Latest news with #outofpocket
CTV News
5 days ago
- Health
- CTV News
Pregnant woman denied health coverage, facing $20K bill to have baby in Manitoba
Nikka Worth has been denied health coverage and is expecting to pay thousands of dollars out of pocket to have her baby in Manitoba. Uploaded June 16, 2025. (Danton Unger/CTV News Winnipeg) A pregnant woman will have to pay thousands of dollars to have her baby in Manitoba after being denied health coverage and losing an appeal. Nikka and Andrew Worth are expecting their first child, a baby girl, at the end of the month. However, the pregnancy is being paid for out of pocket after Manitoba Health denied coverage to Nikka. 'We are at the last stretch. I'm nine months pregnant and no matter what – we will be taken care of,' Nikka told CTV News. 'But it's just that we want to fight for what's fair.' As CTV News first reported, the couple met last year while Nikka was visiting Canada from the Philippines. They fell in love and got married in September. Shortly after, they found out their little family was about to grow. Read more: 'It doesn't feel right': Pregnant woman denied health coverage over provincial 'grey area' The problem is Nikka – a Filipino citizen – is currently in Canada on a visitor record – an extended visitor visa that expires in November. She has been waiting for her permanent residence to be approved. Until it is, Nikka said she's been told she is not eligible for provincial health coverage – despite the fact she's married to a Manitoba resident and the child she's carrying will be a Canadian citizen. 'Canadian health care, I think, is a real point of pride for a lot of Canadians,' said Andrew. 'This has been kind of disillusioning to myself.' Andrew said what makes the situation even more frustrating, is the fact that there are exceptions in Manitoba's rules. According to the province, the spouse of a work permit holder would be eligible for health coverage, but not the spouse of a Canadian citizen. The couple took their case to the Manitoba Health Appeal Board, but it was dismissed earlier this month. 'Unfortunately, the specific wording found within the Act… does not allow for health benefits to be extended to the spouse until they are determined to be a 'resident,'' the board said in a decision obtained by CTV News. CTV News reached out to the Health Minister for comment. A spokesperson from the provincial cabinet communications team responded by email. 'Manitoba provides insurance based on your residency status, which is determined by the federal government,' the email reads, adding if the federal government determines you are a resident, you would be covered by Manitoba. 'Manitoba stipulates that insurance is tied to residency in the Health Services Insurance Act.' All this means Nikka and Andrew will have to cover the cost of the pregnancy. They've already spent about $5,000 on prenatal care and ultrasounds. As for the actual delivery, they've been told a single night in hospital will cost nearly $6,000. If there are any complications, a night in the ICU would cost them more than $16,000. Altogether, in order to bring their baby home, Nikka and Andrew are expecting to pay more than $20,000. They say there is a silver lining, as they've been told the baby will be covered by Manitoba Health. To cover the costs, the couple have taken out a line of credit from the bank and launched a GoFundMe. 'We would just have to pay it off like you pay off a car,' Andrew said. 'We're going to have to take on debt to have a child in Canada, which seems almost ludicrous.'
The Guardian
6 days ago
- Health
- The Guardian
One million Australians missing specialist doctor appointments due to cost, report finds
One in 10 Australians pay almost $600 each year to see specialist doctors, with 1 million delaying or skipping appointments due to the cost, according to new analysis. A report by the Grattan Institute, released on Monday, revealed outpatient fees have soared over the past 15 years. The average initial out-of-pocket psychiatrist fee was $671 in 2023, with some 'extreme fee' specialists charging more than triple the scheduled Medicare fee. It found almost 2 million Australians are delaying or skipping specialist appointments each year – about half due to cost – adding pressure to the country's hospital systems. Experts say a lack of regulation of specialist consultation fees and training positions has led to ballooning costs. The report, Special Treatment: Improving Australians' Access to Specialist Care, found one in 10 low-income patients, with weekly household incomes of less than $500 a week, were billed almost $500 a year in out-of-pocket costs. Sign up for Guardian Australia's breaking news email Some specialist doctors charged more than triple the Medicare scheduled fee, the analysis found. The scheduled fee refers to a fixed payment that the federal government will pay the doctor for the service. Of these 'extreme-fee charging' specialists, psychiatrists had the highest average out-of-pocket costs for an initial consultation – $671. This was followed by $372 for endocrinologists and $369 for cardiologists. 'The specialist system isn't working and Australians – especially poorer Australians – are paying the price,' said the lead report author and Grattan Institute health program director, Peter Breadon. Prof Yuting Zhang, an expert in health economics at the University of Melbourne, said a lack of government regulation of doctors' fees had led to increased costs to patients. 'Doctors can charge whatever they like … The fees have gone up quite a lot, especially for specialist fees relative to GP fees,' she said. 'We have seen a huge increase, but also very large variation across doctors, across regions and even across patients. The same doctor could charge differently for different patients coming to see the same service.' Zhang said in other countries with similar universal healthcare models, the government had 'some role' in determining fees. She said high specialist fees led to people skipping appointments and their deteriorating illnesses requiring hospitalisation. 'That costs a lot more, so ideally you don't want people to delay,' she said. 'The worry is it increases the downstream cost.' Zhang said often, patients do not know the total cost prior to seeing a doctor, making it harder for them to make an informed decision. 'It's hard for them to compare. But even if they know the price, it might be hard for them to judge if that price is justifiable,' she said. 'Sometimes people think more expensive means better, which in healthcare, often that's not true.' Dr Elizabeth Deveny, chief executive at peak body Consumer Health Forum of Australia, said consent for fees was mandatory but not enforced. Sign up to Breaking News Australia Get the most important news as it breaks after newsletter promotion 'People shouldn't be hit with surprise bills,' she said. Delaying or avoiding specialist treatment is leading to missed diagnoses and avoidable pain, the report found. Many patients waited months or even years for an appointment. In some parts of Australia, wait times for urgent appointments extend beyond the clinically recommended maximum. The report concluded specialist care in Australia was a 'postcode lottery', with people living in the worst-served areas receiving about a third fewer services than the best-served areas. It said public clinics do not do enough to fill these gaps. Zhang said requiring the federal government to increase the training of more specialist doctors could also ease wait times. She pointed to psychiatry as a specialty plagued by shortages. 'In areas like psychiatry, the government should do something to increase supply.' The report makes five recommendations, including that the federal government withhold Medicare funding from specialists who charge excessive fees and publicly name them. It also recommends governments expand public specialist appointments in areas that get the least care to provide more than 1m services annually, enable GPs to get written advice from specialists to avoid almost 70,000 referrals each and provide $160m to train specialists workforces, with funding linked to specialities with shortages and rural positions. The federal health minister, Mark Butler, said the private health sector, including insurers and specialists, needed to do more to protect patients from exorbitant bills. 'The Albanese Labor government will help Australians find the best value when they need specialist medical advice and treatment, by upgrading the Medical Costs Finder to give more transparency on fees,' he said. 'We are committed to working with consumers, the colleges and private health providers on the design and implementation of this important cost transparency measure.'
South China Morning Post
05-06-2025
- Health
- South China Morning Post
4 steps for Hong Kong to tackle fast-rising healthcare costs
Advertisement Avoiding this crisis requires a transformation in cooperation between healthcare providers, insurers and health authorities, underpinned by technology integration across the whole system. Ignoring the impact of Covid-19, healthcare costs rose by 23 per cent in the five years to 2023, with taxpayer-funded costs increasing from 50 per cent of the total to 52 per cent and out-of-pocket costs averaging 30 per cent of total spending for that period. Government healthcare spending grew by 28 per cent, and insurance funding has not reduced the burden on taxpayers and out-of-pocket costs. Relative contributions to healthcare funding from private and employer-based insurance schemes have not grown meaningfully in the past five years, averaging 17 per cent of total spending. Health insurers are struggling with profitability because of inflation in medical costs, leading them to increase premiums. This constrains the take-up of private insurance, adding a new dimension to the sustainability problem. Increasing healthcare costs can only be met through higher private insurance premiums, increased government expenditure and higher out-of-pocket spending. There is no magic fourth way to fund the system. Advertisement
South China Morning Post
05-06-2025
- Health
- South China Morning Post
Four steps for Hong Kong to tackle fast-rising healthcare costs
Advertisement Avoiding this crisis requires a transformation in cooperation between healthcare providers, insurers and health authorities, underpinned by technology integration across the whole system. Ignoring the impact of Covid-19, healthcare costs rose by 23 per cent in the five years to 2023, with taxpayer-funded costs increasing from 50 per cent of the total to 52 per cent and out-of-pocket costs averaging 30 per cent of total spending for that period. Government healthcare spending grew by 28 per cent, and insurance funding has not reduced the burden on taxpayers and out-of-pocket costs. Relative contributions to healthcare funding from private and employer-based insurance schemes have not grown meaningfully in the past five years, averaging 17 per cent of total spending. Health insurers are struggling with profitability because of inflation in medical costs, leading them to increase premiums. This constrains the take-up of private insurance, adding a new dimension to the sustainability problem. Increasing healthcare costs can only be met through higher private insurance premiums, increased government expenditure and higher out-of-pocket spending. There is no magic fourth way to fund the system. Advertisement
Medscape
21-05-2025
- Health
- Medscape
Is Universal Healthcare a Realistic Ask for Europeans?
Out-of-pocket costs are silent barriers to healthcare, said João Vasco Santos, MD, PhD, president of the Public Health Economics Section at the European Public Health Association. 'They result in financial hardship and unmet health needs in every European country, disproportionately affecting various groups, particularly those experiencing social vulnerability. These costs delay treatment, exacerbating health inequality even further. They are also the most regressive form of health financing,' he told Medscape Medical News . João Vasco Santos, MD, PhD In 2023, nearly 4% of adults in the European Union (EU) reported having unmet medical needs, and close to 5% experienced unmet dental needs. Although the EU generally offers extensive healthcare coverage, significant barriers persist for certain vulnerable groups, including the need to pay out of pocket for services such as optical treatments, dental care, physiotherapy, reproductive health, psychotherapy, and prescribed medicines for common chronic conditions. According to the World Health Organization (WHO), up to 1 in 5 European households face catastrophic health costs, leaving them unable to afford essentials like food, housing, and heating. Another 1%-12% of households end up in poverty or even worse financial struggles due to out-of-pocket healthcare payments. Experts told Medscape Medical News that, to improve healthcare access, especially to vulnerable groups, EU countries need to learn from each other's experiences, set benchmarks, and collect high-quality data. The Cost of European Healthcare 'We see out-of-pocket payments in every health system in Europe,' said Sarah Thomson, PhD, senior health financing specialist at the WHO Barcelona Office for Health Systems Financing. These payments result when people are not entitled to publicly financed healthcare but also when co-payments are required for covered healthcare, particularly for outpatient prescribed medicines, she explained. Sarah Thomson, PhD 'Even among high-income individuals, there are times when they may face financial hardship due to out-of-pocket spending, particularly regarding certain medical products or dental care,' said Santos. Thomson explained that healthcare accessibility and costs vary significantly across the EU. For example, in the Netherlands, prepaid public funding covers approximately 80%-90% of healthcare costs, leaving only about 10% to be paid out of pocket. In contrast, Italy has significantly higher out-of-pocket expenses, accounting for around 23% of its current health spending. 'The more countries invest publicly in their health systems, the less people usually have to pay out of pocket,' said Thomson. 'As a result, the share of total health spending from out-of-pocket payments is much smaller in the Netherlands than in Italy.' This isn't the only factor that affects access to healthcare, however. Another factor is whether the healthcare system is designed to include co-payments and whether low-income households are exempted or if there is an income-based cap on them, Thomson explained. Understanding Two Different Approaches European healthcare financing varies widely from being primarily through the government budget, like in Italy, to heavily relying on employer and employee social insurance contributions, like in the Netherlands, or something in between, such as in France. Thomson said that users can face some level of co-payment in any of these models. In 2023, out-of-pocket payments represented 23% of Italy's €176 billion healthcare bill, up by 10% from the previous year, explained Domenica Matranga, PhD, professor of medical statistics at the University of Palermo, Palermo, Italy, to Medscape Medical News . 'There was a dramatic increase because this is the effect of the enormous public debt we have and of unacceptably long waiting lists.' Italy's National Health Service is funded through general taxation and provides universal coverage for all citizens and residents, with hospitals and most primary care services largely free at the point of use. While each region is responsible for organizing and delivering health services, the essential benefits package is established nationally and must be offered uniformly throughout the country. Still, there are problems. There is a significant disparity in access to high-quality healthcare between the north and south. Additionally, Italians are required to make co-payments for certain services, including medicines, outpatient specialist visits, diagnostic tests, and dental care. And even though financial support is provided for very young children, pensioners, and the unemployed, for example, there is no overall cap on co-payments. The Netherlands, on the other end, operates under a social health insurance system. Dutch residents must register for mandatory healthcare insurance, and they all receive at least a government-defined basic benefits package. They pay monthly insurance premiums and have an annual deductible of approximately €385. They do not need to make additional payments for general practitioner visits or standard hospital care. However, they must pay the initial portion of their healthcare costs related to non–primary care services out of pocket each year before their insurance coverage takes effect. 'We have universal health coverage that is quite comprehensive in the Netherlands,' said Pieter Bakx, PhD, an associate professor affiliated with the Health Economics group at the Erasmus School of Health Policy and Management, Rotterdam, the Netherlands. 'The defined set of benefits is relatively broad, and co-payments tend to be low. This applies particularly to long-term care; when compared to neighboring countries, people pay relatively low user fees.' Pieter Bakx, PhD The Dutch population typically reports low levels of unmet medical treatment needs. They do have some out-of-pocket expenses for services such as adult dental work, physiotherapy beyond a certain limit, and eyeglasses. However, their out-of-pocket spending is far below the EU average. To cover expenses that fall outside the basic benefits package of their insurance, they usually purchase supplementary voluntary health insurance policies. Toward Fairer European Healthcare 'Introducing an EU-wide benchmark or target for all countries would be a good approach to improving healthcare affordability in our continent,' said Santos. A good equity-based benchmark could be for no more than 2% of EU households to experience catastrophic health spending, he said. 'Then, consider coverage, coverage, coverage. I think it's all about coverage policies and trying to showcase how these coverage policies in some countries are achieving results in terms of access to healthcare.' Thomson added that learning from one another is often overlooked. Despite the potential benefits of observing how other countries address common problems, she said there is typically a surprising lack of understanding about these approaches. This gap exists partly because policymakers often lack the time to explore international solutions when faced with immediate crises, and because politics is a cyclical process and people constantly change. There is significant need to actively promote and support the sharing of experiences and knowledge among different countries, she said, but quality data are necessary before information can be shared. 'I think the EU can play a significant role in data collection, ensuring that countries gather information on who experiences unmet healthcare needs, who face financial hardship, and the reasons behind this,' Thomson added. 'The EU could do more to encourage member states to collect this data more regularly because data is very powerful.' Bakx emphasized that Europeans are all in the same boat. The population is aging, which means that the demand for healthcare will increase while the supply of healthcare workers will decrease. 'The big challenge now, and even more in the future, is the demographic transition,' agreed Franca Maino, PhD, associate professor of social and political sciences at the University of Milan, Milan, Italy, and scientific director of the Percorsi di Secondo Welfare Observatory. 'So it's really crucial to have a guiding framework at the EU level to develop long-term care systems in all member states. As of now, some countries don't have a [proper] long-term care system.' Franca Maino, PhD
