GPs offering ‘bang for buck’ amid soaring specialist fees

Patients are being forced to fork out hundreds of extra dollars within the private health system, according to new data shedding a light on skyrocketing costs.
 
The new analysis from Private Healthcare Australia (PHA) found some common procedures funded by health insurance have increased by 300% in five years, with the biggest changes occurring in hospital fees for heart angiogram procedures and gastroscopies, where the out-of-pocket costs surged from $50 in 2017–18, to $200 in 2022–23.
 
Meanwhile, the cost of a hysteroscopy jumped by 87%, and a transperineal prostate biopsy also rose by 70%.
 
Another ‘concerning emerging trend’ identified by PHA is that some procedures which previously had no out-of-pocket charges are now also attracting fees. Cataract surgery and a cystoscopy both had no cost five years ago, and now have a $100 and $200 median out-of-pocket fee respectively.
 
By way of comparison, general practice out-of-pocket costs have increased by 13.8% over the same period, with RACGP President Dr Nicole Higgins pointing out that GPs have worked hard to ensure gaps remain affordable.
 
‘GPs really offer the most bang for buck – we know there are concerns around cost of living for people, and practices are under the same cost of living pressures as other businesses and the rest of the community,’ she told newsGP.
 
‘We have to pay our staff, our electricity bills, our rent, and those costs skyrocket, and we’re also vital employers in our communities, especially in rural and regional areas.
 
‘We’re very mindful of striking the balance between keeping our doors open, employing our staff, and ensuring that general practice is accessible and affordable.’
 
According to data from the Department of Health and Aged Care, the average out-of-pocket cost for seeing a GP in 2017–18 was $37.39, compared to $42.55 last year.
 
Meanwhile, the Australian Institute of Health and Welfare found that in December 2023, the percentage of provider fees paid by Medicare was 85% for GP attendances, compared to 60% for specialist attendances.
 
The comparison comes at the same time as GPs face more cost pressures than ever before.
 
Bulk-billing rates are plummeting, with doctors having to make difficult decisions about when to charge patients.
 
Additionally, Dr Higgins said the looming threat of an unwanted payroll tax reform is also adding to GPs’ stress and threatening patient costs. 
 
If implemented, patients are expected to be charged around $20 extra per visit.
 
‘We’ve now got to the point where we actually have to make choices about keeping our doors open, and we can no longer afford to swallow those costs,’ Dr Higgins said.
 
‘My message to GPs is to value your worth, and your training, and the quality of the care delivered to your patients.
 
‘I understand how mindful we are when looking after our vulnerable patients and how frequently we discount fees to provide care that we need to.’
 
The rising costs in private health have led PHA to call for tougher laws to better protect consumers from unexpected bills to ensure consumers are not held liable for any costs that are not disclosed up-front.
 
PHA Chief Executive Dr Rachel David said anecdotal reports suggest some people are getting shocked by bills worth hundreds of dollars after their treatment.
 
‘These bills can come from the hospital, medical specialists, or pathology and diagnostic services they encountered,’ she said.
 
‘In the current cost-of-living crisis, we must do everything we can to reduce the cost of medical treatment for Australians who are increasingly relying on private health insurance to get fast access to private healthcare and avoid public hospital waiting lists.’
 
The new data comes as the independent Scope of Practice review begins to take shape, aimed at ensuring Australia’s healthcare professionals are working to their full potential.
 
Dr Higgins said she hopes this review will help both individual GPs and the profession ‘promote how we ensure patients get value for money’, as well as keep costs down in the future.
 
‘Some of the ways we can make access more affordable is reducing the red tape barriers to GPs,’ she said.
 
‘GPs can and are willing to do more and are trained to do many of these activities, it’s the legislation that prevents us from doing that.’
 
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