Dr Rachel David spoke to ABC Radio Sydney about the rising cost to specialist doctors in some parts of Australia and what can be done to improve access

27 Aug 2025Interviews and Transcripts

Transcript

Station: ABC Radio Sydney
Program: Mornings
Date: 27/8/2025
Time: 9:16 AM
Compere: Hamish Macdonald

Interviewee: Dr Rachel David, CEO, Private Healthcare Australia

HAMISH MACDONALD:	If you’ve ever gone to a specialist, a medical specialist that is, you’ll know that the fees are often pretty exorbitant. Earlier this year, a Grattan Institute report found that more than one in five Australians who saw a specialist in 2023 were charged a fee deemed to be extreme, this is defined as costs that are more than three times the Medicare schedule fee. So I’d like to hear from you on this morning. Have you been ripped off, do you think, by the specialist? How much were you charged? 1300-222-702. I’d really like to hear from you on this. What was your experience? What needs to change? How do we stop people making money out of these procedures? Obviously, the intention of the Medicare scheme is to make it equitable for all of us. Dr Rachel David is the Chief Executive of Private Healthcare Australia, the peak body for health insurers in this country. Good morning to you.
RACHEL DAVID:	Morning, Hamish.
HAMISH MACDONALD:	Explain to us your point of view on this. Why are practitioners charging so much above?
RACHEL DAVID:	Well look, since the pandemic drew to a close, we’ve actually seen quite a marked jump in inflation of doctors’ fees, so that we’re now seeing some quite extraordinary numbers. Like to see a psychiatrist in the community, some are charging over $900 for a first appointment, $600 for a cardiologist or an obstetrician, and some pretty hefty fees even for things like dermatology in the community. Now one thing that is even more worrying than that is that we’re seeing that people are delaying or not pursuing medical specialist referrals because they’re worried about the cost. Between 10 and 20 per cent of people, depending on who you ask, the ABS or one of the universities that studied this, have actually said that, look, they were referred to a specialist for a good reason, but they haven’t gone because they perceive they can’t afford it. The issue for health funds and private health is this is also dampening demand for private hospitals, just as they’ve been beaten up with the pandemic and the lockdowns. So we’re seeing that the number of appointments for a specialist has dropped by 10 per cent even as the population has increased. And our issue from the point of health insurance is we can’t cover- legally we can’t cover the cost of seeing a doctor in their rooms or in the community. The health insurance only kicks in once you’re admitted to hospital.
HAMISH MACDONALD:	[Interrupts] But a lot of people, though, would say- well, part of the reason for steering away from those things is because the health insurance is so expensive.
RACHEL DAVID:	Well, that’s true, but the price of health insurance premiums is very closely regulated by the federal government. So every year the health funds submit to the prudential regulator APRA and the Department of Health what their claims experience has been and what claims they’re predicting. And they go through it with a fine-tooth comb and sometimes ask the funds to resubmit four or five times to make absolutely sure that the premium they’re charging is covering the real costs in the health sector. But unfortunately, one of the things we’ve seen is that inflation has been very sticky in the health sector and it is running higher than the consumer price index.
HAMISH MACDONALD:	Julie from Killara has called in. What does your psychiatrist charge, Julie?
CALLER JULIE:	Oh, yes, hi. It’s $365 for half an hour.
HAMISH MACDONALD:	Wow. That seems quite a lot.
CALLER JULIE:	It is a lot.
HAMISH MACDONALD:	How do you feel about that charge?
CALLER JULIE:	Oh, I think it’s enormous. I go anyway because I’m happy with the psychiatrist. But at one point, I felt it necessary to go once- I was going once every week, but that changed. But then of course, I get up to the maximum safety net very, very quickly. And then it’s only something like, I don’t know, $60, $80 for half an hour. So it’s a big difference, but it’s only because I’ve spent so much money.
HAMISH MACDONALD:	Yeah. Julie, appreciate the call this morning. Karina in Rosehill, good morning to you. Your son has a lot of appointments. What’s the sort of price range that you end up with?
CALLER KARINA:	For a 15-minute appointment with a gastroenterologist, the first charge is $350. Subsequent appointments are $230. He had to have a colonoscopy with my private health fund because he’s under 18. I didn’t have to pay the $500 excess, but I had to pay $500 to the gastroenterologist. That wasn’t successful, so we had to see a second gastroenterologist. I was forced to see a nurse, so that was $200. And then the gastroenterologist, that process was free. But I heard that he charges $450 for his first appointments, which is again, 15 minutes.
HAMISH MACDONALD:	And so do you know what the difference is between these fees and the schedule, the Medicare schedule fee?
CALLER KARINA:	Yes, because you pay that on, say, a credit card, and then Medicare gives you the rebate, which is about $40, $50 or something.
HAMISH MACDONALD:	Okay. So the difference that you’re talking about is hundreds of dollars?
CALLER KARINA:	Hundreds of dollars each time I have to take him to an appointment.
HAMISH MACDONALD:	Thanks very much for your call this morning. Dr Rachel David is the Chief Executive of Private Healthcare Australia. Do these sorts of experiences surprise you?
RACHEL DAVID:	Well, not since the pandemic, no. This is very distressing to listen to. But one thing that we are looking forward to is the Albanese Government has made a commitment before the election to put all of the medical specialist fees up on a website. So when people go to their GP and they’re at the point of referral, they can talk to their GP with some information in their hand about what medical specialists in their area are charging. And if cost is becoming an issue for them, the GP then can help direct them to an appropriate and also an affordable specialist. And I mean, I think it’s important to stress that in Australia, the requirements for medical training are so high that there’s no link between price and quality. So the fact you’re paying a high amount to a specialist versus another specialist doesn’t guarantee you a better outcome, and many of the cheaper specialists actually have more experience and more skills that they can bring to the table. So this website will help, but it does appear that in the community, some of these fees have become completely uncoupled from what Medicare is able to reimburse.
HAMISH MACDONALD:	Yeah, John in Newtown says, Hamish, I’d like to know why you can’t claim some specialist fees through your health fund. Can you answer that, Rachel?
RACHEL DAVID:	Yeah, this goes right back to when Medicare was put together in 1984. So the health funds were bolted into the Medicare system to co-fund hospital care, essentially. So if you’re admitted to hospital, the fund can pay for the doctor, and many funds do have no-gap schemes with doctors once people get into hospital. But it was felt at the time that if health funds were able to contribute to the fees in a doctor’s rooms or the community, that would be inflationary. And the reason it would be inflationary is that under the Constitution, it’s very difficult for the Commonwealth Government to limit what private doctors charge. In fact, a big part of the Medicare system has been built around that constitutional constraint, which means it’s very tough. They can’t continue to chase ever-increasing fees by increasing the Medicare rebate because that would blow up the budget. So it is a difficult problem for them to fix.
HAMISH MACDONALD:	Dr Rachel David, thanks very much for talking to us this morning.
RACHEL DAVID:	Thanks, Hamish.
HAMISH MACDONALD:	Dr Rachel David there, Chief Executive of Private Healthcare Australia.
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