‘Just not liveable’: The ‘phenomenal’ costs of seeing a medical specialist

For mother-of-three Kimberley Grima, the costs of specialist fees quickly add up.

Ms Grima has had to defer medical appointments and scans because her family simply couldn’t afford to pay.

She’s one of many patients questioning why a proposed $8.5 billion injection into GP services over four years hasn’t been matched with a similar investment in specialist care.

The chronic pain advocate has Complex Regional Pain Syndrome, migraines and endometriosis, meaning regular visits to pain specialists, a neurologist and a gynaecologist.

“We can’t afford to just keep paying specialist after specialist,” she said.

Her three children also have a range of conditions, requiring consults with cardiologists, respiratory physicians, psychiatrists and paediatricians.

“I can’t afford three specialists in one week, so I’m cancelling appointments,” she said.

She said she has delayed a scan she needs for two years so she can afford appointments for her children.

The family’s annual specialist bills frequently exceed $3,000, but they only hit the yearly Extended Medicare Safety Net, which offers money back after the $2,600 threshold is reached, in October or November each year.

“By that time of year specialists are going on holidays, so what good is it?”

Specialist bulk-billing figures low

Labor last week pledged $8.5 billion to Medicare to expand bulk-billing incentives for GPs and the Coalition matched its pledge.

But statistics point to a more serious problem for specialist medical care.

Department of Health figures show the most recent bulk-billing rate among specialists was 28.4 per cent compared to 77.5 per cent at the GP in the final quarter of 2024.

The average out-of-pocket to patients was $115 for specialist treatment compared to $46 at the GP.

Patients were even worse-off at the obstetrician, with the average out-of-pocket being $307, or $224 for an anaesthetist.

In a statement, Health Minister Mark Butler said he understood concern about out-of-pocket costs for specialists, but his focus was “unapologetically” on general practice.

But speaking to ABC radio on Wednesday, Mr Butler conceded Labor, if re-elected, had “to do something about out-of-pockets for specialists” and he had conveyed this to the Australian Medical Association, the peak professional body for doctors.

“They’re growing just far too fast … and they’re meaning that people aren’t going to the doctor when they need to, and that was the core promise of Medicare,” he said.

Opposition health spokesperson Anne Ruston said the Coalition’s focus had been on GPs because patients had been avoiding care and this had implications for the entire health system, but said there was “more to do”.

The Greens have announced they would add ADHD and autism assessments to Medicare, and set the rebate for doctors at the average cost of diagnosis — giving a strong incentive for specialists, psychologists, psychiatrists, paediatricians and GPs to bulk bill for the assessments, saving families from paying anything.

Huge out-of-pocket costs

Patient advocates insist something has to change.

Chronic Pain Australia chair Nicolette Ellis said the current Medicare rebates did not go anywhere near covering specialists’ bills, which could range from $200 to $750.

With the current rebate for a new specialist consultation running at just $148, and $74 for ongoing patients, it has prompted renewed calls for bigger Medicare rebates for specialist consults.

“Many people living with chronic pain are also seeing multiple specialists. Most people are paying $200 a month to see a specialist,” she said.

She said surveys showed Chronic Pain Australia members went without food and fuel to pay health bills while others went without care.

Jennifer Martin, president of the Royal Australasian College of Physicians, which represents most types of specialists, welcomed the injection of GP funding, saying it would take pressure off specialists.

However, she said Medicare rebates had not kept pace with costs.

“Specialist consultations are now significantly longer. They’re significantly more complex and have to incur significant costs,” she said.

“It’s the costs of wages for staff in the office, it’s the cost of importing medications or equipment, and generally, just those costs of providing that care.”

Chronic Pain Australia would like to see more pain programs accessible at GP rooms to help keep patients out of specialists’ offices, as well as other measures that help support patient care by other health workers.

Safety net provides limited help

Medicare Safety Nets are supposed to help patients by giving them some money back once they spend more than a certain amount on out-of-hospital medical services.

But data shows the schemes don’t provide relief for most families.

Figures provided to the ABC by the Department of Health show less that one in 20 Australians meet the Extended Medicare Safety Net each year, which offers the highest level of assistance.

While the number of patients accessing it has increased 44 per cent in past years, the value of the health care it supports has risen 75 per cent, meaning the sickest patients are being charged more than ever and Medicare is picking up the bill.

The average cost per patient in that scheme rose from $554 per year in 2019 to $671 in 2024.

And under the Medicare Safety Nets, families must accrue thousands of dollars in out-of-pockets costs before they qualify for maximum benefits, and even then they need to cover some continuing expenses.

Kimberely Grima said she believed all children should be bulk-billed by specialists, and that would take pressure off her family.

“Something needs to be put into play,” she said

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