The specialists charging eye-watering mark-ups on medical fees

Australians paid more than five times the benchmark price for a visit to a specialist doctor on more than a million occasions last year, the Department of Health has found.

Health Minister Mark Butler has put “excessive” specialist fees in his sights as Labor attempts to ease persistent cost of living pressures on Australians.

But his department has also uncovered a broader affordability problem: specialist out-of-pocket costs have been rising at twice the rate of inflation over the past decade.

Australians paying for out-of-pocket, out-of-hospital specialist fees last year were charged $458 more than they were in 2019, according to a department consultation paper into specialist affordability released this week. That’s a more than 75 per cent jump, to $4.17 billion.

In-hospital gap fees for those with private health insurance rose almost as sharply over the same period, the paper found.

The department acknowledged the “significant community concern” over the rising cost of healthcare, and it said the government was concerned about the pace with which specialist fees were increasing. But it said its paper was primarily focused on excessive fees charged by a “small minority of providers on top of these general fee increases”.

Specialist healthcare cost more than five times the benchmark price on 1.24 million occasions last year. Another 6 million services were billed at between three to five times the schedule fee.

The government determines the benchmark schedule fee for services, and providers can set their own prices on top.

Dermatologists charged the most above the benchmark for out-of-hospital services, and had the highest proportion of patients paying five times the schedule fee. Obstetricians, gynaecologists and sports and exercise specialists followed. In hospital, anaesthetists charged the most above the benchmark.

The department said many providers recognised their ethical obligations to ensure fees for healthcare were reasonable.

“However, analysis of the fees charged by providers indicates there are providers who are charging fees that are significantly higher than their peers,” its paper said.

The department said limited transparency over how costs were set, the imbalance of power between the provider and patient, and excessive fees were compromising access to specialist services.

Those with chronic health conditions or in need of ongoing psychiatric care faced a greater financial burden when returning to the same high-fee provider, the paper said.

Private Healthcare Australia chief executive Dr Rachel David called for Labor to do more to tackle rising costs as the Australian Bureau of Statistics reports millions of Australians are delaying or going without healthcare due to the cost.