Medical specialist fees have been rising far beyond Medicare support, leaving patients with heavy out-of-pocket costs, long public waiting lists and a health system that needs stronger public controls.

Medical specialist fees have been out of control for years. Waiting times for treatment can be up to six years.

The Minister for Health Mark Butler has drawn attention to the extraordinary increase in specialist fees, saying they are “getting out of control”. He hinted that controlling fees might be practicable and necessary.

The problem had its origin under the Coalition government when Peter Dutton was the Minister for Health. In 2014 he froze Medicare rebates. The freeze lasted for six years. That was used as the pretext for specialists and others to increase fees. The escalation of specialist fees has continued ever since. It is a system without any “guard rails”.

It is not surprising that the income of specialists has increased dramatically. Taxation statistics from 2022/23 revealed that of the top five occupations in Australia for taxable income, four were for medical specialists – surgeons, anaesthetists, internal medicine specialists and psychiatrists. They’ve been having a field day at the expense of patients and taxpayers.

These higher incomes for private specialists is also a problem for public hospitals, with specialists in public hospitals chasing higher income as private specialists.

The problem is both costs and waiting times.

Some specialist doctors such as psychiatrists and surgeons and now charging up to $1,000 upfront for the first appointment. One in two patients do not know their fee before attending their first appointment. Cataract surgery and knee replacements can leave patients $2,000 or more out of pocket, even with private health insurance.

There is also a geographic and specialist inequality. Specialists are heavily concentrated in major cities. Regional and rural patients face higher fees with the additional cost of travel to see a specialist. The National Party........

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