A short new report has revealed a shockingly common hidden problem — unaffordable out of pocket fees from medical specialists in Australia. Angus Witherby is perhaps the poster child for this predicament. Since his PCA diagnosis in late 2022, he has endured a frustrating six-month delay waiting to see that private specialist in Sydney. Witherby had spent about $1,500 to get preliminary consultations and tests. Unfortunately, this well-intentioned crusader only ended up getting a few hundred dollars back in rebates. The most shocking aspect of the report is that more than 1 in 5 Australians that see a specialist have to pay high upfront fees. These excessive charges are more than three times the Medicare schedule fee.
The burden of healthcare costs is not shared equally across the country. The result is a postcode lottery. In rich communities, people get a lot more services than in poorer communities. More recently, the study’s findings have fueled demands for reform to curb the worsening inequities in healthcare access and affordability.
The Financial Strain of Specialist Care
Angus Witherby’s ordeal is testament to the difficulties and costs many Australians encounter trying to access their necessary and urgent specialist care. When he was diagnosed with prostate cancer, he had to wait six months for an appointment. The wait took a serious toll on his health. He didn’t find out until later that the cancer had spread beyond his prostate — complicating and worsening his treatment options.
“So, I had to make that decision, which was not an easy one to make at the time,” – Angus Witherby.
Witherby’s start-up costs were $1,500, a substantial sum for most Australians. Yet the rebate he was given only paid a fraction of these expenses, resulting in him still paying a large amount out of pocket. Unfortunately, this is not an isolated example—more patients are waking up to faces like Muñoz’s much more frequently.
The report uncovers a lack of consistency in average out-of-pocket costs for first time consultations. These costs vary widely based on the fee structure of the specialist. Specialty care deeply reflects this, with the average consultation in psychiatry at $671 and immunology at $358. This inconsistency cuts straight to the heart of the sustainability and equity of our healthcare system.
Disparities in Access and Services
The report emphasizes the gaps in access to specialist care according to geographic area. Australians living in wealthier areas are given nearly a quarter (25 percent) more specialist services than those Australians living in poorer communities. Such disparities continue to call into question the equity of healthcare delivery across the country.
Peter Breadon, health program director at Australian think tank the Grattan Institute, urged a reimagining of our fundamentally broken healthcare system. He stated, “We found that the whole system is pretty much broken, it’s been left on autopilot.” This plea represents a rising exasperation among patients and health care activists who think that immediate change is overdue.
“What we need is a strong public health system so that there is a genuine choice for people who can’t afford to pay for their care,” – Peter Breadon.
This crisis should compel the Australian government to reconsider its funding approaches as a matter of urgency. No one should have to worry about their healthcare because of the weight of crushing debt.
The Case for Reforming Medicare
In particular, people are awakening to the importance of climate justice. They want to see better accountability from the Medicare system, fighting to make sure rebates cover inflation and the increasing cost of life. Angus Witherby pointed out that “the Medicare rebates need to be real — they have not been indexed anything like according to inflation.” He said without these changes, millions of Australians would be left to suffer under the burden of increasing healthcare costs.
Our colleagues at the Australian Medical Association oppose these egregious fee-setting practices just as strongly. It recognizes that there needs to be a balance between public and private healthcare options. Danielle McMullen, representing the AMA, stated, “The AMA has never supported egregious fee setting, but what we do support is that balance of public and private care that makes Australia’s healthcare system so unique.”
As battles over access and affordability rage on in the healthcare space, it is clear that the old normal cannot persist any longer. Peter Breadon noted the importance of addressing these issues head-on: “It’s a very expensive, difficult, complex system that’s not producing good outcomes despite vast sums of money. We do need to rethink it and do it differently.”
