Experts are calling for more transparency around specialist fees after finding huge variations in fees and bulk billing rates within and between specialties and geographic locations.
According to the analysis of Medicare claims data from 2015 published in The Medical Journal of Australia the amount paid by patients for an initial consultation varied more than five-fold in some specialties.
Immunology/allergy specialists charged the most for an initial consultation with a mean of $257 followed by neurologists ($252) and rheumatologists ($236). Endocrinologists charged $223, which translated into an average $94.70 out-of-pocket cost for the patient.
The analysis also revealed that most specialties bulk billed between 30-42% of visits, with haematologists and medical oncologists the only specialties to bulk bill more than half their patients.
Coauthor Professor Gary Freed from the University of Melbourne’s Centre of Health Policy said the main issue was the lack of evidence that any variation in fees reflected the quality of care.
“Patients are best served by reliable and validated quality measures of outpatient care to help them determine the best or most appropriate physician for their needs,” he told the limbic.
Dr Ian McRae, a research fellow in the ANU’s Research School of Population Health, said patients were currently unable to make informed choices.
“At the moment people can use websites to find a doctor but they can’t find out how good they are or how much they charge,” he told the limbic.
He wrote in an accompanying MJA editorial that self-regulatory solutions by colleges had not constrained fees and lifting the current freeze on Medicare rebates would have little effect.
“If the government wants to improve the affordability of medical specialist services without incurring large, uncontrollable costs, direct regulation is one option, but one that is likely to generate considerable debate,” he wrote.
“Improving the transparency of pricing could increase competition and place downward pressure on unreasonable fee-setting, and may provide the most affordable and fair approach to the problem,” he suggested.
Professor Bu Yeap, Chair of the Endocrine Society of Australia’s Medical Affairs Committee, said practitioners based their fees and bulk billing rates on factors including the socio-economic demographics of the area they work in, practice overheads, and the length and complexity of the consultation.
“This is very different from a proceduralist’s consultation which is largely to determine the necessity or otherwise for the procedure and provide information to the patient about that procedure,” he told the limbic.
“As acknowledged in the MJA paper, Medicare rebates have not kept up with inflation, whereas practice costs (rent, salaries) continue to increase, so an increase in gap costs to patients and a fall in bulk billing rates are to be expected.”
He said the Society fully supports the concept that fees are transparent and patients are informed of any gap payment.