WENDY Favorito knows only too well the cost of seeing a specialist doctor. Having lived with arthritis since the age of six, the mother of two sees a rheumatologist up to five times a year to manage the symptoms of her condition.
A 15-30 minute consultation costs her $96 out-of-pocket each time. The initial consultation fee for her doctor would be $160.
Despite spending more than $370 a month on private health insurance for herself and her family, the insurer does not cover this expense.
New research shows Mrs Favorito is not alone. Many Australians are paying hundreds of dollars to see a specialist who may unbeknown to them, and without any justification as to why, charge five times more than their peers.
For the first time, researchers have mapped the prices of 11 non-surgical specialist groups across Australia, allowing patients to see how their doctor's fees compares with others.
The study of "gap" or out-of-pocket fees – the difference between what Medicare pays for a specialist doctor's service and what the doctor believes their service is worth – comes amid rising concern about health costs in Australia and fears doctors are charging primarily what their local market will bear.
The research found that neurologists (brain specialists), endocrinologists (hormone specialists), rheumatologists (musculoskeletal specialists), and allergy and immunology specialists are charging some of the highest prices for private consultations outside the public health system.
Ten per cent of patients seeing these doctors are paying more than $170 out of pocket for an initial consultation, when the average "gap" fee for their specialty is $95-130. Under Australian laws, health insurers are not allowed to cover these out-of-pocket costs.
The research also shows a huge variation in gap fees charged by cardiologists (heart specialists), gastroenterologists (gastrointestinal specialists), geriatricians (aged-care specialists), haematologists (blood specialists), oncologists (cancer specialists), nephrologists (kidney specialists) and those who practise respiratory medicine.
For example, 10 per cent of patients are paying cardiologists less than $23 at one end of the spectrum and another 10 per cent are paying more than $127 at the other end. The average fee is $74 and the median is $67, meaning half pay more or less than this. This variation exists with no clear justification such as experience or performance outcomes.
Compared to GPs, who bulk bill more than 85 per cent of visits (meaning patients pay no out-of-pocket fee), the researchers found a rate of 30 to 42 per cent for most of these specialists.
Geriatricians were the least likely to bulk bill, with a rate around 18 per cent. Haematologists and oncologists were the most likely to bulk bill with rates over 50 per cent.
The research, published in the Medical Journal of Australia on Monday, also found differences across the states and territories, More than 70 per cent of consultations were bulk-billed in the Northern Territory, compared with less than 50 per cent in Victoria and New South Wales.
The findings, which replicates similar data for surgeons, has triggered again debate about policies to reduce doctors' fees.
Some academics have called for doctors to be banned from Medicare payments if their fees are extreme, as well as schemes to reward those who charge specific fees.
There have also been calls for doctors to publish their fees on comparison-websites so patients can shop around.
A spokesman for Health Minister Greg Hunt said large out-of-pocket fees were of concern and that doctors and specialists were obliged to fully explain costs to patients.
He said the minister had asked the health department to prepare advice on opportunities for more "data transparency to encourage greater information for consumers and therefore promote more competition".
Private Healthcare Australia, which represents health insurers, said the findings of the report should steer the federal government to allow insurance coverage for visits to specialists in situations where out-of-hospital care can be substituted for a hospital admission, where it is part of integrated care for the treatment of chronic disease, or where it can be used to prevent readmission to hospital.
Michael Gannon, President of the doctors' union, the Australian Medical Association, agreed that the government could consider such a change, but said it probably won't because health insurance premiums are already rising rapidly, and such a move would lead to even higher premiums.
Mr Hunt's spokesman declined to comment on the likelihood on such a change.
Dr Gannon, an obstetrician, said doctors charged private fees above what medicare paid them because they have to meet their own rising costs, for staff, utilities, and indemnity insurance. The government's freeze on indexation of the Medicare Benefits Schedule was also prompting doctors to charge higher fees, he said.
Author of the research, Professor Gary Freed of Melbourne University, concluded that there should be more transparency about doctors' fees and the quality and outcomes of their care to determine any variations in fees.
The Sydney Morning Herald
