Australians facing serious health conditions are being forced into 'impossible choices' due to soaring specialist medical fees, with patient advocates warning the system lacks essential protections. Stories are emerging of individuals on low incomes depleting their savings to afford essential follow-up care, highlighting a growing crisis in healthcare affordability.
Patients Left Embarrassed and Financially Strained
One patient, Mary, who receives a disability pension for myalgic encephalomyelitis, experienced this first-hand. After a cardiac emergency in 2016, her follow-up appointments with a cardiologist in Melbourne moved to private consulting rooms, with out-of-pocket costs exceeding $100 per appointment by November 2023. By the start of 2024, her savings were exhausted. When she raised her inability to pay, a practice staff member allegedly accused her of disrespect in front of other patients, leaving Mary feeling 'embarrassed'.
Dr Elizabeth Deveny, CEO of the Consumer Health Forum of Australia (CHF), states Mary's case is not isolated. "When costs fluctuate or communication breaks down, people are forced into impossible choices," she says. "These stories highlight the need for stronger protections and better transparency. It's about a system without effective guardrails." The CHF is urgently lobbying the government for reform.
A System Under Pressure and Calls for 'Ethical Reflection'
Former chief medical officer Professor Brendan Murphy has called for 'ethical reflection' among specialists in the Medical Journal of Australia. He notes that while many older specialists maintain lower fees, younger doctors often charge more, partly due to significant HECS debts and later career starts. "For low income people with chronic disease, it really is presenting a problem with access to care," Murphy told Guardian Australia. He advocates for 'more nuanced charging practices' for concession card holders and pensioners.
This pressure is forcing patients towards the private system even when they cannot afford it. Sam, a Sydney retiree seeing nine specialists, found accessing public care nearly impossible unless arriving by ambulance. After a long wait for a public ENT appointment, he was told he first needed a private consultation. He eventually found a specialist who charged only the Medicare scheduled fee, but such cases are not guaranteed.
Structural Flaws and the Government's Next Steps
Professor Owen Ung, President of the Royal Australasian College of Surgeons, explains that in places like New South Wales, many specialists are not allocated public outpatient clinics, making private rooms the only option. He acknowledges a 'very small minority' charge egregiously but argues some high fees are justified due to inadequate Medicare rebate indexation and high practice costs. He criticises a system that remunerates for 'occasions of service, not quality of service'.
Federal Health Minister Mark Butler has declared tackling specialist fees a priority for the government's second term, describing some as 'out-of-control' and a 'rip-off'. His first concrete step will be to mandate that specialists publicly disclose their fees on the Medical Costs Finder website, after voluntary measures failed. However, he acknowledged constitutional limits on directly regulating what doctors charge.
Professor Ung warns the symbiotic relationship between public and private healthcare is at peril. "So many people now can't afford private health insurance. They can't afford private care. And if that keeps moving in that direction, that puts more pressure on our public hospitals," he said. "We've got to make sure that we provide health care for everybody."
