Fees for specialist doctors are rising faster than Discounts on medical careresulting in greater payment disparities for patients.

Latest data from Australian Institute of Health and Welfare shows that in the primary quarter of this yr, Medicare rebates covered just over half (52%) of total payments. This is down from 72% twenty years ago and is the bottom percentage in history.

Doctors can charge whatever they like while the federal government sets the Medicare rebate. The difference between them or the gap affects patients. In the case of GPs, the federal government provides incentives for doctors omnibus accountbut there isn’t a such incentive for other specialists.

Doctors blame too low rebates for big payment gaps, they usually’re partly right. After accounting for inflation and rising demand, the typical dollar amount one person receives annually in Medicare rebates has fallen. AU$349 to AU$341 over the past decade.

But that is only a part of the issue. When many individuals cannot afford tons of (if not 1000’s) of dollars for essential specialty care, we want to have a look at why fees are so high.

How do professionals determine their remuneration?

Although general practice is technically a specialization, after we discuss medical specialists in this text, we mean specialists who are not general practitioners. These may include pediatricians, oncologists, psychiatrists and dermatologists.

When determining fees, professionals consider a mix of things on the patient level, on the physician level, and on the system level.

Patient characteristics, comparable to the complexity of their condition, may increase the value. This is because more complex patients may require more time and resources.

Professionals, based on their experience, perceived skill level, or ethical considerations, may charge kind of. For example, some specialists say they provide discounts for specific groups, e.g. children or retirees.

System-level aspects, including the fee of running a practice (e.g., hiring staff) and the placement of the practice, also play a task.

Problems arise when prices vary significantly, which regularly signals limited competition or excessive market power. This applies to medical services where patients have little control over prices and rely heavily on doctors’ recommendations.

IN recent researchmy colleagues and I discovered that the salaries of execs in the identical field vary significantly. In some cases, the most costly specialist charged greater than twice as much as the most affordable.

Physician characteristics influence fee setting

Me and my colleagues recently analyzed tens of millions of compensation claims from private hospitals in Australia between 2012 and 2019. We found that the wide variation in fees is basically as a result of differences between individual physicians, quite than aspects comparable to patient complexity or the differences we’d expect between specialties.

Up to 65% of the variation in total fees and 72% in out-of-pocket payments will be attributed to differences between physicians in the identical field.

To understand what physician-level aspects lead to high fees, we watched data from a representative survey of specialists. We found that senior professionals have lower fees and better aggregate fee rates. Practice owners typically charged higher fees.

We also found that physicians’ personality affects how much they charge and the way often they bill patients collectively. Physicians who scored higher on the personality trait of agreeableness were more prone to bill patients in bulk, while those that scored higher on neuroticism tended to overcharge patients.

We couldn’t show any evidence that the fees were related to competition.

Impact on patients

This will not be a competitive market. On the contrary, it has high entry restrictions (long training requirements) and a limited supply of specialists, especially in rural and distant areas. Meanwhile, patient access is controlled by the necessity to have referrals, which often expire after a yr.

Patients are often unable to buy or make informed decisions about their care as a result of a lack of knowledge in regards to the true costs and quality of services.

For private hospital services, the fee structure is complicated by the undeniable fact that several providers (e.g., surgeon, anesthesiologist, surgical assistant) bill individually, making it difficult for patients to know the full cost prematurely.

Despite efforts to introduce price transparency in recent times, including through the federal government Treatment cost search engine website, the system stays unclear. Reporting is voluntary and the evidence is mixed on whether these tools are effective in lowering prices or increasing competition.

All of this contributes to high and unpredictable out-of-pocket costs, which might result in financial burdens for patients. ABOUT 10.5% of Australians the reported cost was the explanation for delaying or avoiding a specialist visit in 2022–2023.

This raises necessary questions on the fairness and sustainability of Australia’s universal health care system, which relies on the principle of equal access to take care of all residents.

What will be done?

Patients can take steps to attenuate their costs by actively looking for information. This includes asking your GP for a variety of options after referral to a specialist. Please keep in mind that a referral from your loved ones doctor will be used with every other doctor of the identical specialization.

Similarly, ask your specialist receptionist what the fee and discount might be before or after making an appointment detailed quote before going to hospital. Look around if it’s too high.

But the responsibility doesn’t rest solely with patients. For example, the federal government could try to deal with this problem by increasing investment in outpatient care in public hospitals, which could increase competition for specialists. It could also publish a fee range in comparison with a rebate for all consultations paid for by Medicare, quite than counting on doctors’ voluntary reports.

Price transparency alone will not be enough. Patients also need high-quality information and higher guidance to navigate the health care system. That’s why continued investment in improving health awareness and care coordination is significant.

If the situation doesn’t change, the financial burden on patients will likely proceed to extend, undermining each individual health outcomes and the broader goals of equal access to health care.

Fourteen years ago, semaglutide’s older cousin (Ozempic and Wegovy) entered the market. The drug liraglutide is sold under brand names Victoria AND Saxenda.

Patents for Victoza and Saxenda now expired. Likewise other pharmaceutical corporations working develop “generic” versions. These are prone to be a fraction of the running costs, i.e around 400 Australian dollars monthly.

So how does liraglutide compare to semaglutide?

How do these medicines work?

Liraglutide was not originally developed as a slimming treatment. Like semaglutide (Ozempic), it originally treated type 2 diabetes.

Liraglutide and semaglutide medications are often called GLP-1 mimetics, which suggests they mimic the natural hormone GLP-1. This hormone is released from the small intestine in response to food and works in several ways to enhance the best way the body handles glucose (sugar).

How do they stop hunger?

Liraglutide works in several areas of the unconscious a part of the brain, particularly the hypothalamus, which controls metabolism, and in parts of the brainstem answerable for transmitting information to the hypothalamus in regards to the body’s dietary status.

His actions seem to cut back hunger in two alternative ways. First, it helps you are feeling full faster, making smaller meals more satisfying. Second, it changes yourmotivational meaning” towards food, which suggests it reduces the quantity of food you’re on the lookout for.

The original formulation of liraglutide, intended for the treatment of type 2 diabetes, was marketed as Victoza. Its ability to cause weight reduction was obvious soon after entering the market.

Shortly thereafter, a stronger preparation called Saxenda appeared releasedwhich was intended for weight reduction in obese people.

How much weight are you able to lose using liraglutide?

People react otherwise and shed weight to various degrees. But here we will highlight the typical weight reduction that users can expect. Some will lose more (sometimes rather more), some will lose less, and a small proportion will not respond.

The first GLP-1 mimetic drug was exenatide (Bayetta). It continues to be available for the treatment of type 2 diabetes, but there are currently no generics. Exenatide does provide some weight reduction, but it is sort of modest, normally around 3-5% body weight.

In the case of liraglutide, people taking the drug to treat obesity will use a stronger drug (Saxenda), which normally gives roughly 10% weight reduction.

Semaglutide in a stronger form called Wegovy normally causes 15% weight reduction.

The newest GLP-1 mimetic drug available on the market, tyrzepatid (Mounjaro for type 2 diabetes and Zepbound for weight reduction), causes weight reduction of roughly 25% body weight.

What happens if you stop taking them?

Despite the effectiveness of those drugs in weight reduction, they don’t appear to vary the patient’s established weight.

Therefore, in lots of cases, when people stop taking them, they experience: rebound to original weight.

What is the dose and how often does it have to be taken?

Liraglutide (Victoza) for type 2 diabetes is identical drug as Saxenda for weight reduction, but Saxenda has the next dose.

Although the goal of motion of every preparation is identical (GLP-1 receptor), as a way to control glucose levels in type 2 diabetes, liraglutide must reach (primarily) the pancreas.

However, to realize weight reduction, it must reach a part of the brain. This means crossing the blood-brain barrier – and never everyone does this, which suggests you might have to take more.

All current formulations of the GLP-1 mimetic are injectable. This will not change when generics of liraglutide appear available on the market.

However, they differ within the frequency of injection. Liraglutide is given as an injection once a day, while semaglutide and tirzepatide are given once per week. (This makes semaglutide and tyrzepatide rather more attractive, but we can’t see semaglutide as generics until 2033.)

What are the negative effects?

Because all of those drugs have the identical purpose within the body, they mostly have the identical negative effects.

The most typical are various gastrointestinal disorders, incl nausea, vomiting, flatulence, constipation and diarrhea. These occur partly because these medications slow the passage of food from the stomach, but they will generally be managed by slowly increasing the dose.

Recent clinical data suggests that slowing gastric emptying can be and will be problematic for some people increase the danger of food entering the lungs during surgerysubsequently it is vital to inform your doctor in case you are taking any of those medicines.

Since these are injections, they also can result in injection site reactions.

Several cases of thyroid disease and pancreatitis have been reported during clinical trials. However, it is just not clear whether this may be the case attributed to drugs that mimic GLP-1.

Drugs that mimic GLP-1 have been found to work in animals negatively affect the event of the embryo. There is currently no data from controlled clinical trials regarding their use while pregnant, nonetheless animal data suggest that these drugs mustn’t be used while pregnant.

Who can profit from them?

GLP-1 mimetic drugs used for weight reduction (Vega, SaxendaZepbound/Mounjaro) are approved to be used by obese people and are intended to be used only together with weight loss plan and exercise.

These drugs must be prescribed by a health care provider and are usually not covered by the Pharmaceutical Benefits Scheme for obesity, which is considered one of the explanations they’re expensive. However, over time, generic versions of liraglutide will likely develop into cheaper.

Cuffing season is upon us, and with it comes seasonal depression.

According to licensed psychotherapist Janet Doveaddressing “loneliness” may be difficult since it isn’t one-dimensional. He believes that seasonal changes affect mood, causing, for instance, seasonal depression (SAD), which can even affect feelings of loneliness. “People living in areas exposed to drastic temperature changes may feel lonely. For example, during the summer, residents of Nevada and Arizona experience days of over 113° for over 100 days and unusual humidity,” Dove states.

He believes extreme weather conditions are causing people to retreat and stay indoors. People living alone at home can experience enormous feelings of loneliness, taking us back to the pandemic once we had to isolate and shelter in place. Conversely, colder weather often forces people indoors, limiting social interactions. Additionally, seasonal affective disorder (SAD) can affect your mood, leading to feelings of isolation.

ESSENCE: Do you think that the change in temperature contributes to an increase in loneliness?

Żaneta Dove: Without a doubt, temperature drops can contribute to increased loneliness. From a clinical standpoint, I can consider a few things which may explain this. As the colder months of fall and winter approach, the times turn out to be shorter, leading to less natural sunlight. This reduction is important because sunlight is crucial for mental and emotional health. Sunlight provides us with vitamin D and plays a key role in regulating the production of serotonin and dopamine, two key neurotransmitters.

These neurotransmitters are essential for improving mood and reducing levels of depression and anxiety. Not getting enough sunlight can reduce the quantity of those “happy chemicals,” making people more susceptible to sadness and loneliness. In fall and winter, this problem often takes the shape of seasonal affective disorder (SAD). Symptoms of SAD include, but should not limited to, lack of interest in previously enjoyable activities, social withdrawal or isolation, increased sensitivity to rejection, feelings of hopelessness, anxiety, and increased irritability.

In addition to biochemical changes, lower temperatures often discourage people from spending time outdoors. Less time outdoors may mean more time indoors in isolation. Social isolation is a breeding ground for loneliness, and a sudden decline in social engagement can leave you feeling disconnected and depressed.

Finally, two of our biggest holidays fall in the colder months. While Thanksgiving and Christmas can bring holiday cheer for some, lots of my clients find these celebrations emotionally charged and exhausting, often exacerbating feelings of loneliness and inadequacy. Complicated dynamics between members of the family, unmet expectations and unresolved conflicts can aggravate seasonal symptoms at the moment of 12 months. As a result, some may retreat from isolation in an attempt to avoid the extra stress, anxiety and depression that will include this season.

This time of 12 months is infamously referred to as “cuffing season” – the increase in people in search of company throughout the colder months. And while finding the proper cuff partner can aid you avoid seasonal blues, it isn’t the one solution. Here are some additional approaches to consider from Dove, Ashley McGirt and Meagan Watson:

1. Connect with others: Contact friends or family via phone calls, texts or video chats. Plan to catch up commonly.
2. Join groups or clubs: Get involved in local people events, clubs or online groups that share your interests.
3. Volunteer: Helping others can create a sense of connection and purpose.
4. Practice self-care: Engage in activities that promote well-being, reminiscent of exercise, hobbies, or mindfulness.
5. Seek skilled help: Consider talking to a therapist or counselor if the loneliness is overwhelming.
6. Be lively: Regular physical activity can improve your mood and energy, making social interactions easier.
7. Discover latest interests: Learning something latest can connect you with like-minded people.
8. Prioritize connection and seek spaces of belonging. Ask yourself: give attention to scheduling time with people, planning activities, and finding communities that nurture connection and belonging throughout the colder months. When we search out people, places, and spaces where connection and belonging exist, it becomes easier to prioritize and remember (especially in moments of loneliness) the environments that already nourish and support us.
9. Remind yourself that loneliness is a natural a part of the human experience: We are designed to feel and process loss and loneliness. To experience the total spectrum of feelings, we want to create space for whatever we’re fascinated by without the pressure to immediately change or eliminate it. As the months get colder and the vacation season approaches, it is simple to compare all of the stuff you do not have in your life to the stuff you do have. Building a gratitude practice focused on self-compassion that helps you see loneliness as the typical person’s experience may be a grounding practice. You do not have to transform your loneliness into gratitude or suppress it in favor of self-compassion. Instead, allow solitude to exist alongside what you’re grateful for and practices that supply you a compassionate space in which to feel what you’re feeling.
10. Engage in group activities that distract and contribute: Volunteering, hobbies, group exercise, group therapy, etc. are great examples of activities that temporarily distract you from the sensations and feelings related to loneliness. Some activities, reminiscent of community volunteering and group therapy, allow you to hold space for other people’s feelings, make a helpful contribution to others’ lives, and feel supported while you support others. It is crucial to be mindful of how long and the way often you’re distracted from solitude. Watching a comfort show or FaceTiming together with your best friend overseas may ease your feelings in the moment, however it probably won’t do away with them completely. Commit to returning to feelings of loneliness after they arise, and in doing so, observe them with intentional care and self-compassion. If you discover this difficult, contact a skilled who can aid you take care of the complex emotions you might be experiencing.