Report finds patients’ medical payments can vary up to 400pc among specialists


A new report in the Medical Journal of Australia has found that there is a massive variation in the out-of-pocket payments patients make to medical specialists, both within a given discipline and from location to location.

The report co-authored by Professor Freed and Amy Allen from the Melbourne School of Population and Global Health showed that the cost for patients could vary by up to 400 per cent within one speciality, but patients had no way of knowing whether the service would be better if they chose the more expensive option.

Key statistics from the report:

  • Most specialties bulk-billed between 30 and 42 per cent of visits
  • The highest rates of bulk-billing were in haematology, 60 per cent, and medical oncology, 53 per cent
  • The lowest was in geriatric medicine, 17 per cent
  • Doctors in the Northern Territory bulk-billed 76 per cent of visits, a greater proportion than anywhere else
  • Bulk-billing rates in New South Wales and South Australia were just above 40 per cent
  • Western Australia was the only state with a rate below 20 per cent
  • Within each specialty, the average range of charges varied by over 70 per cent

The authors analysed Medicare claims data from 2015 for an initial outpatient appointment in 11 non-surgical specialties. They were cardiology, endocrinology, gastroenterology, geriatric medicine, haematology, immunology/allergy, medical oncology, nephrology, neurology, respiratory medicine, and rheumatology.

The specialty with the greatest difference in the range of fees was neurology, where the difference among doctors was $189, the equivalent to a 125 per cent difference.

The narrowest variation was within geriatric medicine, where the range was $62.50, or 15 per cent.

The authors found because there was no publicly available information about the quality of care, the fee variations were not based on any objective information about care provided by individual doctors.

Costs varied from state to state

The authors concluded that more research was needed to determine why there were such wide variations, and there needed to be a system in place that measured quality of care, so patients and GPs could make informed decisions when choosing a specialist.

Gary L Freed and Amy R Allen, 'Variation in outpatient consultant physician fees in Australia by specialty and state and territory' Med J Aust 2017; 206 (4): 176-180 link

Croakey Article "Calls for greater transparency on specialists fees & on whether failure to do so should result in sanctions"