“It looks systematic – it’s not as if there’s just one electorate … where it’s all going up.”
He said specialists were more powerful than GPs, whose out-of-pocket fees increased by 32 per cent to an average $37.62 in the same period, and were subject to less competition.
More than two-thirds of specialist attendances attracted an out-of-pocket fee in 2018-19, with only 31.97 per cent bulk billed.
The data, which is based on the electorate of the patient, does not include the out-of-pocket cost of having a surgical procedure, which can run into the tens of thousands of dollars including anaesthetist and hospital fees.
Health Minister Greg Hunt has promised to tackle specialist “bill shock” by setting up a fee transparency website, due to go live by the end of December, after it emerged patients were turning to crowd-funding websites to raise cash for life-saving surgery.
The chance of having to pay an out-of-pocket fee to see a specialist – and how much – varies significantly depending on where Australians live.
Specialists were the least likely to bulk bill patient consultations in the wealthy electorates of Curtin (WA), Moore (WA), Warringah (NSW), MacKellar (NSW), Tangney (WA), Bradfield (NSW), Ryan (Qld), Kooyong (VIC), Goldstein (VIC) and North Sydney (NSW), doing so in between 10.3 per and 13.7 per cent of cases.
The 10 most expensive electorates in which to see a specialist, with average out-of-pocket fees of between $100.99 and $109.90, were all in NSW and the ACT: Sydney, Wentworth, North Sydney, Fenner, Grayndler, Canberra, Kingsford Smith, Warringah, Reid and Bradfield.
The largest increase was in the rapidly gentrifying inner-north Melbourne electorate of Wills, encompassing Brunswick and Coburg, where the average out-of-pocket cost increased by 61 per cent to hit $80.50.
There were also significant increases in the rural Victorian electorates of Bendigo (up 58.9 per cent to $76.30), Corangamite (up 58.6 per cent to $72.01) and Corio (up 58.2 per cent to $69.71).
Australian Medical Association president Tony Bartone said the proportion of medical visits that were bulk billed was “not a marker of how good the health system is” and that both GPs and specialists had suffered under five years of frozen Medicare rebates.
Specialist out-of-pocket fees accounted for just 13 per cent of Australians’ medical expenses, Dr Bartone said, behind non-PBS medicines (30 per cent) and dental treatment (20 per cent).
Consumers Health Forum chief executive Leanne Wells said the data appeared to reflect “what consumers are prepared or able to pay … with those in better-off suburbs paying more”, but that people living in lower socio-economic areas were less likely to be able to access or afford a specialist.
Labor’s health spokesman Chris Bowen said the increase in out-of-pocket costs was “a damning indictment of the Liberals’ record of cuts and neglect in health”, saying Prime Minister Scott Morrison had extended the Medicare rebate freeze, introduced by Labor, when he was Treasurer.
The data also shows that while 85 per cent of GP visits were bulked billed, only 65.4 per cent of patients had every GP visit bulk billed in 2018-19 – up from 60.43 per cent in 2012-13 – reflecting the trend of chronically ill older Australians making frequent visits to bulk-billing GPs.
Mr Hunt was contacted for comment.
Dana is health and industrial relations reporter for The Sydney Morning Herald and The Age.