment type. While public hospitals provide free treatment, private hospitals and certain treatments can incur substantial costs.
Public vs Private Healthcare
In Australia, every citizen with a valid Medicare card is entitled to free treatment in a public hospital. Breast cancer surgery is classified as "Category One" in the public sector, ensuring high-priority treatment within an appropriate timeframe and without long waiting times. However, patients cannot choose their doctor and may be treated by trainees under supervision. On the other hand, private health insurance offers patients the freedom to choose their doctor, shorter waiting times, and access to private hospitals. This flexibility comes at a cost, with private treatment often resulting in out-of-pocket expenses.
Out-of-Pocket Costs
Breast cancer patients in Australia may face significant out-of-pocket costs, especially for specific treatments and medications. A report from the Consumers Health Forum of Australia (CHF) revealed that half of Australian cancer patients incurred out-of-pocket expenses exceeding $5000. Moreover, one in four patients paid over $10,000 out of pocket within two years, and breast cancer patients had the highest median out-of-pocket costs among the five most common cancers. These costs can include charges for surgery, pathology, radiation treatment, diagnostic imaging, and scans.
Financial Support
To address the financial burden, various organisations offer support to breast cancer patients in Australia. The Cancer Council, in collaboration with other organisations, has developed a Standard for Informed Financial Consent to guide discussions about treatment costs. Additionally, the National Debt Helpline provides free and confidential financial counselling services, assisting patients in managing their financial challenges. The Cancer Council also offers a free telephone support service, providing emotional and practical support to those affected by cancer.
While treatment options and financial support are available, breast cancer patients in Australia should carefully consider their choices and be aware of the potential out-of-pocket expenses associated with their treatment journey.
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Financial support services
Breast cancer treatment in Australia can result in significant out-of-pocket costs, with breast cancer being one of the most expensive cancers for patients in this regard. While every Australian with a valid Medicare card is entitled to free treatment in a public hospital, this does not cover treatment in private hospitals, and patients may face long waiting times in the public system. Private health insurance can cover treatment in private hospitals, but patients with such insurance should contact their insurer to clarify if their treatment is covered.
For those facing financial issues due to breast cancer treatment, there are a variety of financial support services available. The Cancer Council Helpline (13 11 20) is a free, confidential telephone information and support service with specially trained staff who can answer questions about cancer and offer emotional or practical support. The Cancer Council also has a Pro Bono Program that helps with legal issues, financial planning, small business accounting, and workplace advice. The National Debt Helpline (1800 007 007) is another free, independent, and confidential service that connects people with financial counsellors in their state or territory. Financial counsellors are qualified professionals who provide free information, advice, and advocacy to people facing financial difficulties.
Breast Cancer Care WA may be able to offer short-term financial assistance or refer patients to an appropriate community support service. They can provide a limited amount of financial assistance to eligible clients struggling to pay basic utility bills, fuel, or groceries, as well as assistance with transport to and from treatment, light household cleaning, and basic garden maintenance. They can also put patients in touch with wig and prosthesis providers and lymphoedema treatment clinics.
The Breast Cancer Network of Australia (BCNA) has a fact sheet on the range of benefits, subsidies, and services that may be available, as well as a Financial Tracker to log expenses. BCNA's Helpline (1800 500 258) provides information, support, resources, and referrals to necessary services.
State and territory governments offer financial assistance for eligible people who must travel for treatment through a Patient Assisted Travel Scheme (PATS). This provides a subsidy for travel and accommodation costs. Services Australia provides information on accessing childcare and the government financial assistance available for this, such as the Child Care Subsidy.
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Subsidised breast cancer medicines
Breast cancer treatment in Australia can be costly, with patients often facing significant out-of-pocket expenses. While everyone with a valid Medicare card is entitled to free treatment in a public hospital, there may still be out-of-pocket costs for diagnostic imaging, pathology, and radiation treatment. For example, a report from the Consumers Health Forum of Australia (CHF) found that patients with breast cancer were charged up to $5000 for surgery, $3000 for pathology, and $5000 for radiation treatment, all out-of-pocket.
To help with these costs, the Pharmaceutical Benefits Scheme (PBS) subsidises certain breast cancer medicines. The Pharmaceutical Benefits Advisory Committee (PBAC) is responsible for recommending which medicines should be subsidised under the PBS. The PBAC considers the clinical and cost-effectiveness of the medicine, as well as how it compares to existing treatments.
In April 2023, the PBAC recommended that three breast cancer drugs be added to the PBS: Keytruda (pembrolizumab) for metastatic triple-negative breast cancer; Enhertu (trastuzumab deruxtecan) for metastatic HER2-positive breast cancer; and Verzenio (abemaciclib) for HR-positive/HER2-negative early breast cancer with a high risk of recurrence. These recommendations were welcomed as an important step forward in providing new treatment options for aggressive forms of breast cancer.
However, it is important to note that not all breast cancer medicines are subsidised under the PBS. This can result in high costs for patients, especially for rare or metastatic cancers. To assist with accessing non-subsidised medicines, patients can explore patient access programs offered by pharmaceutical companies or discuss alternative options with their medical oncologist.
Additionally, organisations like the Cancer Council, Breast Cancer Network Australia, and Financial Counselling Australia provide resources and support to help patients navigate financial concerns related to cancer treatment. These organisations promote informed financial consent, ensuring patients have the information they need to make decisions about their care and manage the associated costs.
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Frequently asked questions
Breast cancer treatment is free in Australia for patients who are admitted to public hospitals and have a valid Medicare card. However, there may be out-of-pocket costs for diagnostic imaging, tests, and drug treatments not covered by Medicare.
Out-of-pocket costs for breast cancer treatment in Australia can vary. A 2015 survey by the Breast Cancer Network found that women with secondary breast cancer treated in the public system paid an average monthly out-of-pocket cost of $531. The same women reported total out-of-pocket costs of $900 on surgery, $1500 on radiotherapy, and $922 on scans.
Yes, there are several financial resources available for breast cancer patients in Australia. The Cancer Council offers a free, confidential telephone information and support service. The National Debt Helpline is also a free service that provides independent and confidential financial counselling.
Private health insurance covers breast cancer treatment in private hospitals, allowing patients to choose their doctor and hospital. However, patients should contact their insurer to understand their specific coverage.
To reduce out-of-pocket costs, patients should understand their treatment options and associated costs. The Cancer Council, Breast Cancer Network Australia, and other organizations have developed resources to guide discussions about financial consent and help patients make informed decisions.
