$1,000 for a one-hour appointment: why are fees for Australia’s specialist doctors skyrocketing?

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In June, Veronica* received an email from the Perth practice where her son sees a paediatrician to manage his ADHD. It said an adjustment to their service fees meant the cost of a one-hour appointment would rise to $1,000.
She had to reread it. A 36% rise in fees?
“I couldn’t actually believe it,” Veronica says. “I thought it was wrong.”
The email, seen by Guardian Australia, says “this decision has not been made lightly” and cites cost increases over two years – including to rent, electricity and wages. Passing on these costs is necessary to “continue delivering the level of service and quality you expect from us”, it reads.
Veronica says if her son’s condition remains stable, “we can just cope with 15-minute appointments annually”.
But she worries that if he needs to be reassessed – as had happened when he was also diagnosed with level 2 autism – frequent lengthy appointments will be needed.
“Children progress, and they need intervention quickly to be able to capitalise on their schooling years and not fall behind or significantly deteriorate in their functioning capacity,” she says.
Veronica is one of dozens of readers who responded to Guardian Australia’s callout to share their experiences of rising out-of-pocket costs to see non-GP specialist doctors.
‘At a tipping point’
Dr Elizabeth Deveny, the chief executive of the Consumer Health Forum (CHF), says the affordability of specialist care is a “live issue”.
“The feedback we get from Australians shows that we’re really at a tipping point,” Deveny says.

Related: More Australians can’t afford specialist fees. Experts say it’s ‘not in the spirit of Medicare’

“You shouldn’t have to win the lottery just to see a specialist for care. Knowing the fee isn’t enough when you can’t afford the service.”
She says while specialists who bulk bill should be commended, action was needed against those charging high out-of-pocket costs.
“When some fees climb much faster than inflation, and people go without care, we can’t keep pretending it’s all just ‘business costs’,” she says.
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A CHF survey of 5,000 Australians showed that only 32% of people felt confident they could afford necessary care if they became seriously ill. About half (49%) reported they hadn’t accessed the healthcare they needed at least once in the last year.
Cost and supply are intertwined too, according to Deveny. Since the Covid-19 pandemic began, she says, many doctors are working fewer hours and some are charging more money for their appointments.
In some parts of the country, specialist scarcity has been linked to higher prices.
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Associate Prof Kudzai Kanhutu, the dean of the Royal Australasian College of Physicians, says there are “big care deserts” because there is no national coordination of specialist training to ensure a pipeline of doctors where they are needed.
A Grattan Institute report published in June affirmed a lack of training positions.
In Western Australia and in rural and regional parts of the country, people consistently struggle to access specialists – particularly paediatricians – due to a rise in neurodevelopmental diagnoses, Kanhutu says.
The blame game
Associate Prof Julian Rait, the vice-president of the Australian Medical Association, says the escalation in out-of-pocket costs has been driven by rising overheads, including wages, utilities and insurance fees. He says these costs are also affecting the public system.
“Where the system is broken down, I believe, is that the public system, which is supposed to provide that safety net, is not functioning that well any more and can’t cope with the amount of demand,” Rait says.

It really erodes trust – like what’s happening here – are people rorting or gaming my health?
Elizabeth Deveny, Consumer Health Forum

That demand then flows back into the private system, he says, meaning patients need to find ways to afford private fees.
The most under-supplied specialties – including dermatology, obstetrics and gynaecology, and ophthalmology – have more applicants for vocational training each year than positions available, according to the Grattan report.
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The training places at hospitals are funded by state governments and accredited by specialist colleges, according to Prof Anthony Scott, from Monash University’s Centre for Health Economics.
“So they tend to blame each other for the lack of training places, because public hospital budgets are fixed,” Scott says.
Tenfold price differences
Consultation fees charged by specialists have been increasing by 5% to 6% a year, which is faster than inflation and population growth while adding to cost-of-living pressures, Scott says.
The average out-of-pocket costs for specialist attendances have grown by 73%, in real terms, since 2010. According to the Grattan report, this rise is larger than for other Medicare services.
The report recommended that the federal government withdraw all Medicare funding from specialists who charge extreme fees, which they defined as being more than three times the schedule fee.
Deveny says consumers are reporting “tenfold price differences for the same things”.
“It really erodes trust – like what’s happening here – are people rorting or gaming my health? Or … if I’m getting the cheapest one, am I missing out on something important?”
Scott’s research examined the argument from doctors that they need to charge more to account for the increasing complexity of patients’ conditions. “We found that only really accounts for about 7% to 8% for variation in fees.”
In general, Scott says, doctors will charge richer people more and poorer people less.

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Increasing Medicare rebates might not be a magic bullet. Evidence shows doctors will increase their fees along with any increase in benefits from the government, the Grattan report found.
Dr Nick Coatsworth, Patients Australia’s ambassador for health reform, says there’s a “triple whammy that is being put on Australians”.
“You pay your Medicare levy through your working life, effectively forced through tax policy to have private health insurance from age 30, and now you’ve got out-of-pocket costs skyrocketing,” he says.
When it comes to fees for procedures, Coatsworth says the growing gaps are “basically eroding the value of private health insurance”.
Price transparency is lacking
Many experts consistently refer to the lack of publicly available information around what fees specialists are charging, pointing to the failure of the much-derided Medical Costs Finder website to provide that service.

Deveny says there is little transparency around how fees are set, so there is no way for patients to understand whether they are paying for better care.
The government does have all the information about what individual specialists charge but does not publish it, Scott says.
According to Rait, if GPs had more information about what specialists charged and what their wait times were they could discuss fees with patients and refer appropriately.
Deveny says sometimes consumers will only be able to pay the lowest fee.
“So if we want care, we need to know where is the lowest fee, remembering that for some people, they won’t be seeing one specialist, they’ll be seeing several,” she says.

Related: Medical specialists’ lack of pricing transparency leading to bill shock for patients

The federal health minister, Mark Butler, agreed that “specialist fees are starting to get out of control in some parts of the country” and that real harm was the result.
Butler has pledged that the government will upgrade the Medical Costs Finder website to provide more transparency on fees, including introducing legislation that would allow them to display the average fee charged by individual doctors.
A power imbalance
People often don’t feel able to challenge the costs of their appointments, according to Patients Australia, whose financial partners include the Pharmacy Guild of Australia as well as Private Healthcare Australia, which represents health insurers.
It released a report in March, based on a survey of 5,451 people, which suggested fewer than one in 10 (7%) will complain when they’re unhappy with fees. Its chief executive, Lisa Robins, said: “There’s an intrinsic power imbalance between a doctor and a patient.”
Veronica says when the paediatrician fees increased for her son, “I wanted to be able to question them, but I couldn’t do that as a patient”.
It was a struggle to find a paediatrician in the first place – she had to ring around as many as she could find, encountering closed books at several clinics, with a public waiting list of more than two years.
“I felt too compromised that we would be at risk of being left without care,” she says.
The clinic has been contacted for comment.
Do you know more? Contact: natasha.may@theguardian.com
*Names have been changed to protect anonymity
Read more:

What are my rights when I need to see a specialist doctor – and what if I can’t afford the fee?

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