Private health insurers demand action on non-GP specialist fees

A new report penned by Private Healthcare Australia is taking aim at medical specialist fees, saying ‘urgent action’ is needed to curb rising costs.  
 
Released on Thursday, the survey of more than 4000 Australians, including 2300 who had been referred to a non-GP specialist recently, found 30% have delayed or cancelled this care due to cost in the past three years.
 
The report says GP attendances are rising at the same time as initial non-GP specialist consultations fall, ‘suggesting patients are being funnelled back to GPs’.
 
It also claims patients are experiencing ‘widespread bill shock and hidden fees’ when accessing community-based specialist care from non-GP specialists.
 
It found specialist fees for in-hospital care jumped 22% since 2022, with the median specialist gap fees being $222.
 
Outside of hospitals, the report said, some patients are being asked to pay up to $1000 up-front for a single appointment with a specialist doctor.
 
Additionally, the survey found 61% of rural Australians say they cannot get a timely appointment with a medical specialist due to shortages in regional areas.
 
Private Healthcare Australia is now calling for ‘referral tools to help GPs show patients local specialists and typical fees’, as well as stronger consumer protections, and improving specialist supply in regional areas.
 
RACGP President Dr Michael Wright told newsGP much of the data is consistent with what was revealed in this year’s Health of the Nation report.
 
That report found that ‘GPs continue to bridge gaps in the health system’, with 90% of GPs saying they regularly manage conditions typically seen by non-GP specialists.
 
‘We’ve seen GP visits going up and we’re probably referring to other specialists more because we’re managing the care in our practices and care is getting more complex,’ Dr Wright said.
 
‘We’re all for transparency around fees, and that’s a good thing, but we just have to be careful that we don’t shift the compliance burden onto GPs.’
 
Private Healthcare Australia chief executive Dr Rachel David said out-of-pockets cost are reshaping how Australians use the healthcare system.
 
‘We also know more people are presenting to public hospital emergency departments with more severe illness,’ she said.
 
‘Some of these patients will be people who could not access specialist care earlier to diagnose or manage their condition.
 
‘If we don’t act, Australians will continue to forgo care, people will get sicker, and the health system will face higher long-term costs from preventable illness.’
 
However, the Australian Society of Anaesthetists President Dr Vida Viliunas said a separate survey of 1000 anaesthetists found ‘an overwhelming majority’ use known-gap or no-gap arrangements where possible.
 
‘The failure to index rebates and the cap on gap limits, makes it increasingly difficult for doctors to participate in these schemes given they fail to adequately cover the true costs of providing safe, high-quality care,’ she said.
 
‘A large majority of anaesthetists provide patients with clear information about likely fees and potential out-of-pocket costs, noting these may change depending on clinical complexity or duration.
 
‘Reform of Medicare and private health insurance rebates to address out-of-pocket costs should not come at the expense of one part of the healthcare system.’
 
The report’s release comes just months after Federal Health and Ageing Minister Mark Butler announced that a crackdown on non-GP specialist fees is ‘on the table’.
 
In December, Minister Butler said he is prioritising addressing ‘out of control’ non-GP specialist fees, saying they are ‘completely a rip-off sometimes, because there is no rhyme or reason to it’.
 
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