Australia: More than 2.2 million Australians paid extremely high out-of-pocket fees for specialist medical consultations in 2025, with psychiatrists and paediatricians among the specialists most likely to charge significantly above government benchmarks, according to a new report by the Grattan Institute.
The report, titled Out of Control – How to Rein in Runaway Specialist Fees, highlights the growing financial burden on patients seeking specialist healthcare and calls for stronger government intervention to address rising medical costs.
It defines an extreme fee as a charge that is at least three times the official Medicare schedule fee, which serves as the government’s benchmark for medical services. The report found that the number of patients facing such charges is increasing, with an additional 250,000 Australians affected each year.
The findings also challenge claims that rising specialist fees are primarily driven by inadequate government rebates and business operating costs. Between 2012 and 2025, Medicare rebates declined by an inflation-adjusted $9, while average patient fees increased by $37, more than four times the reduction in government support. Specialist consultation fees also rose by 4 percent above inflation in 2025.
Psychiatrists and paediatricians among highest chargers
The report identified substantial differences in consultation fees across medical specialties. The most expensive 5 percent of psychiatrists charged a median out-of-pocket fee of $669 for an initial consultation. Among high-cost paediatricians, the median fee reached $362, while high-cost cardiologists charged $265.11.
These charges were significantly higher than those of their peers, with the most expensive specialists charging 104 percent more in psychiatry, 212 percent more in paediatrics and 203 percent more in cardiology.
Initial consultation fees have also increased considerably in recent years. Between 2023 and 2025, the median fee for an initial dermatology consultation increased by $28 to $217.80, while psychiatry consultations recorded a $90 increase to reach $351.
Access to bulk-billed specialist consultations remains limited. In 2025, fewer than one in four initial specialist consultations were bulk-billed. The proportion was below 10% in urology, dermatology, ear, nose and throat medicine, and psychiatry.
Grattan Institute calls for stronger regulation
Lead report author and health economist Peter Breadon stated that greater transparency around specialist fees would be important but insufficient to address the underlying problems in the healthcare system.
The report recommends requiring specialists whose average annual fees exceed three times the Medicare schedule fee to repay all Medicare rebates claimed during that year, while allowing patients to retain their rebates. The proposed measure would affect approximately 6 percent of specialists nationwide, or around 2,000 doctors.
It also recommends that federal and state governments invest $500 million annually to expand public hospital outpatient services, introduce advice lines enabling general practitioners to consult specialists without referring patients, and establish binding medical training quotas to increase the supply of specialists.
The report further highlights the importance of making specialist fees publicly accessible. Legislation passed in September will allow the government to publish specialist fees through its Medical Costs Finder website from 2027.
Government considers measures to address rising costs
Consumers Health Forum CEO Dr. Elizabeth Deveny warned that increasing consultation costs were forcing Australians to delay follow-up appointments or avoid medical care altogether. Dr. Deveny remarked that some patients were left with little choice but to pay high private consultation fees because public specialist waiting lists could extend to two years.
Federal Health Minister Mark Butler noted that the government was considering all available options to control rising specialist fees. A specialist affordability working group has also been established to advise on potential reforms, with Breadon among its members.
Meanwhile, Royal Australasian College of Physicians president-elect Dr. Julian Kelly added that the organisation supported government action to address excessive charges that create financial barriers to healthcare.
He stressed that unreasonable specialist fees were unacceptable and that improving affordability and access to medical services must remain a national priority.
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