Special care changes needed as costs push patients away

High specialist medical costs cause almost two million Australians to delay or skip appointments, but a report suggests stripping public funding to doctors charging excessive fees could be part of the remedy.

About 1.9 million Australians are delaying or skipping critical medical care due to exorbitant fees for specialist doctors, a report by public policy think tank the Grattan Institute has found.

Some private specialist doctors charge patients two to three times more than the rate Medicare sets for those services, the report found.

It said patients of one specialist forked out an average of $300 per year in 2023 - up 73 per cent since 2010.

Average out-of-pocket costs for extreme-fee-charging specialists in 2023 reached $671 for psychiatry services and more than $350 for endocrinology, cardiology, paediatrics, immunology and neurology services.

The high costs leave critical health care out of reach for millions, causing patients in poorer pockets of Australia to wait months or years for urgent appointments, and leading to missed diagnoses, avoidable pain and added pressure on hospitals.

About four in 10 Australians visited a specialist in 2023/24.

About two-thirds across all specialties are private appointments, with patients receiving a Medicare rebate and paying a gap fee.

Grattan's Health Program director Peter Breadon said the system was broken from start to end.

"Everywhere, from how the system is planned and how training is funded through to how we target public investment and integrate the system between primary care and specialist care, it all really needs a lot of change," he told AAP.

Grattan's recommendations include scrapping Medicare subsidies to specialists who charge excessive fees and publicly naming them.

"Hopefully it would discourage those specialists who are charging really unreasonable fees, but this is a problem that needs many solutions," Mr Breadon said.

The report also recommends governments provide one million extra specialist appointment services every year in areas that receive the least care, a system in which GPs can get written advice from other specialists, modernise public specialist clinics, and allocate $160 million to expand specialist training for undersupplied specialties and rural training.

Australian Medical Association President Danielle McMullen said public hospital underinvestment and lagging Medicare rebates made it harder for patients.

"The risks of delaying medical care are that the health problem gets worse," she said, adding it also puts pressure on GPs and hospitals in public and private clinics.

The doctors' association supports most of Grattan's recommendations, but said removing Medicare funding from specialists who charged excessive fees was not practical.

As governments negotiate the National Health Reform agreement, Dr McMullen urged leaders to sort out longer-term funding for public hospitals and develop a health workforce data tracker to show where investment was needed.

Federal Health Minister Mark Butler said private health insurers and specialists needed to do more to protect patients from exorbitant bills.

He said the Albanese government would upgrade the Medical Costs Finder, which helps patients find the best value for specialist medical advice, and was committed to working with stakeholders to improve cost transparency.