Australian killed, another injured after Bali villa shooting
Two Australians were shot at a villa in Mengwi, Bali, according to local police, with one of them killed in the incident.
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The Guardian
an hour ago
- The Guardian
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. Sign up for Guardian Australia's breaking news email 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. Sign up to Breaking News Australia Get the most important news as it breaks after newsletter promotion '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.'
The Age
an hour ago
- The Age
Five graphs that show how the cost of seeing a doctor has skyrocketed
Since 2010, average out-of-pocket costs for visiting a GP have risen from $7 to $11 in real terms. Over the same time, average specialist costs have soared 73 per cent, from $45 to $78 in today's money. About 40 per cent of Australians see a specialist each year. Most of these appointments – about two in three – are private, where patients receive a Medicare rebate and almost always pay a fee. Those who choose to go public pay with their time. Across Sydney, Melbourne, Brisbane and Adelaide, there are 50 specialities with waiting times of more than a year. For some, the wait was longer than three years. High fees reflect an 'uncompetitive' market While some countries, including Canada and France, set some limitations on specialist fees, there is no such regulation in Australia. Specialists here are allowed to set their prices. When patients are quoted a hefty fee for a particular service, they can find it difficult to shop around because there is no easy way to compare prices. The Grattan report said the government's revamped Medical Costs Finder website was a 'positive step', but this is unlikely to be in place for some time – the legislation is expected to be introduced to parliament later this year. The report also identified issues with training pipelines for doctors wanting to enter in-demand fields. The authors said medical colleges – responsible for training specialists – were 'not set up to solve workforce shortages'. They suggested more than $300 million in government spending could go towards boosting training opportunities and directing qualified doctors towards areas of greatest need. Loading Dr Astha Tomar, president of the Royal Australian and New Zealand College of Psychiatrists, said the efforts of medical colleges to enforce safety and quality standards were not a barrier to entry, and welcomed further government funding to get more doctors into psychiatry – which is among the highest charging specialties. The report also proposed denying Medicare claims from specialists who charge more than triple the government-funded rebate – something that has long been proposed but would be difficult to implement. The cost of a first appointment has increased The next chart shows how much the median cost of each specialty has risen in the past five years. The median cost of a first appointment with a psychiatrist is now $240, almost $100 more expensive than in 2018. More than half of nephrology (kidney) and cardiology appointments were bulk-billed five years ago, but each now incurs an average out-of-pocket cost of $37 and $67, respectively. One proposal to fix this is to reduce the need for one-off referrals by enabling GPs to seek written advice from a specialist within three days. The report estimated this could avert 68,000 referrals and save patients $4 million a year. Even low-income families face high out-of-pocket costs On average, Australians spend about $300 a year on specialists. Even in low-income households, the report found 72 per cent of people who saw a private specialist paid a bill at least once. It means one in five Australians needing specialist care delay or avoid care. Every year, 1.9 million people miss out on treatment, and half do so because of cost. For many, the public system is their only option. But that is not viable for those who don't have years to wait for an appointment or live outside major capital cities. Health services are concentrated in our cities It makes sense that most specialists live and work in major cities – they are home to the majority of Australia's population, our research institutions and our busiest and most well-resourced hospitals. But even when accounting for population and need, Sydneysiders and Melburnians are still far better off than their counterparts in the regions. The researchers created a model estimating how many appointments were available per person per year, adjusting for the demographic needs of each community (such as age, Indigenous status and prevalence of chronic health conditions). They estimated the government would need to spend $470 million to boost access to specialist appointments in 81 communities with the lowest access to care. This would provide 1 million face-to-face and telehealth appointments to those most in need.
Sydney Morning Herald
an hour ago
- Sydney Morning Herald
Five graphs that show how the cost of seeing a doctor has skyrocketed
Since 2010, average out-of-pocket costs for visiting a GP have risen from $7 to $11 in real terms. Over the same time, average specialist costs have soared 73 per cent, from $45 to $78 in today's money. About 40 per cent of Australians see a specialist each year. Most of these appointments – about two in three – are private, where patients receive a Medicare rebate and almost always pay a fee. Those who choose to go public pay with their time. Across Sydney, Melbourne, Brisbane and Adelaide, there are 50 specialities with waiting times of more than a year. For some, the wait was longer than three years. High fees reflect an 'uncompetitive' market While some countries, including Canada and France, set some limitations on specialist fees, there is no such regulation in Australia. Specialists here are allowed to set their prices. When patients are quoted a hefty fee for a particular service, they can find it difficult to shop around because there is no easy way to compare prices. The Grattan report said the government's revamped Medical Costs Finder website was a 'positive step', but this is unlikely to be in place for some time – the legislation is expected to be introduced to parliament later this year. The report also identified issues with training pipelines for doctors wanting to enter in-demand fields. The authors said medical colleges – responsible for training specialists – were 'not set up to solve workforce shortages'. They suggested more than $300 million in government spending could go towards boosting training opportunities and directing qualified doctors towards areas of greatest need. Loading Dr Astha Tomar, president of the Royal Australian and New Zealand College of Psychiatrists, said the efforts of medical colleges to enforce safety and quality standards were not a barrier to entry, and welcomed further government funding to get more doctors into psychiatry – which is among the highest charging specialties. The report also proposed denying Medicare claims from specialists who charge more than triple the government-funded rebate – something that has long been proposed but would be difficult to implement. The cost of a first appointment has increased The next chart shows how much the median cost of each specialty has risen in the past five years. The median cost of a first appointment with a psychiatrist is now $240, almost $100 more expensive than in 2018. More than half of nephrology (kidney) and cardiology appointments were bulk-billed five years ago, but each now incurs an average out-of-pocket cost of $37 and $67, respectively. One proposal to fix this is to reduce the need for one-off referrals by enabling GPs to seek written advice from a specialist within three days. The report estimated this could avert 68,000 referrals and save patients $4 million a year. Even low-income families face high out-of-pocket costs On average, Australians spend about $300 a year on specialists. Even in low-income households, the report found 72 per cent of people who saw a private specialist paid a bill at least once. It means one in five Australians needing specialist care delay or avoid care. Every year, 1.9 million people miss out on treatment, and half do so because of cost. For many, the public system is their only option. But that is not viable for those who don't have years to wait for an appointment or live outside major capital cities. Health services are concentrated in our cities It makes sense that most specialists live and work in major cities – they are home to the majority of Australia's population, our research institutions and our busiest and most well-resourced hospitals. But even when accounting for population and need, Sydneysiders and Melburnians are still far better off than their counterparts in the regions. The researchers created a model estimating how many appointments were available per person per year, adjusting for the demographic needs of each community (such as age, Indigenous status and prevalence of chronic health conditions). They estimated the government would need to spend $470 million to boost access to specialist appointments in 81 communities with the lowest access to care. This would provide 1 million face-to-face and telehealth appointments to those most in need.
