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Why Is Seeing A Specialist So Expensive?
●July 1, 2021●5 minute read
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Seeing a specialist in Australia can be pretty expensive, and not always covered by Medicare. According to the Department of Health, only 30% of specialists bulk-bill, compared with 85% of general practitioners (GPs) that bulk-bill their patients.
Unfortunately, there is no concrete answer as to why seeing a specialist is so expensive. However, there are speculations as to why, which we discuss below in detail.
When do you need to see a specialist?
A specialist is a doctor that is an expert in a specific field of medicine. In most cases, you will need to be referred by your GP to see a specialist. If your GP believes this is necessary, they will provide you with a written referral, which needs to be given to the specialist either prior to or at your first appointment.
You might need to see a specialist if you need specialised care that cannot be provided by your GP. While GPs are medical specialists, in other cases, a specialist is a doctor that specialises in one specific medical field. Therefore, they are able to provide you with the most suitable treatment.
What are the most common types of specialists?
There are a number of different types of medical specialists in Australia. According to the Australian Institute of Health and Welfare, these are the most common areas of practice:
- Diagnostic radiologist;
- Emergency medical professional;
- Specialist obstetrician and gynaecologist;
- General surgeon;
- Orthopedic surgeon;
- General paediatrician;
While these are the most common areas of specialty, the list goes on. However, the first five that are listed represent more than 38% of clinical specialists in Australia (as of 2015).
How much does it cost to see a specialist?
There are a few key factors that influence how much a specialist is likely to cost, including:
- Whether they work in the public or private healthcare system;
- Whether they bulk-bill via the Medical Benefits Scheme (MBS)
- Whether there is going to be a gap payment;
- Whether there are payment options available;
- Whether any costs will be covered by your private health cover (if applicable).
If you see a specialist in a public hospital as a public patient, there will be no gap payment for you to pay.
To give you an idea of how much it will cost to see one of the specialists mentioned previously, we’ve collected the prices of seeing five of the specialists listed above: anaesthetist, psychiatrist, cardiologist, dermatologist, and gastroenterologist.
If you’re having surgery, you might need an anaesthetist. Most people don’t need to pay for their anaesthesia costs, with three quarters of health funds paying the Medicare gap. For the people that do pay a gap fee, they are typically out-of-pocket 40% of the entire fee.
Though it varies between states, you will typically be required to pay anywhere from $49 to $120 out-of-pocket for an anaesthetist.
Psychiatrists are specialists in diagnosing and treating mental illness. Most psychiatrists set their own fees, so pricing can vary. However, if you are eligible for Medicare and have a written referral, you should receive a Medicare rebate. Despite this, you’ll still usually have to pay a gap-fee.
According to The Royal Australian and New Zealand College of Psychiatrists, these are the type of fees you can expect when seeing a psychiatrist for the following types of appointments:
- Assessment and GP report: $440 total with a $396.80 Medicare rebate, leaving a $43.20 gap-fee;
- Initial consultation: $400 total with a $228.20 Medicare rebate, leaving a $171.80 gap-fee;
- 30-minute consultation: $200 total with a $116.70 Medicare rebate, with a $83.30 gap-fee;
- 45-minute consultation: $300 total and a $161 Medicare rebate, leaving a $139 gap-fee.
Cardiologists are specialists at diagnosing and treating diseases and conditions of the heart and blood vessels. To see a cardiologist, you’ll need a referral from your GP. According to Better Health, costs will vary depending on the provider, and could be partly or fully covered by Medicare or private health cover.
An example of cardiologist fees is listed below:
- Initial standard consultation: $210 with a $130 Medicare rebate ($99.80 out-of-pocket);
- Review standard consultation: $120 with a $65.20 Medicare rebate ($54.80 gap-fee);
- Complex initial consultation: $315 with a rebate of $227.70 ($87.30 gap-fee).
A dermatologist specialises in diagnosing, treating, and preventing skin conditions. Some common skin conditions that can be treated by a dermatologist include skin cancer, acne, psoriasis, eczema, dermatitis, and warts.
If there is a clear distinction between a cosmetic treatment and a medically necessary treatment, you might be covered by Medicare. However, this will depend on the dermatologist, and it’s always advisable to double-check.
Here is another example of dermatologist fees:
- Initial dermatologist consultation: $265 to $315 ($76.15 rebate with a valid referral);
- Full skin examination: $215 ($38.25 rebate with a referral);
- Skin biopsy: $147 ($38.25 rebate with a referral);
Gastroenterologists treat diseases and conditions related to the digestive system and intestines, including inflammatory bowel diseases, coeliac disease, irritable bowel syndrome, and gastro-oesophageal disease. To see a gastroenterologist, you’ll also need a referral from your GP.
To give an idea of pricing, here is an example of gastroenterologist fees:
- New consultation: $235 with $132.30 rebate ($102.70 out-of-pocket);
- Follow-up consultation: $125 with $66.50 rebate ($58.50);
- New complex consultation: $340 with $231.25 rebate ($108.75);
- Follow-up complex consultation: $175 with $115.85 rebate ($59.15).
Did you know?
In many cases, diagnostic radiology or emergency medical treatments are gap-free. If you have a referral from a GP for diagnostic imaging, like an x-ray, ultrasound, or MRI, you are usually bulk-billed. In addition, emergency treatment in a public hospital as a public patient is free of charge.
So, why is it so expensive?
According to ABC News, there is no real reason that specialist fees are so high in Australia. However, they identified and discussed four potential reasons.
- Government rebates: A potential reason could be that the rebates for some procedures are set too low. However, this reason doesn’t account for the high variation in fees between specialists.
- Supply and demand: It could be solely down to the high demand for a service in a specific location.
- Market power: It could be the result of specialists using their market power to maximise their income.
- Skill-based premiums: Lastly, it could be because some specialists charge a premium for their skills. However, there’s no real way for a patient to know whether this is warranted.
Unfortunately, there isn’t a clear answer as to why seeing a specialist is so expensive. However, there are things you can do to minimise the chances of being thrown off by an expensive specialist bill:
- Ask for an itemised breakdown of your treatment;
- Ask about payment plans before you have your appointment;
- Get multiple quotes from specialists and get your referral sent to the most affordable doctor;
- Consider private health insurance.
For more tips to avoid an expensive medical bill, you can read our recent article. Want to know more about the differences between Afterpay and small loans? We’ve got you covered.
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Written by Rachel Horan
Rachel Horan is a Content Writer for Jacaranda Finance. Rachel has previously produced content for Brisbane City Council, Black & White Cabs, and Clubs Queensland. She has a Bachelor of Mass Communication with Distinction from the Queensland University of Technology.