If you have cancer, a disease such as diabetes or dementia, or need to manage other complex health conditions, you often need expert care from a specialist doctor.

But as our new Grattan Institute report shows, too many people are forced to choose between long waits in the public system or high costs if they go private.

Governments need to provide more training for specialist doctors in short supply, make smart investments in public clinics, and regulate the extremely high fees a small number of private specialists charge.

Fees for private specialist appointments are high and rising.

On average, patients’ bills for specialist appointments add up to A$300 a year. This excludes people who were bulk billed for every appointment, but that’s relatively rare: patients pay out-of-pocket costs for two-thirds of appointments with a specialist doctor.

Increasing GP costs make national headlines, but specialist fees have risen even more – they’ve grown by 73% since 2010.

People who can’t afford to pay with money often pay with time – and sometimes with their health, as their condition deteriorates.

Wait times for a free appointment at a public clinic can be months or even years. In Victoria and Queensland, people with an urgent referral – who should be seen within 30 days – are waiting many months to see some specialists.

High fees and long waits add up to missed care. Every year,

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