Medicare data reveal alarming out of pocket costs to see a specialist

Wednesday, January 22, 2020

Official Medicare data released in response to an October 2019 Senate Estimates Question on Notice reveal the shocking truth about out-of-pocket costs to see specialists in Australia, says Australian Healthcare and Hospitals Association Chief Executive Alison Verhoeven.

‘The data, released according to electorate, show, for example, that anyone in the ACT will pay an average of over $100 out of their own pocket every time they see a specialist.

‘In New South Wales, 28 electorates out of 45 have average costs of over $90 per visit, with eight electorates above the $100 per visit mark.

‘The other states and territories do not fare much better, except for Tasmania and South Australia, and even then, the average out-of-pocket cost per visit is in the $60–$70 range.

‘And let us not forget that an average is an average—many people will be paying much more than these amounts every single time they visit a specialist.

‘The data also show that these out-of-pocket costs have been easily outstripping inflation and income growth every year over the last 7 years.

‘Also shocking are the bulk-billing rates for specialist attendances. In some electorates fewer than 1 in 5 patients are always bulk-billed by specialists. Even in the electorate with the best bulk-billing rates, less than half of people attending specialists are always bulk-billed.

‘Another shock is that these data have been available for several years but never published. They reveal that what we all suspected was true—attending a specialist can be crippling in terms of out‑of‑pocket costs.

‘Instead of revealing the truth we have a glossy government website, ‘Medical costs finder’, which, while well-intentioned, glosses over the actual out-of-pocket pain for patients suffering serious medical conditions.

‘How can we claim to have a universal health system when bulk-billing rates for specialists are so low and out-of-pocket costs so high? 

‘When Health Minister Greg Hunt was appointed, he named Medicare as one of his four pillars of his long-term national health plan. These data expose some major cracks in  the Medicare pillar, which no glossy website can cover up.

‘It is plain that we have a massive problem with specialist costs in Australia, which should be an immediate priority for the incoming Secretary of the Health Department, Professor Brendan Murphy.

‘The data also reveal bulk-billing rates and out-of-pocket costs for attending GPs, by electorate. These data also reveal what we know to be the truth—while there is a high rate of bulk-billed attendances, when it comes to the percentage of patients always bulk-billed the picture is not rosy, and varies hugely according to where you live, with average out-of-pocket costs for people not bulk-billed exceeding $40 per visit for many electorates’, Ms Verhoeven said.

More information on AHHA is available at

The Australian Healthcare and Hospitals Association is the national peak body for public and not-for-profit hospitals, Primary Health Networks, and community and primary healthcare services.

Media enquiries:  Alison Verhoeven, Chief Executive, AHHA

0403 282 501