Response to Grattan report on specialist fees

The RACP recognises that out-of-pocket costs can be a significant barrier to care and is concerned whenever patients delay or forgo necessary treatment because of cost.

The College does not dictate specialist fees and individual physicians are responsible for setting their own charges but we promote ethical billing through professional standards and education.

We have seen the recent Grattan Institute report and agree that affordability deserves serious attention. We think only one side of the situation has been presented and ignores the nuances of medical practice. There are multiple factors at play including Medicare rebates that have not kept pace, rapidly increasing patient complexity, workforce shortages in some specialties and regions, limited capacity within public hospital and community specialist clinics and a growing demand for services that again has not kept pace with population growth.

We strongly support fee transparency and informed financial consent so patients understand out-of-pocket costs before receiving specialist care.

RACP President-elect, Dr Julian Kelly says “The RACP supports the government introducing an effective mechanism to prevent and address extreme charging by the very small minority of specialists involved.

The RACP has a strong interest in fair and sustainable fees. The physicians and paediatricians of the RACP are well aware of the cost of living crisis in Australia and try to maintain their fees at the lowest possible level.”

“Fees are influenced by a range of factors, including practice models, location, workforce availability, case mix, and public and private system pressures. The College's focus remains on ensuring specialist care is accessible and affordable for patients. There is a lack of recognition, that with increased complexity physicians are devoting many hours outside of the consultation to manage their patients - and this has been unpaid work. These things cannot be captured by reports such as the Grattan Institute’s.

“Any action on extreme fees must go hand in hand with broader reform to improve overall access which pleasingly this report demonstrates is a system-wide issue. Strengthening public outpatients and community clinics will necessarily improve both access and affordability. This requires long term sustained investment.

“In addition the Government must address specialist shortages and training bottlenecks to ensure there are enough funded training positions, supervisor roles as well as public positions to meet future workforce needs.” Dr Kelly said.

“Expanding public outpatient and community-based services would also give patients a timely, affordable pathway to specialist care and reduce pressure across the health system.” Dr Kelly said.

“For those interested in a more comprehensive assessment of the situation I suggest you read the colleges excellent submission below.”

The RACP submission into the Inquiry into access and affordability of medical specialists in Australia can be found here.