Going the Australian private health insurance cover route: The cost of double mastectomy to save your life from breast cancer

Going the Australian private health insurance cover route:  The cost of double mastectomy to save your life from breast cancer


When getting a mastectomy done is the only lifesaving option given to patients, there should ideally be easy access to the procedure without long wait times. However, that does not seem to be the case under the Australian health system. For patients who choose to opt for a faster treatment the path of private health insurance can leave them financially drained.

True that the cost of a double mastectomy comes to $0 under the Australian public health system, but the wait times that are given are highly unrealistic for cancer patients. For patients to receive the treatment free of cost, they would have to wait of a period of up to three years before they would be operated upon for breast mastectomy and then reconstruction. Many patients do not have that much time and choose to resort to other options such as have the procedure carried out with the help of private health insurance.

While Medicare patients would incur no out of pocket costs for double mastectomy, patients who choose the private health sector’s service have to pay up to $15,000 for the same. Due to the progressive nature of the disease, patients who opt for private health care often have to incur huge out of pocket expenses even when privately insured.

One such patient is Sam Taylor, a wife and mother of two, who was diagnosed with an aggressive form of breast cancer. Ms. Taylor was told after six months of chemo treatment that her cancer could recur so had no option but to consider privately insured double mastectomy. The cost of the procedure including double mastectomy and breast reconstruction was around $15,000 while private insurance only covered $3600. The rest came from their own pocket.

Like the Taylors, to cope with the astronomical costs of double mastectomy, patients have been known to sells their homes, ask for funds from friends and family and even face complete bankruptcy in some cases.

The long wait times for such and other procedures under the public health sector have lead many Australians to look to the private health sector for faster access to medical services. And every time the service comes at a huge cost to patients and their families. For those without private medical insurance waiting for their turn may be the difference between life and death.

While duplication in the Australian health system; where private health insurance coverage duplicates the public services, was meant to cut wait times in the public sector, the result has not been so. Instead, the system has seen medical professionals abandoning the public health system and opting for its private counterpart. The shift has led to giving private patients priority over others by granting them quicker access to public facilities.

The result has been nothing other than extending wait times for public patients seeking critical illness care. For cancer patient this means that either they look for privately insured healthcare for faster service of they are looking at astronomical figures of $40,000 in lost productivity as well as out of pocket expenses during their treatment.


1) Overlapping health system just helps to ‘jump queue’: http://www.smh.com.au/national/health/overlapping-health-system-just-helps-to-jump-queue-20140420-36yoj.html

2) Critical Illness – Out of Pocket Costs: http://www.maditraumainsurance.com.au/blog/92-critical-illness-out-of-pocket-costs.html