Specialist fees and access

Many Australians now pay a substantial amount out of their own pocket to see a specialist or to have an operation, even with private health insurance. The Government has made this a priority, and 2026 has seen the most detailed public examination of specialist fees and access in a generation.

This page explains what is being examined, summarises what more than 90 organisations, clinicians and patients have told Parliament, and sets out my own view as a specialist anaesthetist working in both public and private practice. I will be giving evidence to the inquiry at a public hearing in November, and will update this page afterwards.

What the Government is examining

Three processes are running at once.

A parliamentary inquiry. In April 2026 the House of Representatives Standing Committee on Health, Aged Care and Disability, chaired by Dr Mike Freelander MP, began an inquiry into access to and affordability of medical specialists. It is examining:

access to specialists in cities and in regional and rural communities, including workforce shortages, waiting times and training;
how referral pathways work for patients, GPs and specialists;
affordability, out-of-pocket costs and how specialists set their fees;
the effect of delayed care on patients and on the wider health system; and
new models of care that might improve access.

Submissions closed on 16 October 2026, and public hearings are now under way.

A Department of Health consultation on "excessive" fees. Separately, the Department of Health, Disability and Ageing has consulted on options to address excessive specialist fee charging. Its own data show that fees above five times the typical (median) fee occur in about 0.7 per cent of in-hospital services. The options range from letters to high-charging doctors and peer review, through incentives for lower fees, to limits on what can be charged. The consultation closed on 19 October 2026.

Fee transparency legislation. In September 2026 Parliament passed laws requiring specialists' fees to be published on the Government's Medical Costs Finder website, rather than leaving publication voluntary.

The profession has also responded. The Council of Presidents of Medical Colleges has released a patient guide on fees, encouraging patients to ask for a written estimate, a second opinion and payment options, and stating openly that extreme fees cannot be defended.

Who has had their say

More than 90 submissions to the inquiry have been published on the Committee's submissions page. They come from a remarkably broad cross-section of the community:

more than 30 patients and carers, describing their own experience of waiting for and paying for specialist care;
about 25 individual doctors, from trainees and rural generalists to surgeons, physicians, paediatricians and anaesthetists;
the medical colleges and specialty societies, including the Royal Australasian College of Surgeons, the Australian and New Zealand College of Anaesthetists (ANZCA), the Australian Society of Anaesthetists (ASA) and the Rural Doctors Association of Australia;
consumer and patient organisations, including the Consumers Health Forum of Australia and disease-specific groups;
hospitals, day hospitals, pathology providers and health technology companies; and
think tanks and academics, including The Australia Institute and health economists.

I have read all of them. What follows is my summary of the broad themes, and my interpretation of what they mean.

What the submissions say

Across very different voices, seven themes recur. The most striking finding is how much patients, consumer groups and clinicians agree on.

1. The cost to patients is real

The patient submissions are the most important reading in the inquiry. They describe years on public waiting lists, repeated referrals, travel for regional families, and bills that arrived after decisions had already been made. Many were privately insured and still faced large gaps. The Department reports that more than 1.9 million Australians delayed or did not see a specialist because of cost in 2024–25.

In my view, any honest discussion has to start here. The question is not whether patients are struggling – they clearly are – but what is driving it.

2. Medicare rebates have not kept pace with the cost of care

This is the most consistent theme across clinicians, colleges and specialty societies, and several patients make the same point. In anaesthesia, the Medicare unit value rose 34.7 per cent between 2001 and 2025, while consumer prices rose 91.6 per cent (ASA). Pathology, which bulk-bills almost everything, shows the same pattern from the other side: after decades of frozen fees, its costs per test now exceed what Medicare pays.

This matters because a patient's out-of-pocket cost is simply the fee minus the rebate. When the rebate falls behind, the gap grows even where fees have only kept pace with costs. Much of what is described as rising fees is, therefore, a falling rebate.

3. Private health insurance is not delivering what members expect

Many submissions describe insured patients surprised by their bills. The colleges, the ASA and surgeons' societies point to the insurers' "known-gap" schemes, which cap the doctor's gap at around $500 per episode. That figure has not been indexed in around 25 years. If a fee exceeds the limit by even a small amount, the insurer's benefit can fall sharply, and the patient's bill can jump by hundreds of dollars.

Private health insurance sits largely outside the Department's consultation. In my view it cannot sit outside the solution.

4. Public hospitals cannot meet demand

Patients and clinicians describe public outpatient waits measured in years – for children's assessments, dermatology, neurology and many surgical conditions. For many families, a private gap is the price of not waiting. Several submissions, including from doctors who work only in public hospitals, make the point that pushing more patients back to the public system is not an option while it is already full.

5. The workforce is stretched and poorly distributed

Specialty after specialty reports shortfalls, especially outside the major cities. ANZCA reports Government modelling of an anaesthetist shortfall of more than 120 full-time equivalents now, rising to more than 1,200 by 2048. Importantly, training numbers are set mainly by funded hospital positions and supervision capacity, rather than by the colleges. More specialists will only reach patients if governments fund the posts, theatres and clinics in which they train and work.

6. Everyone wants transparency – but the form matters

Almost every submission supports clearer information about costs. Consumer groups want a single estimate for the whole episode of care before referral, covering the surgeon, the anaesthetist, the hospital and any tests. Clinicians support that, but several warn that publishing average fees can mislead, and may even push lower fees up. Anaesthesia illustrates the difficulty: fees depend on how long an operation takes and how complex it is, so an "average" anaesthetic fee tells an individual patient very little.

Patients also rarely choose their anaesthetist. That, in my view, places a particular obligation on anaesthetists to make costs clear and to keep gaps modest.

7. Extreme fees are real, few, and should be addressed

The Department's data, the colleges and many doctors agree that a small minority of fees cannot be justified. No college, specialty society or consumer organisation asks for compulsory fee caps. They differ on what should happen instead.

The Australia Institute argues that fees follow what patients can afford to pay, and that higher rebates alone would be absorbed into higher fees. It proposes linking Medicare funding to independent fee benchmarks. Most colleges and societies favour a graduated approach: written cost estimates, feedback to high-charging doctors, and independent peer review.

Both views deserve careful consideration. I believe the evidence favours the second, provided it is paired with action on rebates and insurance. A cap would, as the Department itself notes, be enforced only after the patient has paid.

My submissions

I have made two submissions to the inquiry, both available on the Committee's submissions page under my name (Submissions 14 and 14.1).

Submission 14 argues that access and affordability are, above all, questions of how the health system is designed and funded. It covers Medicare rebates, workforce and training capacity, public hospital access, private health insurance and referral pathways, and explains how anaesthetic fees are calculated.

Supplementary Submission 14.1, Beyond Specialist Fees, was written after reviewing other submissions. It asks what Australia is trying to preserve: one of the best-performing health systems in the world, at a fraction of the cost of some others. It describes the patient's gap as the visible endpoint of a much larger funding system.

The Department's consultation paper

The Department's paper rightly identifies that extreme fees exist and should be addressed. It also shows that which specialties appear to overcharge depends heavily on the benchmark used. Measured against peers, about 13 per cent of in-hospital anaesthetic services exceed twice the median fee. Measured against the Medicare Schedule Fee, the figure is about 40 per cent. An anaesthetic billed exactly within an insurer's own gap scheme already sits at more than twice the Schedule Fee. That reflects how far the Schedule Fee has fallen behind the cost of care, rather than any misconduct.

How I think excessive fees should be handled

In my view, a fee above the AMA's recommended fee should prompt a review – not an automatic finding of wrongdoing. That review should be independent, include specialty input, and give the doctor a right of reply.

For planned care, patients should receive a written estimate before admission that covers every doctor involved. Emergencies are different. When an anaesthetist steps in at short notice, or an operation is added late to a list, there is often time only for a verbal discussion. That conversation should be documented, and the patient given written information as soon as practicable. A form signed on the operating trolley protects no one.

Key messages

The gap a patient pays is the visible endpoint of the funding system. It reflects Medicare rebates, insurer benefits and public hospital capacity as much as the doctor's fee.
Extreme fees are real, few and indefensible. They should be addressed firmly and fairly, through independent review rather than blunt caps.
Rebates and insurance must be part of the answer. Without indexation of Medicare rebates and insurers' known-gap limits, the gap will keep widening regardless of how fees are regulated.
Transparency should cover the whole bill. Patients deserve to know what each doctor charges, what Medicare and their insurer will pay, and what they will pay themselves.
Access depends on capacity. Funded training posts, public clinics and operating theatres matter as much as fees.

Australia should act firmly on genuine outliers. It should not mistake the erosion of its own funding benchmarks for a problem of specialist conduct.

Take-home points for patients

Ask for a written estimate before planned surgery, covering the surgeon, the anaesthetist, any assistant and the hospital.
Ask whether your doctors use your insurer's no-gap or known-gap arrangements, and what your own gap is likely to be.
You are entitled to a second opinion, and to ask about payment plans if cost is a concern.
Ask about the public option. A public hospital may be able to treat you, although waiting times vary.
Your anaesthetist is happy to talk about fees. If you have not received information about the anaesthetic cost before your operation, please ask. See also Fees & Accounts.