Let’s talk about pharmaceuticals, how does that work in Australia?

Dr. Hensley: The pharmacy benefit scheme (PBS) is essentially the preferred drugs list for any private insurer. However, because there’s really only one preferred insurer in Australia, you don’t have to look up all the ones for private insurance company X, Y, or Z. You go to the PBS scheme website, type in the drug you’re thinking of, and it brings up the first option that is available on the PBS website. You can look up and see how much you can give them, how much it’s going to cost them, and if there are any other options.

You learn pretty quickly what certain drugs cost. Most of them are $5 to $10 Australian dollars. It’s not a horrendous amount, but if you’re trying to give them some kind of novel prescription, you’ll quickly learn that it’s pretty expensive.

It does narrow my pharmacologic options a little bit, but it also makes it cost significantly cheaper because it only takes a couple of those outliers that cost $500 or $1,000 a dose to really push drug costs up.

Have you had the experience of being a patient there?

Dr. Hensley: I haven’t, but one of my friends was when we were here in 2019. It’s pretty different. The initial part of going in, being seen, evaluated, getting a bedside ultrasound by the physician—as opposed to getting a formal department ultrasound, because it was two o’clock in the morning and that wasn’t going to happen even in the city of Sydney. Getting all that done and getting the blood work back was about two to three hours in the emergency department. At the end they’re like, “okay, so you’re not Medicare, so you need to pay for this.” It was $500 as opposed to $3,000 or whatever it would cost in the U.S. for a 2 a.m. emergency department visit with multiple blood works, IV pain medications, and an ultrasound.

What have you learned from being in Australia that you think could inform how we do things in the United States?

Dr. Hensley: The biggest thing, and one of the reasons why I wanted to come to a place that had a system such as this, is Australia doesn’t allow non-physicians to dictate the way care is provided. When non-physicians are dictating how care is provided, like in the U.S., it makes things cost more. It just adds bureaucracy to medicine. It makes what we do not really practicing medicine anymore. It makes us practicing bureaucracy of medicine.