Imagine paying $1,000 for a single hour with a specialist doctor - it's a shocking reality for many Australians. This eye-watering fee increase has sparked a heated debate, leaving patients and experts alike questioning the skyrocketing costs of specialist healthcare.
Veronica, a concerned mother, received an email that left her reeling. Her son's paediatrician, who helps manage his ADHD, was increasing their fees by a staggering 36%. She was in disbelief, thinking it must be a mistake. But it wasn't.
The email, which Guardian Australia has seen, explained that the decision was made due to rising costs over two years, including rent, electricity, and wages. The practice justified the increase by stating it was necessary to maintain their high level of service and quality. Veronica, however, is worried about the impact on her son's care, especially if he requires frequent and lengthy appointments due to his condition.
Veronica's story is just one of many shared by readers in response to Guardian Australia's callout. It highlights a growing concern among Australians about the affordability of specialist healthcare.
Dr. Elizabeth Deveny, CEO of the Consumer Health Forum, describes the issue as a "live" and critical one. She believes Australians are at a tipping point, where accessing specialist care feels like winning the lottery. Knowing the fee isn't enough when you can't afford the service, she emphasizes.
A CHF survey of 5,000 Australians revealed that only 32% felt confident they could afford necessary care if they became seriously ill. Nearly half (49%) reported not accessing needed healthcare at least once in the last year due to cost.
The issue is further complicated by the interplay of cost and supply. Since the COVID-19 pandemic, many doctors have reduced their working hours while charging more for appointments. In some areas, specialist scarcity has led to higher prices.
Associate Professor Kudzai Kanhutu, Dean of the Royal Australasian College of Physicians, points to "big care deserts" due to a lack of national coordination in specialist training. A Grattan Institute report confirms a shortage of training positions, especially in Western Australia and rural areas, where access to specialists, particularly paediatricians, is consistently challenging.
The blame game extends to overheads, with rising costs for wages, utilities, and insurance fees driving up out-of-pocket expenses. These pressures are felt not only in the private system but also in the public system, which is struggling to meet demand, according to Associate Professor Julian Rait, Vice-President of the Australian Medical Association.
The most under-supplied specialties, including dermatology, obstetrics and gynaecology, and ophthalmology, have more applicants for vocational training than available positions, the Grattan report reveals. Consultation fees for specialists have been increasing by 5% to 6% annually, outpacing inflation and population growth, and adding to cost-of-living pressures, says Professor Anthony Scott from Monash University's Centre for Health Economics.
The average out-of-pocket costs for specialist attendances have grown by a whopping 73% since 2010, a rise larger than for other Medicare services. The Grattan report recommends the federal government withdraw Medicare funding from specialists charging extreme fees, defined as more than three times the schedule fee.
Deveny highlights reports of "tenfold price differences" for the same services, eroding trust and leaving patients questioning if they're being taken advantage of or missing out on crucial care.
Scott's research challenges the argument that doctors need to charge more due to increasing patient complexity, finding that this accounts for only 7% to 8% of fee variation. In general, doctors charge richer patients more and poorer patients less.
The lack of price transparency is a recurring theme, with experts pointing to the failure of the Medical Costs Finder website to provide publicly available information on specialist fees. Deveny emphasizes the need for transparency so patients can understand if they're paying for better care.
The federal government has acknowledged the issue, with Health Minister Mark Butler agreeing that specialist fees are getting out of control in some areas and causing real harm. Butler has pledged to upgrade the Medical Costs Finder website to provide more transparency on fees, including displaying the average fee charged by individual doctors.
Patients Australia's report, based on a survey of 5,451 people, suggests that fewer than 10% will complain about fees, highlighting a power imbalance between doctors and patients. Veronica's experience reflects this, as she felt unable to question the paediatrician's fees, despite her concerns.
The struggle to find a paediatrician in the first place, with closed books at several clinics and a public waiting list of over two years, left Veronica feeling compromised and at risk of being left without care.
This issue of specialist healthcare costs is a complex and controversial one, with experts and patients alike calling for action. The question remains: how can we ensure access to affordable, high-quality specialist care for all Australians?
