Calls are growing to penalise doctors for overcharging some of the two million Australians who pay 'extreme' fees to see specialists every year.
A new report by the influential Grattan Institute found specialist fees, including for services such as psychiatry, dermatology, or paediatrics, continue to soar — some almost rising by 20 per cent in the past year.
It said 800,000 Australians a year are skipping or delaying specialist care because of cost, while more than two million pay at least one extreme fee a year.
"This broken system needs an overhaul, including penalising specialists who routinely charge patients more than three times the Medicare schedule fee," the Institute's report authors argued.
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Across all specialist medical services, the average specialist fee has gone up by 4 per cent, on top of inflation, in the last year.
Seeing a dermatologist for the first time is now 7 per cent more expensive than a year ago. For psychiatry, it's now 20 per cent more expensive than it was last year, which means fees are going up by about $50 a year.
Some specialists charge more than their peers — the most expensive 5 per cent of psychiatrists charge a median out-of-pocket fee of $669 for an initial consultation. For high-cost paediatricians, it is $362. For high-cost cardiologists, it is $265.
While some services get a partial government subsidy payment through the Medicare Benefits Schedule, Grattan says patient fees have "skyrocketed", and the share of fee-free care is falling. It said some fees are rising faster than inflation.
Doctors' groups say they shouldn't be blamed for the soaring costs of providing specialist services.
The Australian Medical Association blames inadequate medicare rebates, private health insurer benefits, the complexity of cases, geography and workforce supply for the out-of-pocket fees.
Grattan doubts doctors' claims that fees are rising because government funding hasn't kept up with the costs of providing care, or because of costs such as staff, equipment, insurance, and rent.
It said the "real problem" is an unrestrained market with no controls on fees, which it said has been left on "autopilot" for too long.
For example, it said government rebates rose by 8.7 per cent in the past three years, but were "dwarfed" by the 30.6 per cent rise in specialist fees over the same period.
While median costs per business grew by 30 per cent overall, profits grew 70 per cent.
"Patients rarely choose their specialist, cannot easily judge the quality of care, and often cannot find out the price they will pay until they have booked their appointment, or even until they get the bill," it said.
Apart from regulating and reining in extreme fees, Grattan says the government could expand public clinics in areas with too little care, train more specialists, and give every GP easy access to specialist advice.
Grattan also wants to introduce an "annual rule" — where if a specialist's fees average more than triple the Medicare Benefits Schedule fee across a year, they would be required to pay back the Medicare rebates for their services that year.
This would affect fewer than 2,000 specialists — about 6 per cent.
"To make sure Australians can get the care they need, governments must fix those structural problems, not just spend more," it said.
