Australians Priced Out of Essential Specialist Care
Medical experts warn that skyrocketing fees for specialist appointments are creating a healthcare affordability crisis, forcing some Australians to forgo essential medical care. The situation has reached a critical point where families are being priced out of the system despite having health insurance coverage.
The Reality of Rising Costs
One Perth mother, Veronica, experienced this crisis firsthand when she received an email from her son's paediatric practice announcing that a one-hour appointment would now cost $1,000 – a staggering 36% increase. The clinic cited rising operational costs including rent, electricity and wages as justification for the fee hike.
Veronica expressed her disbelief, stating she had to reread the email several times. Her son requires specialist care for ADHD management, and while they can currently manage with shorter annual appointments, she worries about what happens if his condition requires more intensive treatment. "Children progress, and they need intervention quickly to be able to capitalise on their schooling years," she explained.
A System at Breaking Point
Dr Elizabeth Deveny, Chief Executive of the Consumer Health Forum (CHF), describes the affordability of specialist care as a "live issue" that has reached a tipping point. "You shouldn't have to win the lottery just to see a specialist for care," she emphasises.
The data supports these concerns:
- Average out-of-pocket costs for specialist attendances have grown by 73% in real terms since 2010
- Only 32% of Australians feel confident they can afford necessary care if seriously ill
- 49% reported not accessing needed healthcare at least once in the past year
Consultation fees are increasing by 5-6% annually, significantly outpacing inflation and population growth while adding to cost-of-living pressures.
Multiple Factors Driving the Crisis
Associate Professor Julian Rait of the Australian Medical Association identifies rising overheads – including wages, utilities and insurance fees – as primary drivers. He notes that the struggling public system can no longer cope with demand, pushing more patients into the private system where they must find ways to afford substantial fees.
The problem is compounded by specialist shortages in certain regions and specialties. Associate Professor Kudzai Kanhutu highlights "big care deserts" resulting from inadequate national coordination of specialist training. Western Australia and rural areas face particular challenges accessing specialists, especially paediatricians, amid rising neurodevelopmental diagnoses.
Transparency and Power Imbalance
Experts consistently point to the lack of price transparency as a major issue. The Medical Costs Finder website has failed to provide adequate fee information, leaving patients vulnerable to bill shock. Consumers report tenfold price differences for identical services, creating confusion and eroding trust in the healthcare system.
Lisa Robins from Patients Australia reveals that fewer than one in ten patients complain about fees due to an "intrinsic power imbalance between a doctor and a patient." Veronica echoed this sentiment, explaining she felt unable to question the fee increase because finding any paediatrician had been extremely difficult, with public waiting lists exceeding two years.
Federal Health Minister Mark Butler acknowledges that "specialist fees are starting to get out of control in some parts of the country" and has pledged to upgrade the Medical Costs Finder website to provide better fee transparency, including legislation to display average fees charged by individual doctors.
However, research suggests that simply increasing Medicare rebates isn't a solution, as evidence shows doctors tend to increase their fees alongside any government benefit increases. Dr Nick Coatsworth describes the situation as a "triple whammy" where Australians pay Medicare levies, are forced into private health insurance, and now face skyrocketing out-of-pocket costs that erode the value of their insurance coverage.
