Two million Australians are delaying or skipping specialist appointments each year as costs rise

Two million Australians are delaying or skipping an appointment each year, with around half doing so because of the rising cost of seeing a specialist.

The concerning figure was included in the Australia Institute’s submission to a Senate inquiry examining the accessibility and affordability of specialist medical care.

“Seeing a specialist has become a luxury rather than a way for any Australian to receive treatment for a serious health condition,” said Luke Slawomirski, Postdoctoral Research Fellow at the Australia Institute.

“It has become a two-tier system where people who can pay often move quickly, while people who cannot pay are forced to wait or miss out altogether.”

Around two in five Australians see a medical specialist each year, with one in three doing so in the private sector.

However, access is becoming increasingly shaped by income, geography and the ability to navigate complex referral pathways, leaving those with the greatest need at risk of missing out.

“Patients should not have to shop around for specialist care while they’re sick, worried or in pain,” said Mr Slawomirski.

“They deserve clear information about the process, cost, waiting time, public options and outcomes before a referral is locked in.”

Delayed or foregone specialist care can mean medical conditions go undiagnosed, causing the patient’s health to deteriorate and pushing up the eventual cost of care even further.

But for some, postponing or cancelling an appointment is their only option.

The research found that the out-of-pocket costs of seeing a specialist have risen faster than the rate of inflation, wage growth and other medical expenses, with private specialist clinics recording higher gross operating profits than finance, legal practices, accounting and construction.

To highlight the disparity, Mr Slawomirski pointed to the lowest and highest 10 per cent of out-of-pocket costs for hip or knee replacement, which vary by about $5,000 – a 17-fold difference.

“A universal health system should ask people to wait because someone else has greater clinical need, not because they can’t afford the private alternative,” Mr Slawomirski said.

Depending on their postcode, people can face vastly different fees for specialist care.

Earlier this year, Senator David Pocock highlighted that ACT specialists charge an average fee of $605 – more than four times the $144 average charged by their Tasmanian counterparts.

“These are big providers. Looking at what’s available in the ACT, these are not small businesses providing these services,” said Senator Pocock told a Senate Estimates inquiry.

“A provider is charging someone who turns up for a scan in Goulburn or Queanbeyan $47, but when it’s in Canberra it’s $125—same company, same machine—and they’re charging Canberrans more just because they can?” he asked.

The Australia Institute is advocating for a national specialist fee and affordability framework that sets clear benchmarks for reasonable prices.

Under the framework, specialists could participate in a fair-fee or ‘No-Gap & Known-Gap’ arrangement to better protect vulnerable patients from excessive and unpredictable out-of-pocket costs.

“Successive Australian governments have built a market in which patients often need care they cannot safely refuse, but have little information about price, quality, waiting times or public alternatives.”

With Australia’s specialist workforce not distributed according to need, access has been declining in more remote areas where health needs are typically greater.

Mr Slawomirski said more needed to be done to make public sector employment a more desirable option, as well as better planning for future needs by discipline and region.

The Australia Institute submission also suggested the Commonwealth work with states and territories to design and fund a way for GPs and other primary care clinicians to obtain timely input from specialists without every patient requiring a full specialist appointment.

“Raising Medicare rebates without conditions risks pouring more public money into the same broken market. Patients need lower and more predictable gaps, not just bigger subsidies,” he said.

“Specialist expertise is scarce and valuable. We should use it better by supporting GPs with timely advice, strengthening public specialist work, and planning the workforce around need.”