One million Australians missing specialist doctor appointments due to cost, report finds
One in 10 Australians pay almost $600 each year to see specialist doctors, with 1 million delaying or skipping appointments due to the cost, according to new analysis.
A report by the Grattan Institute, released on Monday, revealed outpatient fees have soared over the past 15 years. The average initial out-of-pocket psychiatrist fee was $671 in 2023, with some 'extreme fee' specialists charging more than triple the scheduled Medicare fee. It found almost 2 million Australians are delaying or skipping specialist appointments each year – about half due to cost – adding pressure to the country's hospital systems.
Experts say a lack of regulation of specialist consultation fees and training positions has led to ballooning costs.
The report, Special Treatment: Improving Australians' Access to Specialist Care, found one in 10 low-income patients, with weekly household incomes of less than $500 a week, were billed almost $500 a year in out-of-pocket costs.
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Some specialist doctors charged more than triple the Medicare scheduled fee, the analysis found. The scheduled fee refers to a fixed payment that the federal government will pay the doctor for the service.
Of these 'extreme-fee charging' specialists, psychiatrists had the highest average out-of-pocket costs for an initial consultation – $671. This was followed by $372 for endocrinologists and $369 for cardiologists.
'The specialist system isn't working and Australians – especially poorer Australians – are paying the price,' said the lead report author and Grattan Institute health program director, Peter Breadon.
Prof Yuting Zhang, an expert in health economics at the University of Melbourne, said a lack of government regulation of doctors' fees had led to increased costs to patients.
'Doctors can charge whatever they like … The fees have gone up quite a lot, especially for specialist fees relative to GP fees,' she said.
'We have seen a huge increase, but also very large variation across doctors, across regions and even across patients. The same doctor could charge differently for different patients coming to see the same service.'
Zhang said in other countries with similar universal healthcare models, the government had 'some role' in determining fees.
She said high specialist fees led to people skipping appointments and their deteriorating illnesses requiring hospitalisation.
'That costs a lot more, so ideally you don't want people to delay,' she said. 'The worry is it increases the downstream cost.'
Zhang said often, patients do not know the total cost prior to seeing a doctor, making it harder for them to make an informed decision.
'It's hard for them to compare. But even if they know the price, it might be hard for them to judge if that price is justifiable,' she said.
'Sometimes people think more expensive means better, which in healthcare, often that's not true.'
Dr Elizabeth Deveny, chief executive at peak body Consumer Health Forum of Australia, said consent for fees was mandatory but not enforced.
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'People shouldn't be hit with surprise bills,' she said.
Delaying or avoiding specialist treatment is leading to missed diagnoses and avoidable pain, the report found.
Many patients waited months or even years for an appointment. In some parts of Australia, wait times for urgent appointments extend beyond the clinically recommended maximum.
The report concluded specialist care in Australia was a 'postcode lottery', with people living in the worst-served areas receiving about a third fewer services than the best-served areas. It said public clinics do not do enough to fill these gaps.
Zhang said requiring the federal government to increase the training of more specialist doctors could also ease wait times. She pointed to psychiatry as a specialty plagued by shortages.
'In areas like psychiatry, the government should do something to increase supply.'
The report makes five recommendations, including that the federal government withhold Medicare funding from specialists who charge excessive fees and publicly name them.
It also recommends governments expand public specialist appointments in areas that get the least care to provide more than 1m services annually, enable GPs to get written advice from specialists to avoid almost 70,000 referrals each and provide $160m to train specialists workforces, with funding linked to specialities with shortages and rural positions.
The federal health minister, Mark Butler, said the private health sector, including insurers and specialists, needed to do more to protect patients from exorbitant bills.
'The Albanese Labor government will help Australians find the best value when they need specialist medical advice and treatment, by upgrading the Medical Costs Finder to give more transparency on fees,' he said.
'We are committed to working with consumers, the colleges and private health providers on the design and implementation of this important cost transparency measure.'
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