Almost a million Australians are delaying or skipping specialist care because of the high cost, according to a new report by the Grattan Institute.
One in five Australians were charged an extreme specialist fee in 2023, according to the report’s analysis.
Released on Monday, the report shows that, since 2010, the problem has been getting worse, with fees for specialist care soaring by 73 per cent.
On average, patients in Australia who pay a fee for specialist care are charged $300 a year, and one in 10 low-income patients who are billed pay almost $500 a year.
Due to these costs, millions are having to choose between paying up or waiting too long for care, as public hospitals often have longer wait times and provide just a third of all specialist care.
“In many parts of Australia, wait times for urgent appointments are months longer than clinical guidelines recommend,” the authors write, adding that “these problems have festered because the system has been running on autopilot.”
Some specialist doctors are charging more than triple the Medicare scheduled fee, the report’s analysis found. The scheduled fee is the fixed cost that the federal payment will pay the doctor the service.
Psychiatrists hold the highest average out-of-pocket costs for an initial consultation ($671), followed by endocrinologists ($372) and cardiologists ($369).
What needs to happen?
Noting that specialist care in Australia was a “postcode lottery”, the report gives five key recommendations for governments to improve access to specialist care for everyone.
The report calls for specialists to be trained in rural areas, where the need for access is high, particularly in specialties such as psychiatry and ophthalmology. It also says governments should establish a workforce planning body and tie training funding to its recommendations about what specialist training is needed, and where.
Secondly, governments should invest more in public clinics, the report says, adding that this will help ensure everyone, regardless of their postcode, can access the care they need.
“Specialist care is a postcode lottery: people living in the worst-served areas receive about a third fewer services than the best-served areas,” report authors say.
“Public clinics don’t do enough to fill the gaps. Spending $470 million a year would provide one million extra public appointments each year in the areas that get the least care.”
Thirdly, the report urges governments to modernise public specialist clinics, clarify their role, spread best practices, and publicly report waiting times.
Fourth, governments should support GPs to manage more care, taking the pressure off specialist care.
“Systems that allow GPs to easily get advice from other specialists could avoid 68,000 referrals each year and save patients $4 million in out-of-pocket costs. GPs and other specialists would be paid for their time, at a cost of $26 million a year,” the report says.
Finally, the government should combat extreme fees from specialists, as this could save up to $170 million a year.