Access to specialist doctors is becoming harder for many Australians, as new Medicare data shows a sharp fall in the number of community-based specialist consultations over the past five years—despite a growing population and a record-high uptake in private health insurance.
In 2019, over 5.6 million initial specialist consultations were billed through Medicare. By 2024, that number had dropped to just over 5 million—a fall of nearly 10%. During the same time, Australia’s population increased by more than 7%, underscoring a widening gap between patient needs and access to care.
The drop is being linked to rising out-of-pocket costs. According to new analysis from Zable and Patients Australia, Australians are increasingly putting off specialist visits due to cost or simply not knowing what they’ll be charged. Between 10% and 20% of patients referred to a specialist never make the appointment. The data reveals some alarming figures: private psychiatrists charging up to $950, obstetricians up to $650, and cardiologists up to $600 for a first appointment. Medicare typically reimburses about one-third of these costs, and unless the patient is admitted to hospital, private health insurers are not allowed to pick up the rest.
Private Healthcare Australia has flagged individual examples of nearly $1,000 fees for single psychiatry consultations in both Melbourne and Perth.
Dr Rachel David, CEO of Private Healthcare Australia, says this pricing trend is particularly worrying given the long wait times in the public system.
“If you don’t see a specialist when you need to, you’re more likely to end up in the emergency department later, needing more complex and expensive care. That’s a lose-lose for patients and the health system,” she said.
She warns this isn’t just a problem for patients—it’s affecting the entire private hospital sector. Once seen as a pressure valve for the public system, private hospitals are facing sluggish demand, made worse by inflation and a shift to day surgeries and outpatient treatments.
“We’re seeing record numbers of people with private health insurance, and more Australians living longer with chronic disease. Demand for private hospitals should be surging. But the barrier is clear: the first step—seeing a specialist—is simply too expensive for many,” Dr David said.
This bottleneck at the entry point is stalling the entire system. “If we want our private hospitals to remain viable and help take pressure off the public system, we have to make it easier for people to afford that first specialist visit.”
The federal government is taking steps to improve transparency. The Albanese Government has committed to listing thousands of specialist fees on the Medical Costs Finder website, a platform that allows consumers and GPs to compare costs in advance. Dr David welcomes this move but says it’s urgent.
“We need full visibility on fees, now. Doctors are free to set their prices, and research shows they often do so based on how wealthy the local area is and how much competition they face. That leaves patients in regional and outer suburban areas especially vulnerable to high fees.”
She is quick to dispel any myths about price equating to quality. “There’s no evidence that a higher fee means better treatment,” she said. “Ask your GP to help you find someone affordable. Some doctors still bulk bill or offer support with fees, but you need to ask. Don’t assume you have to skip treatment.”
The issue cuts across income brackets. Even middle-income families are being forced to weigh up essentials against health. The lack of up-front cost transparency, paired with rising fees and an overstretched public system, is creating what some health advocates describe as a silent rationing of care.
Without timely action, the country risks slipping into a two-tier system where access to essential medical care depends more on your postcode than your health needs.
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⚠️#Medicare data shows 10% drop in consultations since 2019 despite population growth.💸Soaring out-of-pocket costs (up to $950/session) deter patients.🏥@PHA_Healthcare warns of system strain as affordability barrier worsens. #TheIndianSun #Healthcarehttps://t.co/HTBT7udiD7
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