Australia’s specialist healthcare system is failing its own triage test—too expensive, too slow, and too skewed towards the wealthy. That’s the blunt diagnosis from the Grattan Institute’s latest report, Special Treatment, which finds almost two million Australians delay or skip vital specialist care every year. The result? Missed diagnoses, prolonged suffering, and a ballooning burden on hospitals that are already stretched.
Despite a universal health system in theory, many Australians are paying privately—and heavily—in practice. Fees charged by private specialists have surged by 73 per cent above inflation since 2010. At the pointy end of the market, 10 per cent of patients shell out nearly $600 annually just to be seen. A psychiatric consultation with a high-fee provider? That’ll be $671, thanks. Even basic access in less specialised fields like general medicine can exceed $290 per session with the most expensive operators. And these aren’t edge cases—they represent a growing part of the mainstream.
The sting hits hardest for those with the least. Australians in the lowest income brackets face sharply higher barriers, with 72 per cent of households earning under $500 a week having paid a specialist bill last year—despite half of them spending more than $170 each, and the top 10 per cent crossing $479. At the other end of the income ladder, those earning over $3,500 weekly were more likely to get care, and more likely to afford it—averaging $849 at the top decile.
But money isn’t the only bottleneck. Time is just as cruel. Public waitlists, especially in regional areas, are months longer than clinical guidelines recommend. And while private access offers a shortcut, it’s a privilege few can afford. The poorest Australians are receiving a third fewer services than the richest, despite often facing worse health outcomes.
Peter Breadon, lead author and Health Program Director at the Grattan Institute, doesn’t mince words: “The specialist system isn’t working—and poorer Australians are paying the price.”
This isn’t a new problem, but it’s one that has become more urgent as Australia’s population ages and chronic illness becomes more common. The specialist training pipeline is sluggish and patchy, with disciplines like psychiatry, dermatology and ophthalmology seeing worryingly low intake over the past decade. Rural Australia is even worse off, with a persistent shortage of on-site specialists and little training infrastructure to change that.
Breadon and his team propose a five-point remedy. First, increase the number of public specialist appointments by a million annually, targeted at communities getting the least care. Second, penalise excessive charging by cutting Medicare funding to high-fee practitioners—and name them. Third, reduce unnecessary referrals by allowing GPs to request formal written advice from specialists. Fourth, update and streamline public clinics nationwide. Finally, inject $160 million into training, with quotas tied to underserved disciplines and regions.
It’s not just a call for money—it’s a demand for better planning. “The system has been on autopilot for too long,” Breadon says. “We need to train the specialist workforce Australia actually needs, not just the one it’s used to.”
The numbers tell their own story. The disparity in out-of-pocket costs across income groups is stark. Those on less than $500 a week paid median annual costs of $172, while wealthier households broke the $800 barrier. In certain specialties, fees have little relation to complexity or urgency. Psychiatry, paediatrics, immunology and endocrinology—none traditionally associated with luxury billing—feature among the most expensive, particularly among practitioners charging triple the scheduled Medicare fee.
The long tail of inequality stretches across geography, too. Rural and regional areas—already struggling with GP shortages—are doubly hit when specialist care is needed. The public clinics that could bridge this divide are thin on the ground in these locations. Years of underinvestment in rural training placements have only made the problem harder to fix.
One of the more novel proposals—allowing GPs to get written guidance from specialists rather than forcing a full referral—could reduce up to 68,000 unnecessary specialist appointments a year, freeing up capacity where it’s needed most.
That may sound modest. But every appointment freed is a chance for someone else to be seen sooner—someone who might otherwise wait six months for a cardiologist in regional Queensland or lose out on early intervention for a chronic condition in outer suburban Sydney.
The proposed public naming of high-charging specialists is likely to be controversial, especially in a sector that has long operated with limited fee transparency. But the argument is straightforward: if taxpayers are footing the Medicare bill, they deserve to know which providers are taking them for a ride.
Healthcare, long seen as a universal right in Australia, is increasingly behaving like a tiered service. Those with money and time can jump queues and get answers. Those without either are left hoping their condition doesn’t worsen before the system gets around to them.
The Grattan report doesn’t promise miracles. It offers arithmetic, accountability and ambition—all rare commodities in health reform debates. The test now is whether any government will have the stomach to act. Because without change, access to care will continue to be rationed by postcode and pay packet.
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