If governments miss this moment, the system will coast until the next deal in 2031, with training on autopilot, gaps in care and fees climbing ever higher.
A referral to a specialist doctor can be scary; you might be worried about getting a new diagnosis or hearing that your condition has gotten worse. But many Australians have an additional worry: whether they can afford the fee.
Fees have surged, and they’re not slowing down. They’ve risen by 78% since 2010 on top of inflation. An initial consultation now often costs hundreds of dollars.
Those fees mean a million Australians each year skip specialist care, risking delayed diagnoses, missed treatments and avoidable illness. Fees don’t just hit the rich; more than 70% of the poorest people who see a specialist pay a fee. It’s no wonder they’re less likely to go in the first place.
To his credit, the federal health minister, Mark Butler, has said high fees are harming patients and things must change. He has taken a good first step by committing to publish information on the fees all specialists charge.
He could extend that reform by requiring that referral letters refer people to the fees website, remind them that they can use their referral to see any specialist and that they can ask for a costs estimate before they book.
But better information alone won’t ensure everyone can get specialist care. Governments should also train more of the doctors we need, boost public services and rein in excessive fees.
Today, the number of training places for specialists is largely determined by the needs of public hospitals and rules set by specialist colleges. That has helped lock in longstanding shortages. Some of the specialties that have been in short supply for decades have the lowest training numbers.
Workforce planning is woeful – there are no targets for how many training places we need in each specialty. There are no targets for where those places should be, despite rural training being the best way to fix rural shortages.
And the millions of dollars earmarked for training comes with no strings attached. Getting the workforce we need should start with governments setting national targets to train the right specialists in the right places and tying funding to meeting those targets.
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Training takes time. To fill gaps now, governments should invest in public clinics. When private providers aren’t there, the public system should fill the gap – but it rarely does. This leaves some communities missing out.
Grattan Institute analysis shows some parts of Australia have a third less specialist appointments than others. Those holes in the safety net must be filled with targeted investment to expand public clinics.
We recommend the federal and state governments should invest $470 million to provide a million more free public visits in the parts of Australia with the least care.
Governments should also directly tackle excessive fees charged by some private specialists. Unlike in some other countries, there is no limit on what specialists can charge patients. A small minority have clearly gone too far, charging average fees more than three times what the government pays them.
That can mean close to $670 for a visit to a psychiatrist, or more than $360 for a visit to a paediatrician or cardiologist. One in five patients were charged an extreme fee at least once in 2023.
There is no evidence that higher fees mean better care; extreme fees aren’t needed to fairly reward skill and experience. Less than 4% of specialists charge them, and average specialist incomes are already among the highest in the country.
Patients should not need to put their health at risk while they shop around for a better deal. The federal government should protect them by setting a limit on the most extreme fees.
These solutions have been neglected. Part of the reason is that the problem spans private and public clinics and federal and state policy: it’s everyone’s fault, so it’s been no one’s responsibility.
But now there is a chance to act. Governments are now negotiating the next five-year national health funding deal. The agreement should include developing national training targets, tying funding to those targets, expanding public clinics and setting targets for public specialist waiting times.
Some reforms don’t need to wait for the funding deal. There are changes that governments and specialist colleges can make right away like removing unnecessary training requirements, making it easier for specialists to migrate to Australia, regulating excessive fees and giving patients better information.
But this is the moment for a big national plan that includes the essential steps of refocusing training and boosting public services. If governments miss this moment, the system will coast until the next deal in 2031, with training on autopilot, gaps in care and fees climbing ever higher.
Peter Breadon is the Health Program Director at Grattan Institute. He has worked in a wide range of senior policy and operational roles in government, most recently as Deputy Secretary of Reform and Planning at the Victorian Department of Health.
This article was first published by the Grattan Institute. Read the original here.