Melbourne, June 16 (The Conversation): Patients battling cancer, diabetes, dementia, or other complex health conditions often require the expertise of specialist doctors. However, as highlighted in the latest report by the Grattan Institute, many face a tough choice between enduring long waits within the public health system or incurring hefty expenses in the private sector.
The report emphasizes the necessity for governments to prioritize training more specialist doctors, strategically invest in public clinics, and regulate the exorbitant fees charged by some private specialists.
Escalating Costs and Wait Times: The financial burden of private specialist appointments is significant and continues to escalate. On average, patients incur annual charges of A$300, excluding those who are entirely bulk billed—a rarity. Approximately two-thirds of specialist consultations involve out-of-pocket costs. Specialist fees have surged by 73% since 2010, surpassing the rise in general practitioner costs, which frequently dominate headlines.
Many patients who cannot afford these costs find themselves paying with time or risking their health as their conditions deteriorate. In Victoria and Queensland, individuals with urgent referrals wait months to see specialists when they should be seen within 30 days.
Consequently, high fees and extended wait times result in 1.9 million Australians delaying or altogether skipping necessary specialist care annually, with half citing cost as the primary deterrent. Additionally, geographical disparities persist, with those in regional and remote areas receiving significantly fewer specialist services even when virtual services are considered. Half of remote communities receive less than one specialist appointment per person each year.
Future-Proofing Specialist Training: Specialist doctor training takes a minimum of 12 years, highlighting the importance of proactive planning. Current government policies lack projections for future specialist needs and fail to link training initiatives to those needs. This has resulted in an imbalance of available specialists, with some fields, such as emergency medicine, flourishing, while specialties like dermatology and ophthalmology face shortages.
Moreover, the location of specialist training plays a crucial role. Many doctors settle in the areas where they train, leaving rural regions with unfilled positions due to a lack of training facilities. To address these issues, governments must align training places with the nation's future health needs and tie funding to these specialties accordingly. In the interim, the federal government should facilitate the entry of qualified overseas specialists by streamlining applications and recognizing relevant international qualifications.
Expanding Public Clinic Access: Public clinics are vital as they provide cost-free specialist care for Australians. However, greater strategic investments are needed to bridge the gap between regions with varying levels of access to specialist services. Adjustments for demographic and economic disparities reveal that underserved areas receive markedly fewer services.
Governments should target funding toward public services in the most needed specialties to elevate access for underserved communities over a five-year plan. An estimated 81 communities need additional specialist appointments, estimated at a million extra across the board. To maximize the efficacy of existing investments, governments should modernize clinics and promote best practices, including virtual care and innovative staffing models. Quick written consultations between GPs and specialists should be encouraged to prevent unnecessary referrals.
Addressing Extreme Fees: Excessive fees remain an issue despite potential increases in public services and specialist availability. A small percentage of specialists—less than 4%—charge extreme fees, reaching or surpassing triple the Medicare schedule fee. In 2023, initial consultations with such specialists, including endocrinologists and cardiologists, averaged AUD 350, with psychiatrists exceeding AUD 670.
These fees are unjustified, not necessary for fair compensation, and do not necessarily correlate with higher quality care. The federal government’s commitment to publishing fee information is a step forward, yet patients may still find it challenging to find alternatives.
The government should directly address extreme fees by requiring specialists who charge such rates to repay Medicare rebates collected in that fiscal year.
It is time for both federal and state governments to take decisive action to reform specialist care, which has been neglected for too long. (The Conversation)
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