Australia’s peak medical organization has raised concerns that proposed reforms targeting specialist fees could inadvertently harm both doctors and patients by failing to address underlying issues driving high healthcare costs.

The Australian Medical Association (AMA) acknowledges that excessive fees by a small number of specialists are a legitimate concern, contributing to increased out-of-pocket expenses for patients and undermining trust in the healthcare system. However, the AMA maintains that such cases are not widespread and cautions that the current reform proposals risk unfairly attributing systemic funding challenges solely to medical practitioners.

“The profession is keen to work with the government to tackle excessive fees, and we have put forward constructive ideas for consideration,” said AMA vice-president Julian Rait. He emphasized that any measures to limit fees must be targeted, evidence-based, and accompanied by broader reforms aimed at improving affordability across the healthcare sector.

The AMA contends that factors influencing out-of-pocket costs extend beyond specialist fees and include broader issues such as inadequate Medicare rebates, insurer fee schedules, shortages in specialist training places, and insufficient specialist services within public hospitals. The association warns that the government’s “heavy-handed” approach could discourage some doctors from offering bulk-billing, potentially reducing patient access to affordable care.

The Australian government is currently reviewing how specialist fees are set, with the objective of identifying ways to curb what it describes as “excessive” charges. A consultation paper released by the government outlined potential options for reform and has invited submissions from stakeholders.

According to the government, concern centers on a minority of providers who may be charging fees above reasonable levels for essential health services. To address this, three potential methods have been proposed to define “excessive fees”:

1. A “reasonableness” standard, which would involve a subjective, case-by-case assessment of fees.

2. Peer comparison, benchmarking fees against those charged by other providers in the market.

3. A benchmark comparison, evaluating fees relative to the Medicare Benefits Schedule (MBS) fees.

The government recognizes limitations inherent in the second and third approaches and suggests that a combination of these methods may be more effective in identifying unreasonable charges.

While the government believes these reforms will help stamp out excessive charges, the AMA argues that without concurrently addressing funding shortfalls and systemic pressures, the proposals risk unintended consequences that could ultimately leave patients worse off.