Latest / The Front / BMWs and broken promises: Inside the specialist fee war

Transcript

BMWs and broken promises: Inside the specialist fee war · The Front

• 0:04
  Speaker 1: From The Australian, here's what's on the front. I'm Claire Harvey.
• 0:06
  Speaker 1: It's Monday, November 2, 2026. If you've been to see
• 0:13
  Speaker 1: a medical specialist lately, you'll know fees are sky high
• 0:17
  Speaker 1: and the rebate often feels paltry. So why can't the
• 0:21
  Speaker 1: government get this under control? And why are the doctors
• 0:24
  Speaker 1: digging in? That's today's story.
• 0:32
  Speaker 2: Specialist care is becoming a luxury and the poorest are
• 0:36
  Speaker 2: hit the hardest.
• 0:38
  Speaker 3: This card says that if you get sick, you'll be
• 0:41
  Speaker 3: looked after.
• 0:42
  Speaker 2: Some specialist doctors now charging triple the Medicare rate. It's
• 0:46
  Speaker 2: forcing two million Australians every year to delay or even
• 0:50
  Speaker 2: avoid care. The government has committed to putting thousands of
• 0:53
  Speaker 2: specialist doctor's fees online so you can shop around.
• 1:00
  Speaker 1: Penny Timms is a health reporter with The Australian, and
• 1:02
  Speaker 1: she's been reporting on one of the biggest changes to
• 1:04
  Speaker 1: come through Australian healthcare for decades. It's about how much
• 1:08
  Speaker 1: specialists charge. Penny, it's funny, isn't it? We're all so
• 1:13
  Speaker 1: used to being empowered consumers these days, but one area
• 1:17
  Speaker 1: of life where I would feel a bit hesitant in
• 1:19
  Speaker 1: asking how much this is going to cost, or maybe two,
• 1:22
  Speaker 1: a fancy dress boutique where there are no prices on anything,
• 1:26
  Speaker 1: and a specialist's office when you're worried about something and
• 1:29
  Speaker 1: you're seeking the advice of an expert. There's a huge
• 1:32
  Speaker 1: change going on.
• 1:33
  Speaker 4: What is it?
• 1:33
  Speaker 3: Look, this is, as you said, a huge area of
• 1:36
  Speaker 3: reform right now. So the Albanese government is really making
• 1:42
  Speaker 3: this issue of specialist fees a huge component of its
• 1:46
  Speaker 3: second term. It really has addressed this and said that
• 1:49
  Speaker 3: this is a priority area of the government. It wants
• 1:53
  Speaker 3: to essentially make sure that there are no specialists who
• 1:56
  Speaker 3: are charging excessive fees. And this is where we start
• 2:00
  Speaker 3: to get into this really complicated story of what is
• 2:02
  Speaker 3: an excessive fee and what can actually be done to
• 2:07
  Speaker 3: rein in those costs. Because at the moment, our doctors
• 2:10
  Speaker 3: are free to charge what they see fit within reason.
• 2:14
  Speaker 1: Mm-hmm. Yeah, I think we've all had that experience of
• 2:17
  Speaker 1: going for the initial consultation and then you.
• 2:19
  Speaker 4: Never discuss this with the doctor.
• 2:20
  Speaker 1: You get a letter from the receptionist telling you what
• 2:23
  Speaker 1: the fee schedule is and you're left thinking, I mean,
• 2:27
  Speaker 1: I wonder if this is negotiable. Is there some sort
• 2:28
  Speaker 1: of discount for paying early?
• 2:30
  Speaker 4: What's the deal?
• 2:31
  Speaker 1: How much are people paying to go and see specialists
• 2:34
  Speaker 1: and how much are those prices varying at the moment?
• 2:37
  Speaker 3: The greatest data that we have at the moment is
• 2:40
  Speaker 3: that Grattan Report has shown that since 2010, out-of-pocket costs
• 2:47
  Speaker 3: for specialist feet, so that is how much the gap
• 2:50
  Speaker 3: is that patients cost, have risen by 73%. That's an
• 2:54
  Speaker 3: extraordinary number. And there are real consequences of this, that
• 2:59
  Speaker 3: it's costing people a huge amount of money to go
• 3:02
  Speaker 3: and get something checked out, especially when, you know, there's
• 3:05
  Speaker 3: a huge rise in chronic disease at the moment. And
• 3:07
  Speaker 3: a really important part of getting on top of chronic
• 3:09
  Speaker 3: disease is ensuring that you're going and getting the best
• 3:12
  Speaker 3: medical advice so that you know can you catch it early?
• 3:14
  Speaker 3: Is there something that you can do intervention-wise to stop
• 3:18
  Speaker 3: the disease or illness progressing so that you can remain
• 3:21
  Speaker 3: part of society, healthy and fit and.
• 3:24
  Speaker 5: Active and involved?
• 3:26
  Speaker 3: And so if we are seeing these costs going up,
• 3:30
  Speaker 3: it obviously has a huge economic consequence then for the Purely,
• 3:35
  Speaker 3: this is just anecdotal, my own experience recently. So I
• 3:39
  Speaker 3: go to a neurologist. I have chronic migraine. And I
• 3:43
  Speaker 3: recently went to my neurologist and I was left with
• 3:48
  Speaker 3: a gap fee of $ 203. So that's pretty standard for
• 3:51
  Speaker 3: when I go to see my neurologist. So his charge
• 3:54
  Speaker 3: was $ 340. Medicare paid $ 136 of that.
• 3:55
  Speaker 5: And so, yeah, I was left out of pocket a
• 3:57
  Speaker 5: bit over $ 200.
• 3:57
  Speaker 1: Wow. Have you ever shopped around to find out how
• 4:04
  Speaker 1: much it would cost to go to a different neurologist?
• 4:07
  Speaker 3: Not for this particular one, but because finding a neurologist
• 4:11
  Speaker 3: for the type of migraine I have is actually really difficult.
• 4:14
  Speaker 5: And so when I found one that was recommended, I
• 4:18
  Speaker 5: just jumped at it.
• 4:19
  Speaker 3: And it's been great. Like medically, it's been revolutionary and,
• 4:22
  Speaker 3: you know, I cannot fault him at all. But previously
• 4:26
  Speaker 3: I did actually shop around. I shopped around once when
• 4:29
  Speaker 3: I was trying to get to the bottom of it all.
• 4:31
  Speaker 3: Part of migraine is that sometimes it can.
• 4:34
  Speaker 5: Give you vertigo as a symptom. And I was having that.
• 4:37
  Speaker 3: And so I went to a ENT and the first
• 4:42
  Speaker 3: one quoted was extraordinarily high. I think it was around
• 4:46
  Speaker 3: about $ 600. And I just thought, I'm going to see
• 4:49
  Speaker 3: if I can actually find somewhere else.
• 4:51
  Speaker 5: And I did.
• 4:52
  Speaker 3: And it was purely a matter of me then calling
• 4:56
  Speaker 3: around and trying to find the different specialists.
• 4:58
  Speaker 5: I'm lucky I'm in Sydney. I could do that. I
• 5:00
  Speaker 5: had that flexibility to do that. But it's really tough.
• 5:03
  Speaker 3: And you've got to have the ability to know that
• 5:06
  Speaker 3: you can actually do that.
• 5:07
  Speaker 5: You've got to know where to call, who to call.
• 5:09
  Speaker 5: I'm a health journalist, I know.
• 5:11
  Speaker 4: Yeah, that's right.
• 5:16
  Speaker 1: So there's all sorts of reasons why you want to
• 5:19
  Speaker 1: see a specialist, especially as you develop a relationship with them.
• 5:22
  Speaker 4: But that means you're very vulnerable to the pricing, doesn't it?
• 5:25
  Speaker 1: It's not really a market in which price comparison is possible,
• 5:29
  Speaker 1: I think.
• 5:30
  Speaker 5: It's not.
• 5:30
  Speaker 3: It's a very, very difficult thing to tackle, which is
• 5:34
  Speaker 3: why this has been such a bugbear for governments. Every
• 5:39
  Speaker 3: government has known this has been a problem, as we said,
• 5:42
  Speaker 3: since 2010.
• 5:43
  Speaker 5: We can see the data. It's getting worse and worse
• 5:46
  Speaker 5: and worse.
• 5:47
  Speaker 3: And no one's been able to really tackle this because
• 5:50
  Speaker 3: it is just such a huge beast.
• 5:52
  Speaker 5: If it can be tackled, this is going to be monumental.
• 5:56
  Speaker 3: Like it will be a real game changer for health.
• 5:58
  Speaker 1: It sounds to me as though the Australian Medical Association
• 6:02
  Speaker 1: and the various specialist colleges.
• 6:03
  Speaker 4: Are resisting this change. Why?
• 6:05
  Speaker 1: I mean, specialists are driving around in BMWs. They don't
• 6:09
  Speaker 1: seem to be struggling. Surely they can cope with a
• 6:11
  Speaker 1: little bit of price transparency.
• 6:14
  Speaker 5: Yeah.
• 6:14
  Speaker 3: So in this entire discussion, there's two elements to it.
• 6:17
  Speaker 3: So there is this price transparency, which specialists will have
• 6:21
  Speaker 3: to put their pricings on a website. And that one,
• 6:24
  Speaker 3: I think a lot of people are okay-ish with that happening.
• 6:28
  Speaker 3: So that's in the process of being set up at
• 6:30
  Speaker 3: the moment. And previously, there's been a voluntary call for
• 6:34
  Speaker 3: people to do this. Not too many took up that offer.
• 6:38
  Speaker 5: Surprise.
• 6:39
  Speaker 4: Shock, horror.
• 6:40
  Speaker 1: Yeah.
• 6:43
  Speaker 2: It's meant to give patients the power to shop around,
• 6:46
  Speaker 2: but this $ 20 million government website hasn't lived up to expectations.
• 6:51
  Speaker 2: Of 11,000 specialists nationwide, only 70 doctors have signed up
• 6:56
  Speaker 2: to it.
• 6:57
  Speaker 5: So now it will be mandated.
• 6:59
  Speaker 3: The other element of this is just how... it is
• 7:03
  Speaker 3: determined what an excessive fee is. And this is the
• 7:07
  Speaker 3: really complicated area that the doctors are getting very upset about.
• 7:11
  Speaker 3: So at the moment, the government has been seeking feedback.
• 7:16
  Speaker 3: One of the options could be that it looks at
• 7:18
  Speaker 3: the market and analyses whether or not this is a
• 7:21
  Speaker 3: reasonable cost, given the grand scheme of things. Another option
• 7:25
  Speaker 3: would be comparing fees across peers. So other specialists in
• 7:32
  Speaker 3: that area. And the third option, which seems more problematic,
• 7:37
  Speaker 3: is assessing how vastly different a fee is compared to
• 7:43
  Speaker 3: how much you get back from Medicare. That is hugely unpopular,
• 7:47
  Speaker 3: even in its own setting out of this document.
• 7:51
  Speaker 5: The government has flagged this as.
• 7:53
  Speaker 3: An issue because the Medicare rebate just hasn't kept pace
• 7:57
  Speaker 3: with society.
• 7:58
  Speaker 5: It doesn't reflect now.
• 8:00
  Speaker 3: What you should be expected to pay. So there's a
• 8:02
  Speaker 3: huge amount of fear as to what would happen if
• 8:05
  Speaker 3: that actually was to stay in play. It doesn't seem
• 8:08
  Speaker 3: like it will because it has already been flagged that
• 8:11
  Speaker 3: that has problems to it. And if it was, then
• 8:14
  Speaker 3: perhaps other tactics would also have to be introduced.
• 8:21
  Speaker 1: The government's under pressure to cut spending. Medicare is obviously
• 8:24
  Speaker 1: a giant proportion of government spending and it's a beloved
• 8:27
  Speaker 1: Labor Party reform that they're very proud of. Every Australian,
• 8:32
  Speaker 1: from newborn babe to Prime Minister, can share in the cheapest,
• 8:36
  Speaker 1: simplest and fairest health insurance scheme Australia's ever had. But
• 8:42
  Speaker 1: the Medicare rebate is supposed to be a price signal
• 8:45
  Speaker 1: to the doctor, right?
• 8:46
  Speaker 4: It's supposed to be, well, the rebate here is $ 250. So...
• 8:51
  Speaker 4: Is the purpose of this kind.
• 8:53
  Speaker 1: Of cost cutting by the government or is it cutting
• 8:56
  Speaker 1: the cost of living or what are they trying to
• 8:58
  Speaker 1: get to?
• 8:59
  Speaker 3: They're trying to stamp out any specialist charging beyond what
• 9:04
  Speaker 3: is reasonable. It's been widely acknowledged that there is a
• 9:08
  Speaker 3: problem of price gouging, for lack of better terms. But
• 9:14
  Speaker 3: it is also identified that it's not hugely widespread.
• 9:19
  Speaker 5: It is a problem and it needs to be addressed.
• 9:21
  Speaker 3: It needs to stop because it not only means that
• 9:25
  Speaker 3: patients are being charged huge amounts of money, it leads
• 9:29
  Speaker 3: to the entire industry being discredited by a few.
• 9:34
  Speaker 4: So the voluntary code didn't really work.
• 9:36
  Speaker 1: The government's tried and failed to kind of rein in
• 9:39
  Speaker 1: the specialists or the medical colleges in terms of who's
• 9:42
  Speaker 1: allowed to train the next generation to break this stranglehold
• 9:47
  Speaker 1: they have on their own profession. they would say, well, look,
• 9:50
  Speaker 1: it's the existing orthopedic surgeons and the College of Orthopedic
• 9:53
  Speaker 1: Surgeons or whatever we're talking about, you know, breast specialists
• 9:56
  Speaker 1: who know how to do the training. We can set
• 9:57
  Speaker 1: the exams and we can run the registration of the
• 9:59
  Speaker 1: next generation.
• 10:01
  Speaker 4: The government would say, well, maybe.
• 10:03
  Speaker 1: We should open that out to universities or TAFEs to
• 10:05
  Speaker 1: be able to offer this kind of registration. They seem
• 10:08
  Speaker 1: extremely powerful, the doctors. Can the government win?
• 10:12
  Speaker 5: It's going to be a tough battle.
• 10:13
  Speaker 3: It's going to be a very tough battle for them
• 10:16
  Speaker 3: to win this. I think that they are putting all
• 10:20
  Speaker 3: options on the table so that the colleges and the
• 10:26
  Speaker 3: profession as a whole is forced to pick one. There's
• 10:29
  Speaker 3: been an option on the table where you can go
• 10:32
  Speaker 3: and you can try and sort this out amongst yourselves
• 10:35
  Speaker 3: and it hasn't worked.
• 10:36
  Speaker 5: So now... the government's having to intervene.
• 10:39
  Speaker 3: And I think that there is a lot of concern
• 10:43
  Speaker 3: in the medical industry about what will actually happen. And
• 10:46
  Speaker 3: so I think that it could force some of the
• 10:48
  Speaker 3: hand of different medical groups to do things that perhaps
• 10:51
  Speaker 3: in the past have.
• 10:52
  Speaker 5: Been a little bit on the nose.
• 10:55
  Speaker 3: I was speaking quite recently to the incoming president of
• 10:58
  Speaker 3: the Australian Medical Association. And I just said, what do
• 11:01
  Speaker 3: you see for specialist fees? And he said, it's going
• 11:04
  Speaker 3: to be my first huge battle. I know I'm coming
• 11:07
  Speaker 3: into a huge fight right now. He's having to fight
• 11:10
  Speaker 3: for his colleagues who have voted him to be the
• 11:14
  Speaker 3: next president and to represent them and their interests. At
• 11:18
  Speaker 3: the same time, he said to me, there's so many
• 11:20
  Speaker 3: different cost pressures. One of the biggest problems is that
• 11:22
  Speaker 3: doctors fear that they are basically going to become the
• 11:26
  Speaker 3: scapegoats of huge amounts of money it takes to deliver
• 11:31
  Speaker 3: healthcare in this country. So when you look at overhead costs,
• 11:34
  Speaker 3: when you look at the Medicare rebates not keeping up
• 11:37
  Speaker 3: with everyday reality, these are huge problems. And so he
• 11:43
  Speaker 3: knows that this is something that he'll have to tackle.
• 11:45
  Speaker 3: And he did say, you know, there does need to
• 11:47
  Speaker 3: be an increase in training.
• 11:50
  Speaker 5: Of specialists as well. So I think that, yeah.
• 11:53
  Speaker 4: It went like that. More supply equals lower prices, right?
• 11:57
  Speaker 5: That's it.
• 11:58
  Speaker 3: But one of the other issues is that it takes
• 12:00
  Speaker 3: so long to be able to get those trained specialists
• 12:03
  Speaker 3: through the system. So this will not be an easy fix,
• 12:06
  Speaker 3: won't be a quick fix. And efforts previously to try
• 12:09
  Speaker 3: to get more specialists into different fields haven't really resulted
• 12:13
  Speaker 3: in lower fees.
• 12:14
  Speaker 5: So it's going to have to be very targeted. It's
• 12:17
  Speaker 5: a huge issue.
• 12:18
  Speaker 4: Well, lots of great stories to come, I'm sure. Penny,
• 12:20
  Speaker 4: thank you.
• 12:21
  Speaker 5: Thank you.
• 12:29
  Speaker 1: Penny Timms is a senior health reporter with The Australian.
• 12:32
  Speaker 1: You can check out our ongoing coverage of this dispute
• 12:35
  Speaker 1: and all the rest of the best news in health
• 12:37
  Speaker 1: right now at theaustralian.com.au slash health.