Dr Rachel David spoke with ABC radio South Australia about the rising cost of procedures in the private health system

To over $5,650. So look, this is a big change and we’ve plotted that. From about the year 2023 through to now there’s been very high inflation of specialist doctor’s fees, which we’re trying to get to the bottom of. But there’s a few things that we think might be causing this. And one is that, as a consequence of the pandemic, some medical specialists are working less and charging more out-of-pocket so they can make the same income. We don’t have market data from that, but that’s been reported to us by some of the hospitals, some of the private hospitals.

The other thing really contributing to this is the early release of superannuation for medical procedures, and that has caused a very unfortunate spike in inflation for particular medical procedures, namely weight loss surgery, essential breast surgery, and some of the orthopaedic procedures like joint replacements that have jumped up as well.

Well, this is a really difficult problem for the Government to fix, but it is something that the private health sector needs to work with the Government on pretty urgently because the community is hurting on this issue. And we’ve really, through our work, we’ve found out that at least one in five people who have been referred to a medical specialist by their GP has not attended because of the cost. And not only is that bad for their health, it’s bad for private hospitals that don’t get patients through people that should be treated, and it’s bad for public hospitals when they turn up in the ED with something badly wrong with them.

So, what can the Government do? Well, it’s working pretty hard on something called the Medical Cost Finder website. So, before the election the Government announced it was going to put all specialist fees up on a website and publish them so that patients could talk to their GP about the cost at the time they’re referred. And they can be given a few options rather than being shunted down the path of only one specialist who might be the most expensive. And then, we are very much supporting GPs being given some more help to refer patients, like a fully automated referral system, so that they can choose between multiple different specialists. And if the patient doesn’t attend, they have the opportunity to ask why.

We’re also pushing for some much better consumer protections for patients that are seeking treatment in the private sector when they see a specialist. And that means they need to be given a proper quote well in advance of surgery – not on the same day, but well in advance before surgery is booked, which includes most of the costs that you’d expect from that surgical procedure.

We know there’ll be disclaimers. We know things go wrong. But in the private sector, most procedures are pretty similar. It is completely possible for the treating doctor to give the patient some idea of what costs will be in advance of surgery.

Look, the costs are set by the Federal Government – pays a rebate to patients called the Medicare Benefits Rebate. And anyone who’s received treatment from a GP or a specialist in Australia would know what that is. That’s the amount that you get back when you go to a doctor. And that kind of is supposed to anchor the price.

But in Australia, under the constitution, constitutional law in Australia says that private doctors are free to charge whatever they like on top of that.

Yeah, well, it looks like prices have surged forward well ahead of inflation. These prices are going up at over double digits per year. So look, it is something we need to get to the bottom of – why the market is doing this at the moment and what we can do to pull prices down to more reasonable levels.

Because at the moment we have a serious issue with people who’ve been referred to see a medical specialist who are not going. These are people that have got some things that are pretty serious going on.

Look, under the constitution in Australia, surgeons are given protection that- well, not just surgeons, like, any medical practitioner who practices in private is permitted to charge whatever fee they like. But if they don’t bill appropriately, particularly if they’re found to be cheating the Medicare system somehow, then it’s the Federal Government, through the Department of Health, that regulates that.

But what we’re- but there’s another element to it in that if people are not- if their rights as a consumer are not respected, ie if they’re not told what something’s going to cost in advance of surgery, that’s an issue for the consumer law in Australia and it’s an issue that normally the ACCC would something to say about.