Huge variation in specialists’ fees spark concern

Some patients may be paying over five times more than others do in out-of-pocket costs for their first consultation with a specialist in Australia, prompting calls for greater transparency.

An analysis of 2015 Medicare claims data also revealed that bulk-billing rates varied between location as well, with rates in the Northern Territory nearly twice as high as anywhere else.

Haematology and medical oncology were the only specialties bulk-billing more than half of initial consultations, the analysis found.

RACGP president Dr Bastian Seidel urged specialists to stick to the AMA-recommended fees, saying this kind of variation reflected poorly on the medical profession.

“I’m not saying you can’t charge above and beyond the AMA-recommended rate, but you need very, very good reasons, and you need to disclose that at the start of the consultation with the patient,” Dr Seidel said.

Data from 2013-14 found that almost 8% of patients delayed or avoided seeing a specialist for a necessary consultation because of concerns about the price.

This study showed that at the most expensive end, patients could be looking at a $340 fee for visiting a neurologist, a more than $200 out-of-pocket expense.

Because there was no publicly available information on the quality of care or any other quality measures, such variation in specialist fees was not based on any objective measure of care provided by individual doctors, the authors of the study wrote.

Dr Seidel echoed the calls in the accompanying editorials that were published alongside the analysis, calling for greater transparency to help curtail unreasonable fee-setting.

“Australia has the highest rate of out-of-pocket specialist expenses [in the world] and that is really concerning,” he said.

While there has been a big focus on GP costs over the last few years, “the cost drivers and those charging tremendous out-of-pocket fees are not GPs”, Dr Seidel said.

High specialist fees were particularly troubling when patients had no choice between specialists, such as in rural and regional areas, Dr Seidel said.

And as much as rising fees was a concern for patients, it would be impossible to expect GPs to be able to find the cheapest specialist for those patients, he said.