SYDNEY, June 15, 2025
specialist Fees: A Costly Pill for Australians
New analysis reveals that soaring specialist fees are causing financial strain for many Australians, leading to delayed or skipped medical appointments.
- One in 10 Australians pay almost $600 annually for specialist visits.
- almost 2 million Australians delay or skip specialist appointments each year.
- Psychiatrists have the highest average out-of-pocket costs for initial consultations.
Are Australians getting a raw deal when it comes to specialist care? A new report shows that the cost of seeing specialists is hitting many in the wallet, with roughly one in ten people paying nearly $600 each year. This financial burden is causing a ripple effect, with many delaying or even skipping vital appointments.
A recent report from the Grattan Institute, released on Monday, shines a harsh light on the rising costs of outpatient fees over the past 15 years. The numbers are startling: in 2023, the average initial out-of-pocket fee for a psychiatrist was $671. Some specialists, dubbed “extreme fee” providers, are charging over three times the scheduled Medicare fee. The report, titled “Special Treatment: Improving Australians’ Access to Specialist Care,” found that almost 2 million Australians are delaying or skipping specialist appointments annually, with cost being a major factor.
What is Medicare? Medicare is Australia’s global health insurance scheme, providing free or subsidized access to a wide range of health services.
For low-income patients, the situation is even more challenging. The report found that one in 10 with weekly household incomes under $500 face out-of-pocket costs of nearly $500 per year. This financial squeeze is further compounded by the fact that some specialists are charging substantially more than the Medicare schedule allows.
Psychiatrists top the list with the highest average out-of-pocket costs at $671 for an initial consultation. Endocrinologists come in at $372, and cardiologists at $369.
Average Out-of-Pocket Costs (Initial Consultation):
- Psychiatrist: $671
- Endocrinologist: $372
- Cardiologist: $369
“the specialist system isn’t working and Australians – especially poorer Australians – are paying the price,” said Peter Breadon, the lead author of the report and Grattan Institute health program director.
Prof Yuting Zhang, a health economics expert at the University of Melbourne, points to the lack of government regulation of doctor’s fees as a primary cause for the escalating costs. “Doctors can charge whatever thay like… The fees have gone up quite a lot, especially for specialist fees relative to GP fees,” she said.
Zhang emphasized the significant variation in fees, depending on the doctor, location, and even the patient. This inconsistency makes it difficult for patients to make informed decisions about their care.
“That costs a lot more,so ideally you don’t want people to delay,” Zhang said. “The worry is it increases the downstream cost.”
Dr. Elizabeth Deveny, chief executive at Consumer Health Forum of Australia, highlights that while consent for fees is mandatory, it’s not always enforced. This leaves patients vulnerable to unexpected bills.
Real-Life Impact: “I delayed seeing a specialist for months because I was worried about the cost. By the time I finally went, my condition had worsened, and I needed more extensive treatment,” shares a patient from Melbourne.
delaying or avoiding specialist treatment has serious consequences, the report found. Many patients face missed diagnoses and unnecessary suffering. Appointment wait times can stretch for months or even years, with urgent appointments exceeding recommended maximums in some parts of Australia.
The report concludes that specialist care in Australia resembles a “postcode lottery,” with disparities in service access between different areas.Public clinics are not doing enough to address these gaps.
Zhang suggested that the government should increase the training of specialist doctors to address wait times, particularly in specialties with shortages, like psychiatry.
Federal Health Minister Mark Butler acknowledged the problem. He stated that the private health sector needs to do more to shield patients from exorbitant bills. The government plans to improve the Medical Costs Finder to increase fee transparency.
“we are committed to working with consumers, the colleges and private health providers on the design and implementation of this critically important cost transparency measure,” Butler said.
Navigating the Specialist System: What Can Australians Do?
The financial burden of specialist fees in Australia is a significant concern,as highlighted in the Grattan Institute report.Rising costs are impacting access to crucial healthcare, particularly for low-income earners. Patients are delaying or altogether skipping appointments, and this, as emphasized previously, leads to worsened health outcomes. But what can patients do to navigate this complex system and mitigate these rising costs?
One crucial step is to be informed. Researching specialists and their fees *before* an appointment can considerably reduce unexpected costs. The Federal Government’s Medical Costs finder, which Minister Butler mentioned he plans to improve, aims to increase fee clarity. Until then, patients can proactively ask about fees when booking appointments. Inquire about the estimated cost of the consultation and any potential out-of-pocket expenses. Also, find out how long the consultation will take.
Another avenue is to consider bulk-billing options where available. Bulk billing, where the Medicare benefits cover the entire cost of the consultation, eliminates out-of-pocket expenses. While not all specialists offer this, it’s worth inquiring about bulk-billing options with your general practitioner or consulting a service like Healthdirect to find bulk-billing specialists in your area.
Explore all available options.Public hospitals offer specialist services that are often more affordable. However, these services can come with longer wait times. private health insurance can also help cover some specialist fees, but it’s essential to carefully review your policy and understand what’s covered. Policy details can vary considerably.
Negotiating specialist fees is not always possible, but it is worth a try.If the cost of a consultation seems excessive compared to other specialists in the area, politely explain your financial situation and inquire whether the specialist is open to discussing a reduced fee or a payment plan.
Are specialist fees in Australia negotiable? While it may not always be possible, it never hurts to politely discuss the possibility of a reduced fee or payment plan, especially for individuals with financial constraints.
Here are some practical tips to navigate specialist fees:
- Research Fees: Before making an appointment, inquire about specialist fees and potential out-of-pocket costs.
- Check Bulk-Billing: Find out if the specialist offers bulk
