Australia’s healthcare system is facing a growing crisis in specialist care, as many patients encounter tough choices between expensive private consultations and long waits in public hospitals. This situation highlights systemic challenges that urgently require government action to ensure timely, affordable specialist care for all Australians.
Many patients are caught in a difficult bind: see a specialist privately at a high cost or wait for extended periods in the public system. Despite federal efforts to improve access to general practitioners, specialist services remain constrained by high fees, limited bulk billing options, and excessive wait times.
Chronic diseases affect nearly half of the Australian population, with one in five people living with two or more chronic conditions. As these health needs become more complex, specialist care has never been more critical. However, accessing such care is increasingly difficult.
Since 2010, specialist consultation fees have surged by over 70 percent. By 2023, an initial consultation with a psychiatrist typically cost patients nearly AUD 250 out of pocket. As a result, nearly one million Australians have delayed or forgone specialist treatment due to cost.
In major cities including Sydney, Melbourne, Brisbane, and Adelaide, waiting times for public specialist appointments — such as cardiology and paediatrics — now exceed one year in 50 different specialties. The combination of high fees and long waits means nearly two million Australians are postponing or skipping recommended specialist care, risking missed diagnoses and more costly treatment later.
Experts call for comprehensive reform of the specialist care system to address training bottlenecks, insufficient planning and investment, uneven public services, and excessive private fees.
“There is nothing preventing some specialists from charging fees two to three times above the Medicare schedule fee,” said Peter Breadon, Health Program Director at the Grattan Institute. “This undermines affordability and access.”
Training More Specialists
Australia currently lacks clear targets for specialist workforce numbers. Training funding is mostly not aligned with actual healthcare gaps, and distribution of specialists in rural areas remains inadequate. Breadon argues for a national workforce planning body to coordinate training and investments, ensuring specialists are trained where they are most needed.
Strengthening Public Clinics
For many Australians, private specialists are prohibitively expensive or too distant. Some regions, such as Wide Bay in Queensland and western Tasmania, receive about one-third fewer specialist services per person compared to well-served areas like eastern Sydney. Government funding is often driven by historical patterns rather than current needs.
To address this, governments should commit to providing a national minimum level of specialist services and increase public clinic appointments, especially in underserved regions, by about one million each year.
Improving Clinic Efficiency
Significant variability exists in clinic management across hospitals. Improvements could be made by redefining workforce roles, enhancing appointment scheduling and triage, and adopting better technology. Public reporting of waiting times and sharing of best practices are key steps toward modernizing specialist clinics.
Supporting General Practitioners
Many specialist referrals could be avoided if GPs had faster access to specialist advice. Some states, like Queensland, have started implementing systems enabling GPs to consult specialists quickly, potentially preventing 68,000 referrals annually and saving patients an estimated AUD 4 million in out-of-pocket costs. Nationwide adoption of such systems is encouraged.
Tackling Excessive Specialist Fees
Unlike typical markets, specialist healthcare in Australia faces limited competition, and fee regulation is lacking. A small proportion of specialists charge fees that far exceed Medicare’s schedule fee without clear justification.
Breadon recommends that the federal government reclaim subsidies from the roughly 4 percent of specialists who charge more than triple the schedule fee on average, ensuring public funds are used responsibly.
The Way Forward
With Australia’s population aging, the pressures on specialist care will intensify unless decisive reforms are made. As negotiations over the National Health Reform Agreement continue, collaboration between federal and state governments is essential to transform specialist care into a more accessible, affordable, and efficient system.
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