Alyse Bradley did the math. The cost of living with multiple chronic health conditions has left her at least $400,000 out of pocket over the past two decades.
Each year the 37-year-old pays $600 for regular GP visits, $2,000 for specialist appointments, $1,000 for scans, $4,800 for ongoing pain treatments including physiotherapy, $1,400 for a variety of medications and $1,200 for vitamins.
Bradley estimates she has lost between $5,000 and $10,000 in annual income due to unpaid leave when she cannot work. This was especially true early in her career, when employers couldn’t see that anything was physically wrong and wouldn’t believe her.
Bradley, now a professional in the financial world, began experiencing symptoms of severe complex endometriosis, adenomyosis and chronic pelvic pain as a teenager, but was not diagnosed until age 27.
Amid the physical and emotional challenges caused by the diseases, Bradley says she experienced intense anxiety from the financial consequences.
Over the years, she has done her best to keep her financial burden under control. She got a second job working weekends after racking up thousands of dollars in debt that she only recently paid off. She has been forced to move in with her mother, on and off, after several endometriosis surgeries.
“Not only do you worry about pain on a daily basis, but also about the cost of it, you actually think about it all the time,” says Bradley. She is now the Treasurer of QENDO, a peak body for people affected by endometriosis and other pelvic health related conditions.
Bradley was able to put a down payment on her own apartment last year at the age of 36, but still feels “like I am many years behind my friends, especially with the savings in the bank”.
The cost of living crisis is worsening the gender health gap, the Royal Australian College of General Practitioners (RACGP) has warned. It is stated that women spend more years in poor health than men and are more likely to forego health care as out-of-pocket expenses increase. The peak body for GPs also says Medicare’s gender bias means women pay more than men for basic healthcare.
RACGP president Dr Nicole Higgins says women are more likely than men to have chronic conditions – not just those linked to their reproductive system such as endometriosis or polycystic ovarian syndrome, but also autoimmune diseases and mental health conditions.
According to government data, adult women have a higher overall percentage (56%) of having at least one of ten common non-gender-related chronic conditions compared to adult men (49%)with a particularly higher prevalence for conditions such as osteoporosis, arthritis, asthma, mental and behavioral problems.
Many women miss out on care because they can’t afford it, Higgins says. Women are almost twice as likely to postpone a visit to the doctor. “In the past twelve months one in 25 women have postponed care, compared to one in 40 men.”
Women are also penalized because of the way Medicare rebates are structured, Higgins says. “Medicare rewards procedural medicine – not cognitive, talking, preventive medicine. It punishes people the longer they stay with their doctor.”
The council is urging the federal government to increase Medicare rebates for longer GP consultations.
Yvonne Appleby requires care for several chronic conditions: type 2 diabetes, severe chronic asthma, glaucoma, severe arthritis in her knees and high blood pressure since the birth of her son. She also suffered from migraines until menopause and had benign breast lumps removed.
The 60-year-old’s specialist treatments have proven costly; the $600 for a brain MRI that confirmed her glaucoma was borrowed from her mother.
Because she was hospitalized for more than two weeks due to a severe asthma attack, she was forced to shorten her working hours. Appleby says most of her part-time biweekly pay of $645 goes toward medical expenses, even though her retirement card gives her significant “godsend” discounts on all her medications.
after newsletter promotion
“I am lucky to live in the parental home where I was born, because if I had to pay rent I would have no hope… you couldn’t pay rent and medicine at the same time, you would have to choose one” , she says.
She has always been able to bulk bill for her regular GP appointments “otherwise it would have just cost me a fortune – all the time back and forth”.
But earlier this year, Appleby’s primary care doctor died, forcing her to switch doctors at the clinic, meaning she now has to pay $64.85 out of pocket per appointment.
Finding another doctor who bulk-bills doesn’t feel like an option, she says. “I really don’t want to change clinics because they have my entire medical history from my previous GP, and it’s just all too difficult.”
Dr. Nisha Khot, the vice-chairman of the peak body for obstetricians and gynaecologists, agrees that the gender gap in Medicare needs to be addressed – including the disparity in rebates for items specifically related to women’s health.
Khot points to contraception. “If men undergo a vasectomy procedure, the Medicare rebate is more than $200, while when women have an intrauterine device (IUD) inserted – which is actually a procedure that takes longer than a vasectomy – the Medicare rebate for that is $75.”
Khot says rebates for many gender-specific Medicare items, such as pregnancy scans, have not changed in more than three decades, despite becoming more detailed and complex, leaving patients with obstetricians and gynecologists the highest out-of-pocket expenses of all medical specialties.
The National Women’s Health Advisory Council was formed in late 2022 to address medical misogyny. Ged Kearney, the assistant health minister and chairman of the council, says the government is conducting an investigation gender audit of specific Medicare services to ensure fairer discounts for women as part of the Continuous Medicare review.
Khot welcomes Kearney’s commitment to viewing the discount system through an intersectional and gender lens. “We would like to see that promise become a reality because it will make a huge difference.”
The government has committed to funding longer appointments among gynecologists, which will come into effect next year, but more items will require higher discounts, Khot said.
Bradley says the health sector and politics have historically been ruled by men – many of whom “even in 2024 have no idea” of the health issues women face and their costs.
“However, the stigma around these conversations is slowly changing, but we still have a lot to do.”
Khot says there is “no good reason” for the large gender gap in healthcare.
Like Bradley, Khot says she is hopeful for change, “because there is more interest (in the issue) and more people are willing to talk about it… I’ve always said it takes a coalition of women.”