Three out of four patients pay out of pocket when they see a specialist, with two in five paying $201 or more.
The health system is moving from “universal” to a “user pays partially insured system”, says patient advocacy group Patients Australia.
Today, PA (formerly the Australian Patients Association), in partnership with La Trobe University, released its 2025 Patient View Report.
The report, which surveyed 5451 patients about GP and non-GP specialist care, found that 62% of patients paid out of pocket when seeing their GP.
Almost half of these patients paid an average gap fee of $51 or more.
Over 90% of patients felt that private health insurance should cover GP out-of-pocket costs and almost half of those surveyed felt the gap was unreasonable.
The report said that the public was “rapidly losing a once cherished feature of healthcare in this country”.
“We are moving from a ‘universal’ system where care can be accessed by anyone at any time to a ‘user pays’ partially insured system in which health practitioner out-of-pocket costs are becoming a major barrier to essential care,” read the report.
According to the Australian Institute of Health and Welfare, the bulk billing rate was 78% in 2024.
While the recent $8.5 billion investment in general practice was welcomed, the authors of the PA report said more needed to be done “to strengthen consumer protections and ensure the long-term affordability of specialist care for Australian patients”.
Outside of general practice, almost three out of four patients paid out-of-pocket fees to see specialists in private rooms, two fifths of whom were paying $201 or more.
The research found that one in five patients were skipping specialist appointments or declining treatment due to cost.
By law, health insurers are unable to cover specialists’ costs unless they happen during hospital admission.
According to Private Healthcare Australia CEO Dr Rachel David, while most specialist doctors charged fairly, there was evidence that inappropriate fees were increasing.
“We have heard reports of people being charged more than $950 for a single visit to a psychiatrist and more than $650 for a single visit to an obstetrician,” she said.
“This is understandably putting people off seeing specialist doctors when they need to, and it’s clearly putting untold numbers of people at risk of worsening health and crises that land them in hospital.
“It’s also wreaking havoc for private hospitals because people need to be able to see a specialist doctor to get referred into a private hospital for treatment.
“With 20% of people referred to a specialist doctor skipping attendance or declining treatment due to the cost, it is no wonder some private hospitals are struggling, and private hospital beds are sitting empty.
“We must get specialist doctors charging more reasonable fees if we want to address this unbalanced use of our hospital resources.”
PHA called for the federal government to step in with measures to remedy the disconnect, including an opt-out system for Medical Cost Finder.
“There was bipartisan political support for the ‘No Surprises Act’ in the US, so consumers can confidently proceed with healthcare knowing they won’t get a financial shock at the end,” said Dr David.
“If people do not receive a proper quote for out-of-pocket costs well in advance of planned surgery, or if financial consent is not provided or provided under duress, they should not be obliged to pay.”
Patients Australia’s ambassador for health reform Dr Nick Coatsworth said there was a “serious deficiency” in protection for patients.
“Whilst not all doctors practice in this way, this survey shows that there it is of a scale that warrants intervention by government to protect healthcare consumers.
“Billing practices that are invisible to government need to be banned, and we need to do that because it’s impossible to assess impact of taxpayer-funded Medicare rebate increases unless every doctor is transparent about their out-of-pocket fees.”
