High fees not new but some are 'excessive'

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High out-of-pocket costs are not a new issue but a minority of medical specialists are charging "excessive" fees, according to Commonwealth Chief Medical Officer Professor Brendan Murphy.

Professor Murphy made the comment during a roundtable discussion, hosted by ABC Radio, that also included Private Healthcare Australia CEO Dr Rachel David and Dr John Quinn from the Royal Australasian College of Surgeons.

Dr Quinn said most specialists are charging appropriate fees but the College is "upset and concerned" about "excessive fees and playing on the vulnerable and sometimes exploiting patients and their families in a vulnerable period of their life."

He added that some people might think higher fees mean a better service but that is "not necessarily the case and almost certainly not the case with surgery."

"The fact that you may pay more for a surgeon does not guarantee a better outcome or better experience or anything better than the public hospital system where it will cost you nothing - nothing at all - and you will get a first class, first-rate service," said Dr Quinn.

Dr David said from the perspective of private health insurers, approximately one in every hundred claims are related to very high fees "and they tend to be clustered in particular areas - particular people that are working in very high-income areas."

"And where we have the issue - where it becomes most difficult is in those treatment areas where there is a lot of emotion attached to them like cancer, and there are a couple of forms of cancer treatment where we have heard where people can experience quite high gaps if they go to particular people."

Professor Murphy said most specialists are "pretty good" at providing financial information but only after the initial consultation. 

"Once you have had that initial consultation, you are in a very difficult relationship position where it is quite hard to pull out. You have decided on the surgery, you may have cancer, and suddenly you find that you are going to be charged $10,000 out-of-pocket.

"It is pretty difficult to then extricate yourself from that situation and go back to your GP and get a referral to someone who might charge $1.000 or nothing out-of-pocket."

Professor Murphy said transparency is key to ensure general practitioners are able to refer patients to specialists with the relevant information on fees. 

Health minister Greg Hunt announced earlier this year the government would fund the development of a national searchable website to provide the public with greater access to information about the costs of specialist services.

The announcement followed the release of a report from the ministerial advisory committee on out-of-pocket costs comprised of stakeholders and chaired by Professor Murphy.

Professor Murphy said the government is also working to emphasise the absence of any relationship "at all between fees charged and the quality of care."

"We have a very, very well-trained health system in Australia and there is no relationship between higher fees and higher quality care."

He continued, "Medicine, unfortunately, does not normally behave like a market, so transparency is absolutely critical. And we do have now in some specialities - certainly in the big cities - a very good, in fact arguably an over-supply of some specialists. So choice and competitive pressure may then influence some of the outlier fees."

Dr Quinn said the College approached around 60 surgeons in the past year regarding potentially excessive fees. "...and many of those have changed their fee when there has been discussion with the patient and the College of Surgeons," he said.