More than 2.2 million Australians were charged specialist fees classified as extreme in 2025, according to a Grattan Institute report published on Sunday, November 8. The policy thinktank identified psychiatrists and paediatricians among the specialists most likely to routinely charge unreasonably high amounts and called for regulation to improve access to care.
The report defines an extreme charge as at least three times the Medicare schedule fee, the government's benchmark price. It found that another 250,000 patients face such charges each year. Declining rebates and business expenses explained only a small part of fee growth, the researchers said. Between 2012 and 2025, Medicare rebates declined by $9 in real terms while average patient fees increased by $37. Average specialist fees rose 4% above inflation in 2025 alone.
Among the most expensive 5% of psychiatrists, the median out-of-pocket charge for a first appointment was $669. The corresponding figures for high-cost paediatricians and cardiologists were $362 and $265.11. Those charges exceeded their peers' fees by 104%, 212% and 203%, respectively. Across initial consultations, median dermatology fees increased by $28 to $217.80 between 2023 and 2025, while psychiatry fees climbed $90 to $351, both outpacing inflation.
The institute proposed requiring specialists whose annual fees average more than three times the Medicare schedule fee to reimburse the government for every rebate claimed that year. Patients would retain their rebates. About 2,000 doctors, roughly 6% of specialists nationally, would be affected, including more than 60% of private dermatologists and one-quarter of obstetrician-gynaecologists.
Bulk-billing covered fewer than one-quarter of initial specialist consultations in 2025. In urology, dermatology, psychiatry and ear, nose and throat care, the proportion was below 10%. Dr Elizabeth Deveny, chief executive of the Consumers Health Forum, said patients were increasingly limiting their care or missing follow-up appointments because of costs. She said a two-year public waiting list could leave people feeling they had no alternative but to pay.
Health economist Peter Breadon, the report's lead author, said clearer pricing information would help but could not repair the market by itself. He argued that specialist shortages, lengthy public waits and difficulties assessing the quality of care weakened the pressures that would normally restrain prices. Appeals for doctors to regulate their own fees had failed to reverse the longstanding trend, he said.
Legislation passed in September will allow the government to publish all specialists' fees on the Medical Costs Finder website from 2027. Participation has previously been voluntary. Since the website began in 2019, only about 100 of the 6,300 eligible specialists have publicly provided their fees.
Other recommendations include annual investment of $500 million by federal and state governments to expand public hospital outpatient clinics. The institute also called for advice lines allowing GPs to consult specialists quickly, potentially avoiding referrals, waiting periods and fees, alongside compulsory training quotas for medical colleges.
Federal health minister Mark Butler told Guardian Australia that all options remained under consideration to curb rising specialist charges. The government has formed a specialist affordability working group to advise on changes, with Breadon among its members.
Dr Julian Kelly, president-elect of the Royal College of Physicians, said the organisation would support government regulation addressing extreme fees. He said excessive charges that obstruct access or impose unreasonable financial pressure were indefensible, and that improving affordability and access should remain a national priority.
