What the ABC reported
On 4 November, ABC News reported that the parliamentary inquiry into access to specialists is considering a broad overhaul. The aim is to help patients who can't afford private fees or who wait years on public lists. Options include Medicare funding for GPs to get specialist advice without a separate referral. The Grattan Institute argues that specialist shortages are pushing fees up and wants rules aimed at the minority who overcharge. The committee chair, Dr Mike Freelander, said he doesn't want "a blame game". He said the inquiry will also look at practice costs, patient complexity and whether Medicare rebates need lifting.
How AMA (NSW) responded
AMA (NSW) said that nearly all specialist care is provided appropriately. It argued that an inquiry into fees which ignores Medicare's shrinking contribution is only looking at half the picture. It is calling for 1,000 more public specialists over four years and for more outpatient clinics.
Read the AMA (NSW) post on LinkedIn
My view
The patients in this story are real, and their waits are unacceptable. But fees are the most visible part of the problem, not its cause. Access and affordability depend mostly on how the system is designed: sustainable funding, workforce planning, training capacity and the ability of public hospitals to run outpatient clinics.
When the Medicare rebate falls further behind the cost of providing care each year, the gap paid by patients grows. That is arithmetic, not greed.
The projected shortage of almost 7,000 specialists by 2033 is a training problem. In my own college, the number of trainees is limited by how many government-funded posts there are in public hospitals, not by the college. Holding colleges to account will not create training places that governments have not funded.
I support better use of consultations. Formally funding GPs to get specialist advice could save patients a wait, a fee and an appointment they may not need.
Where fees are genuinely excessive, they deserve scrutiny. But reform built around a few outliers would leave the structural problems untouched. I welcome the chair's statement that this should not be about blame.
Disclosure: I have made a submission to this inquiry and will give evidence at a public hearing. I'll update this commentary afterwards.
See also: Specialist fees and access and Seven dollars and the no-gap cliff.
The views in "My view" are my own and do not represent Alfred Health, ANZCA or any other organisation with which I am associated. The reporting sections summarise the original articles, which are linked.