Special care changes needed as costs push patients away
High specialist medical costs cause almost two million Australians to delay or skip appointments, but a report suggests stripping public funding to doctors charging excessive fees could be part of the remedy.
About 1.9 million Australians are delaying or skipping critical medical care due to exorbitant fees for specialist doctors, a report by public policy think tank the Grattan Institute has found.
Some private specialist doctors charge patients two to three times more than the rate Medicare sets for those services, the report found.
It said patients of one specialist forked out an average of $300 per year in 2023 - up 73 per cent since 2010.
Average out-of-pocket costs for extreme-fee-charging specialists in 2023 reached $671 for psychiatry services and more than $350 for endocrinology, cardiology, paediatrics, immunology and neurology services.
The high costs leave critical health care out of reach for millions, causing patients in poorer pockets of Australia to wait months or years for urgent appointments, and leading to missed diagnoses, avoidable pain and added pressure on hospitals.
About four in 10 Australians visited a specialist in 2023/24.
About two-thirds across all specialties are private appointments, with patients receiving a Medicare rebate and paying a gap fee.
Grattan's Health Program director Peter Breadon said the system was broken from start to end.
"Everywhere, from how the system is planned and how training is funded through to how we target public investment and integrate the system between primary care and specialist care, it all really needs a lot of change," he told AAP.
Grattan's recommendations include scrapping Medicare subsidies to specialists who charge excessive fees and publicly naming them.
"Hopefully it would discourage those specialists who are charging really unreasonable fees, but this is a problem that needs many solutions," Mr Breadon said.
The report also recommends governments provide one million extra specialist appointment services every year in areas that receive the least care, a system in which GPs can get written advice from other specialists, modernise public specialist clinics, and allocate $160 million to expand specialist training for undersupplied specialties and rural training.
Australian Medical Association President Danielle McMullen said public hospital underinvestment and lagging Medicare rebates made it harder for patients.
"The risks of delaying medical care are that the health problem gets worse," she said, adding it also puts pressure on GPs and hospitals in public and private clinics.
The doctors' association supports most of Grattan's recommendations, but said removing Medicare funding from specialists who charged excessive fees was not practical.
As governments negotiate the National Health Reform agreement, Dr McMullen urged leaders to sort out longer-term funding for public hospitals and develop a health workforce data tracker to show where investment was needed.
Federal Health Minister Mark Butler said private health insurers and specialists needed to do more to protect patients from exorbitant bills.
He said the Albanese government would upgrade the Medical Costs Finder, which helps patients find the best value for specialist medical advice, and was committed to working with stakeholders to improve cost transparency.
High specialist medical costs cause almost two million Australians to delay or skip appointments, but a report suggests stripping public funding to doctors charging excessive fees could be part of the remedy.
About 1.9 million Australians are delaying or skipping critical medical care due to exorbitant fees for specialist doctors, a report by public policy think tank the Grattan Institute has found.
Some private specialist doctors charge patients two to three times more than the rate Medicare sets for those services, the report found.
It said patients of one specialist forked out an average of $300 per year in 2023 - up 73 per cent since 2010.
Average out-of-pocket costs for extreme-fee-charging specialists in 2023 reached $671 for psychiatry services and more than $350 for endocrinology, cardiology, paediatrics, immunology and neurology services.
The high costs leave critical health care out of reach for millions, causing patients in poorer pockets of Australia to wait months or years for urgent appointments, and leading to missed diagnoses, avoidable pain and added pressure on hospitals.
About four in 10 Australians visited a specialist in 2023/24.
About two-thirds across all specialties are private appointments, with patients receiving a Medicare rebate and paying a gap fee.
Grattan's Health Program director Peter Breadon said the system was broken from start to end.
"Everywhere, from how the system is planned and how training is funded through to how we target public investment and integrate the system between primary care and specialist care, it all really needs a lot of change," he told AAP.
Grattan's recommendations include scrapping Medicare subsidies to specialists who charge excessive fees and publicly naming them.
"Hopefully it would discourage those specialists who are charging really unreasonable fees, but this is a problem that needs many solutions," Mr Breadon said.
The report also recommends governments provide one million extra specialist appointment services every year in areas that receive the least care, a system in which GPs can get written advice from other specialists, modernise public specialist clinics, and allocate $160 million to expand specialist training for undersupplied specialties and rural training.
Australian Medical Association President Danielle McMullen said public hospital underinvestment and lagging Medicare rebates made it harder for patients.
"The risks of delaying medical care are that the health problem gets worse," she said, adding it also puts pressure on GPs and hospitals in public and private clinics.
The doctors' association supports most of Grattan's recommendations, but said removing Medicare funding from specialists who charged excessive fees was not practical.
As governments negotiate the National Health Reform agreement, Dr McMullen urged leaders to sort out longer-term funding for public hospitals and develop a health workforce data tracker to show where investment was needed.
Federal Health Minister Mark Butler said private health insurers and specialists needed to do more to protect patients from exorbitant bills.
He said the Albanese government would upgrade the Medical Costs Finder, which helps patients find the best value for specialist medical advice, and was committed to working with stakeholders to improve cost transparency.
High specialist medical costs cause almost two million Australians to delay or skip appointments, but a report suggests stripping public funding to doctors charging excessive fees could be part of the remedy.
About 1.9 million Australians are delaying or skipping critical medical care due to exorbitant fees for specialist doctors, a report by public policy think tank the Grattan Institute has found.
Some private specialist doctors charge patients two to three times more than the rate Medicare sets for those services, the report found.
It said patients of one specialist forked out an average of $300 per year in 2023 - up 73 per cent since 2010.
Average out-of-pocket costs for extreme-fee-charging specialists in 2023 reached $671 for psychiatry services and more than $350 for endocrinology, cardiology, paediatrics, immunology and neurology services.
The high costs leave critical health care out of reach for millions, causing patients in poorer pockets of Australia to wait months or years for urgent appointments, and leading to missed diagnoses, avoidable pain and added pressure on hospitals.
About four in 10 Australians visited a specialist in 2023/24.
About two-thirds across all specialties are private appointments, with patients receiving a Medicare rebate and paying a gap fee.
Grattan's Health Program director Peter Breadon said the system was broken from start to end.
"Everywhere, from how the system is planned and how training is funded through to how we target public investment and integrate the system between primary care and specialist care, it all really needs a lot of change," he told AAP.
Grattan's recommendations include scrapping Medicare subsidies to specialists who charge excessive fees and publicly naming them.
"Hopefully it would discourage those specialists who are charging really unreasonable fees, but this is a problem that needs many solutions," Mr Breadon said.
The report also recommends governments provide one million extra specialist appointment services every year in areas that receive the least care, a system in which GPs can get written advice from other specialists, modernise public specialist clinics, and allocate $160 million to expand specialist training for undersupplied specialties and rural training.
Australian Medical Association President Danielle McMullen said public hospital underinvestment and lagging Medicare rebates made it harder for patients.
"The risks of delaying medical care are that the health problem gets worse," she said, adding it also puts pressure on GPs and hospitals in public and private clinics.
The doctors' association supports most of Grattan's recommendations, but said removing Medicare funding from specialists who charged excessive fees was not practical.
As governments negotiate the National Health Reform agreement, Dr McMullen urged leaders to sort out longer-term funding for public hospitals and develop a health workforce data tracker to show where investment was needed.
Federal Health Minister Mark Butler said private health insurers and specialists needed to do more to protect patients from exorbitant bills.
He said the Albanese government would upgrade the Medical Costs Finder, which helps patients find the best value for specialist medical advice, and was committed to working with stakeholders to improve cost transparency.
High specialist medical costs cause almost two million Australians to delay or skip appointments, but a report suggests stripping public funding to doctors charging excessive fees could be part of the remedy.
About 1.9 million Australians are delaying or skipping critical medical care due to exorbitant fees for specialist doctors, a report by public policy think tank the Grattan Institute has found.
Some private specialist doctors charge patients two to three times more than the rate Medicare sets for those services, the report found.
It said patients of one specialist forked out an average of $300 per year in 2023 - up 73 per cent since 2010.
Average out-of-pocket costs for extreme-fee-charging specialists in 2023 reached $671 for psychiatry services and more than $350 for endocrinology, cardiology, paediatrics, immunology and neurology services.
The high costs leave critical health care out of reach for millions, causing patients in poorer pockets of Australia to wait months or years for urgent appointments, and leading to missed diagnoses, avoidable pain and added pressure on hospitals.
About four in 10 Australians visited a specialist in 2023/24.
About two-thirds across all specialties are private appointments, with patients receiving a Medicare rebate and paying a gap fee.
Grattan's Health Program director Peter Breadon said the system was broken from start to end.
"Everywhere, from how the system is planned and how training is funded through to how we target public investment and integrate the system between primary care and specialist care, it all really needs a lot of change," he told AAP.
Grattan's recommendations include scrapping Medicare subsidies to specialists who charge excessive fees and publicly naming them.
"Hopefully it would discourage those specialists who are charging really unreasonable fees, but this is a problem that needs many solutions," Mr Breadon said.
The report also recommends governments provide one million extra specialist appointment services every year in areas that receive the least care, a system in which GPs can get written advice from other specialists, modernise public specialist clinics, and allocate $160 million to expand specialist training for undersupplied specialties and rural training.
Australian Medical Association President Danielle McMullen said public hospital underinvestment and lagging Medicare rebates made it harder for patients.
"The risks of delaying medical care are that the health problem gets worse," she said, adding it also puts pressure on GPs and hospitals in public and private clinics.
The doctors' association supports most of Grattan's recommendations, but said removing Medicare funding from specialists who charged excessive fees was not practical.
As governments negotiate the National Health Reform agreement, Dr McMullen urged leaders to sort out longer-term funding for public hospitals and develop a health workforce data tracker to show where investment was needed.
Federal Health Minister Mark Butler said private health insurers and specialists needed to do more to protect patients from exorbitant bills.
He said the Albanese government would upgrade the Medical Costs Finder, which helps patients find the best value for specialist medical advice, and was committed to working with stakeholders to improve cost transparency.
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SBS Australia
5 hours ago
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'The system is broken': Report recommends outing specialists with excessive fees
Nearly 1.9 million Australians are delaying or skipping critical care due to high specialist fees. Some specialists charge two to three times the Medicare rate, with annual costs topping $670 for some services. Grattan Institute urges reforms, including naming overcharging doctors and expanding access in underserved areas. The report recommended naming specialists who charge excessive fees and scrapping medicare subsidies for them. Some private specialist doctors charge patients two to three times more than the rate Medicare sets for those services, the report found. It said patients of one specialist forked out an average of $300 per year in 2023 - up 73 per cent since 2010. Average out-of-pocket costs for extreme-fee-charging specialists in 2023 reached $671 for psychiatry services and more than $350 for endocrinology, cardiology, paediatrics, immunology and neurology services. The high costs leave critical health care out of reach for millions, causing patients in poorer pockets of Australia to wait months or years for urgent appointments, and leading to missed diagnoses, avoidable pain and added pressure on hospitals. About four in 10 Australians visited a specialist in 2023/24. About two-thirds across all specialities are private appointments, with patients receiving a Medicare rebate and paying a gap fee. Grattan's Health Program director Peter Breadon said the system was broken from start to end. "Everywhere, from how the system is planned and how training is funded through to how we target public investment and integrate the system between primary care and specialist care, it all really needs a lot of change," he told AAP. Federal Health Minister Mark Butler said private health insurers and specialists needed to do more to protect patients from exorbitant bills. He said the Albanese government would upgrade the Medical Costs Finder, which helps patients find the best value for specialist medical advice, and was committed to working with stakeholders to improve cost transparency. "Hopefully it would discourage those specialists who are charging really unreasonable fees, but this is a problem that needs many solutions," Breadon said. The report also recommends governments provide one million extra specialist appointment services every year in areas that receive the least care, a system in which GPs can get written advice from other specialists, modernise public specialist clinics, and allocate $160 million to expand specialist training for under-supplied specialities and rural training. Australian Medical Association President Dr Danielle McMullen said public hospital underinvestment and lagging Medicare rebates made it harder for patients. "The risks of delaying medical care are that the health problem gets worse," she said, adding it also puts pressure on GPs and hospitals in public and private clinics. The doctors' association supports most of Grattan's recommendations, but said removing Medicare funding from specialists who charged excessive fees was not practical. As governments negotiate the National Health Reform agreement, McMullen urged leaders to sort out longer-term funding for public hospitals and develop a health workforce data tracker to show where investment was needed.
ABC News
7 hours ago
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Specialists charging excessive fees should be stripped of federal funding, according to new report
Specialists charging too much should be named, shamed and stripped of federal funding according to a new report, which has found more than 20 per cent of Australians who visited a specialist were slapped with an exorbitant fee. The Grattan Institute report paints a bleak picture of specialist care in Australia, where people suffer unnecessary illness and pain as they queue for care or struggle to pay for it. It found more than one in five Australians who saw a specialist in 2023 were charged a fee deemed "extreme", defined as costs that are on average more than three times the Medicare schedule fee. The Grattan Institute's health program director Peter Breadon said specialist fees are a problem that are only getting worse, with the report finding out-of-pocket costs had soared by almost 75 per cent in real terms since 2010. "In Australia, far too many patients are left with a really difficult choice when they get a referral for a specialist doctor visit. "They've either got to front up for really high out-of-pocket fees in a private clinic or wait months or sometimes even years longer than recommended in a public clinic." Outpatient clinics run by public hospitals provide just one-third of specialist care, meaning most Australians are treated by private specialists who are free to charge whatever they like in an unregulated system. The federal government sets a Medicare Schedule Fee for different medical services, and then pays a percentage of that in the form of a rebate. But there can be huge disparities between the Medicare rebate and fees charged, leaving patients with high out-of-pocket costs. The average cost of an initial consult with specialists who charged extreme fees was about $670 for a psychiatry appointment, the report found, and about $370 for an endocrinologist. Mr Breadon said while only about four per cent of specialists were charging extreme fees, more should be done to punish them. He argued the federal government should name and shame specialists who charge extreme fees and even withdraw Medicare rebates from them. "We think those fees are far too high. There's no justification for them. There's no evidence that the doctors charging extreme fees are providing better care," he said. "That's why we've said the government should claw back the government funding that's given to those providers, because the government shouldn't be subsidising care that most people can't afford and that there's no good reason for charging patients so much." Specialist care is a "postcode lottery" in Australia, according to the report, with people in wealthy communities receiving about a quarter more services than those in poorer communities, despite being healthier. It said each year almost two million people delay seeing a specialist or skip it altogether, leading to avoidable suffering while placing additional pressure on hospitals. And it found patient conditions could deteriorate while people lingered on waiting lists, delaying crucial diagnoses and treatment. After being diagnosed with prostate cancer in 2022, Angus Witherby had to wait six months to see a private specialist in Sydney, several hours away from his home in Moree, in regional New South Wales. It was another two months before he had surgery. As he waited, the cancer spread. "I discovered the delay had meant that the cancer had actually escaped the prostate and had gone into some of the surrounding tissues, so it turned out to be a much more significant operation, and I'm left with a 25 to 30 per cent chance of recurrence of the cancer," he said. Mr Witherby spent about $1,500 on initial specialist consultations and tests, and only got a couple of hundred dollars back. "The Medicare rebates need to be real — they have not been indexed anything like according to inflation," he said. "They need to keep up with cost of living." The report said long waiting lists and missed care were costly for the health system, with sicker patients likely to need more intensive and expensive care down the track. Demand for specialists is partly being driven by an ageing population and the increasing prevalence of chronic illnesses, meaning more people needed specialists than ever before. But training places for the next generation of doctors are limited, tied to funding and teaching capacity. The report argues that in most markets, extreme prices would fall over time as new providers enter the market and offer better value for money. But it said problems with specialist training mean new providers can't easily enter the field and the resulting extreme fees reflect an uncompetitive market. The report called on federal and state governments to set targets for specialist training and increase funding to train more doctors. As well as penalising specialists charging extreme fees, it makes a raft of additional recommendations, like calling on the state and federal governments to boost funding to public specialist clinics by $500 million a year in areas with the least care. It also called on the federal government to direct the competition watchdog to study specialists' costs and fees. The Australian Medical Association (AMA) president, Danielle McMullen, said there were a range of factors contributing to high out-of-pocket costs for patients, including workforce shortages, a lack of investment in public specialist outpatient clinics, and Medicare rebates failing to keep pace with inflation. "The AMA has never supported egregious fee setting, but what we do support is that balance of public and private care that makes Australia's healthcare system so unique," Dr McMullen said. "What we need is a strong public health system so that there is a genuine choice for people who can't afford to pay for their care. "We know that across many parts of Medicare, the cost of providing care has outstripped the growth in those Medicare rebates … so we're keen to have those discussions with the government as well." While the Grattan report said the government should examine the rebate, it noted that raising the government's contribution is unlikely to address extreme fees for specialist appointments, because doctors tend to increase fees when they know patients will be eligible for additional benefits. Health Minister Mark Butler said the private health sector needed to do more to protect patients from exorbitant bills. He also pointed to the government's recent efforts to upgrade a specialist price disclosure website, and said work was underway to bolster the specialist workforce and alleviate pressures on public hospitals. "All Australians deserve access to affordable healthcare," he said. "Thanks to the Albanese Labor government's investments, more doctors have joined the system in the last two years than any time in the past decade." The report didn't specifically look at public or private surgeries, but Mr Breadon said it was clear there were "other reforms to do downstream" like surgery waiting times and out-of-pocket costs. After Mr Witherby paid for his initial specialist consults, he then had to choose between forking out about $5,000 in out-of-pocket costs for the prostate cancer surgery or paying his tax bill. "I sail very, very, very close to the wind with that operation and it really came down to did I pay the ATO? Would I owe them, or did I have the operation," he said. "And if I didn't have the operation, well, the ATO wasn't getting any money. I wasn't going to be here. "So, I had to make that decision, which was not an easy one to make at the time." Now he's preparing for more out-of-pocket costs for an upcoming hip replacement surgery, after being told the wait in the public sector was five to eight years. He called for more government investment into the sector. "We're starting to understand some of the complex ways in which the systems are failing. You know, I do have the view that the medical system in Australia has fundamentally failed in that there are so many problems, so many gaps, so many shortcomings, so many people who are doing without," he said. "It's a very expensive, difficult, complex system that's not producing good outcomes despite vast sums of money. We do need to rethink it and do it differently."
West Australian
8 hours ago
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Elizabeth Baldwin: WA has some of the worst access to specialist medical care in Australia
Every year, two million Australians delay or skip specialist healthcare. That number should ring alarm bells. A referral to a specialist — such as a psychiatrist, paediatrician, or ophthalmologist — usually means your GP has identified that you have a potentially serious problem that requires further investigation or treatment. Skipping specialist care can delay diagnosis and treatment, causing pain and suffering for patients and higher costs for the health system later on. But Australia's long-neglected specialist system leaves some patients little choice. People who can pay for a private appointment do. But those consultations can cost a bomb. Bulk-billing rates are far lower than for GPs: only a third of specialist appointments are free, compared to 78 per cent of GP appointments. For those who do have to pay, bills can add up quickly. Average out-of-pocket costs amounted to $300 in 2023. It's no surprise that some people report taking on debt or skimping on other essentials to pay for seeing a specialist. Individual appointments can cost hundreds of dollars. One in 10 Australians who paid to see a psychiatrist in 2023 paid $400 out of pocket for their initial consultation alone. Those who can't afford the fees join the queue for an appointment at a public specialist clinic. But those wait times can extend months, or even years. Pay or delay: it's a painful dilemma. Our new Grattan Institute report on specialist care shows that it's a dilemma Western Australians know well. Our research shows parts of WA have some of the worst access to specialist care in the country. People living in Bunbury, Mandurah, and Outback WA get far fewer specialist appointments per person than the national average — counting both private and public, virtual and in-person appointments. Both the Federal Government and the Western Australian government need to take action to improve people's access to specialist healthcare. First off, they should work together to train the specialists we need, where we need them. One of the big reasons for the lack of regional and rural specialists is that there hasn't been enough opportunities for specialists to train in those areas. Specialists often do their final training in their 30s — exactly the time they might be settling down and putting down roots. If they train in a big city, that's typically where they'll stay for the rest of their career. Despite this, rural specialist training has languished. A third of final-year medical students say they intend to work outside the major cities, but just 14 per cent of specialist trainees actually do. For example, the NT has no accredited training sites for facial trauma specialists, despite having a similar volume of cases to Victoria. The specialist college requires that each training location have four trainees, which isn't feasible in the Territory. To break the impasse, governments should work together to identify future healthcare needs across the country. Then, they should only fund training positions that align with those plans. The next step to improve people's access to specialist care is more targeted investment in public clinics. In areas where there aren't enough private specialists, public clinics should step up to fill the gaps. At the moment, there are too many gaps. The areas with the least private care gets about 26 fewer appointments, per 100 people, every year — but only an extra three public appointments. The Federal and State Governments should provide a million extra services every year in the areas that are missing out the most. Parts of WA need a big service boost. Outback WA needs at least a 20 per cent increase in total specialist appointments. Other places need investment in just one or two specialities. For example, Perth's North East and North West are well below the national average for paediatrics care. Lastly, the Federal Government should tackle extreme fees. A small number of specialist doctors charge fees that are much higher than average — triple the base amount that Medicare pays, or even more. This can be $370 for a single endocrinology or cardiology consultation, or up to $670 for a single psychiatry visit. The Federal Government should take back the Medicare subsidies it pays to doctors charging these extreme fees — and it should name them publicly. A referral to a specialist doctor should set you on a path to the care you need, not a months-long queue or a bill shock. Governments should act now to ensure every West Australian can get specialist treatment when they need it. Peter Breadon is Grattan Institute's Health Program Director; Elizabeth Baldwin is Senior Associate at Grattan Institute
