Australia Specialist Fees: Grattan Wants Medicare Clawback
The Grattan Institute says psychiatrists, paediatricians and other specialists are driving 'extreme' fees in Australia, with 800,000 people skipping care each year. It wants overcharging doctors to repay Medicare funding. The AMA says the problem is broader, and the health minister says all options are open.
The Grattan Institute, an independent Australian think tank, said psychiatrists and paediatricians are among specialists most likely to charge "extreme" fees, and urged that overcharging doctors be made to repay their Medicare funding. Its policy brief says more than 800,000 Australians skip or delay specialist care each year because of cost.
Fees for specialist practitioners are rising far faster than inflation, the report found. The most expensive five per cent of psychiatrists charge a median out-of-pocket fee of $669 for an initial consultation.
Peter Breadon, Grattan's health program director, said extra government funding would not stop some specialists exploiting patients. He called for a penalty instead.
"This small minority of doctors should be forced to repay the value of their Medicare funding at the end of each year," Breadon said.
He said building up public clinics, helping GPs provide more care and training more specialists were "desperately needed". "But that will take years to work," he said. "In the meantime, fees keep rising, and every year more Australians are paying extreme fees."
Rebates not the cause, report says
The brief builds on earlier Grattan work that found some specialists charge more than three times the Medicare fee schedule. Breadon and co-authors Mia Jessurun and Thomas Shortridge examined whether slow growth in Medicare rebates explains the rise.
They concluded it does not. Rebates have declined by $9 in real terms since 2012, but fees have risen by $37 in real terms over the same period, covering the shortfall more than four times over.
GP visits show no similar surge, the authors noted. Those fees have largely kept pace with inflation.
Rising costs do not explain it either. Over 16 years, the median gross profit of a specialist business grew by 73 per cent, ahead of profit growth in GP, legal, accounting and construction businesses.
Doctors and government respond
The Australian Medical Association said affordability reaches well beyond specialist fees. President Michael Bonning said governments must address "the full range of factors", including Medicare rebates, public outpatient capacity, specialist workforce shortages and private health insurance arrangements.
The association also called for a major increase in specialist training positions, to head off a projected shortfall of specialist doctors in coming decades.
Health Minister Mark Butler said all options were on the table to rein in fees. He said patients will get more transparency when specialist fees are listed on the Medical Costs Finder website from 2027.
A parliamentary committee led by Labor MP and pediatrician Mike Freelander is examining other ways to bring fees down, including whether GPs can play a greater role in specialist care.
