2.2 million patients face specialist fees triple the government benchmark

More than 2.2 million Australians paid specialist fees that were at least three times the government benchmark in 2025. A report from the Grattan Institute published on November 8 details how these extreme charges are eroding access to private healthcare. The thinktank identified psychiatrists and pediatricians as the specialists most likely to routinely charge these high amounts.

The report defines an extreme charge as a fee that is three times or more than the Medicare schedule fee. In 2012, average patient fees stood at a certain level. By 2025, those fees had increased by $37 in real terms. Over the same period, Medicare rebates fell by $9. The gap between what patients pay and what the government reimburses has widened considerably.

Among the most expensive 5% of psychiatrists, the median cost for a first appointment reached $669. For high-cost pediatricians, the figure was $362, and for cardiologists, it was $265.11. These figures exceeded the fees charged by their peers by 104%, 212%, and 203%, respectively. In dermatology, median fees for initial consultations rose by $28 between 2023 and 2025, reaching $217.80. Psychiatry fees climbed by $90 to $351 over the same two-year span.

Bulk billing, where the specialist claims the Medicare benefit directly from the government, covered fewer than 25% of initial specialist consultations in 2025. In urology, dermatology, psychiatry, and ear, nose, and throat care, the proportion of bulk-billed visits was below 10%. Dr Elizabeth Deveny, chief executive of the Consumers Health Forum, noted that patients are increasingly limiting their care or missing follow-up appointments due to these costs.

The institute proposed a new rule for specialists whose annual fees average more than three times the Medicare schedule fee. Under this proposal, those doctors would have to reimburse the government for every rebate claimed that year. Patients would still receive their rebates. Approximately 2,000 doctors, or 6% of all specialists, would be affected by this change. This group includes more than 60% of private dermatologists and one-quarter of obstetrician-gynecologists.

Peter Breadon, a health economist and the report's lead author, stated that clearer pricing information helps but cannot fix the market alone. He argued that specialist shortages and long public waiting lists weaken the pressures that usually keep prices down. He also noted that appeals for doctors to self-regulate their fees have failed to reverse the trend of rising costs.

New legislation passed in September requires the government to publish all specialists' fees on the Medical Costs Finder website starting in 2027. Previously, participation was voluntary. Since the website launched in 2019, only about 100 of the 6,300 eligible specialists have publicly shared their fees.

The institute also recommended that federal and state governments invest $500 million annually to expand public hospital outpatient clinics. It called for advice lines that allow general practitioners to consult specialists quickly, potentially avoiding referrals and fees. Medical colleges would also be asked to set compulsory training quotas.

Federal Health Minister Mark Butler told the Guardian Australia that all options to curb rising specialist charges remain under consideration. The government has formed a specialist affordability working group to advise on changes. Peter Breadon is one of the members of this group.

Dr Julian Kelly, president-elect of the Royal College of Physicians, said the organization supports government regulation of extreme fees. He described excessive charges that block access or impose unreasonable financial pressure as indefensible. Improving affordability and access should remain a national priority, he said.