Latest news with #specialistcare
ABC News
9 hours ago
- Health
- ABC News
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."
The Guardian
18 hours ago
- Health
- 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.'
