Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Well, there's a new report which paints a bleak picture
of specialist care in Australia, where people are suffering unnecessary
illness and pain as they q for care or struggle
to pay for it. The report, which has been put
together by the Gratten Institute, found that more than one
in five Australians who saw a specialist in twenty twenty
(00:21):
three were charge a fee deemed extreme, defined as costs
that are on average more than three times the Medicare
schedule fee. Now joining us on the line is the
Gratton Institute Health Program Director Peter Braden. Good morning to you. Peter.
Good morning Peter, Thanks so much for your time. Can
(00:41):
you tell me more about what the report looked into.
Speaker 2 (00:45):
Well, we looked at how many Australians are saying they
can't get the specialist care that typically their GP has
recommended they need, and it's about two million Australians. Half
of those say they're not getting care because of the cost.
And we found that those costs have skyrocketed. So not
only two entry times you go to a specialist clinic
(01:07):
in the private sector you charged a fee. Those fees
have gone up by seventy three percent since twenty ten,
and as you mentioned, in some cases they're really high.
But that's not the only problem. If you've got a
high fee, you might identifind that well. The only alternative
is a really long wait list in the public system
where you might be stuck waiting for months or even
(01:28):
a year for the care you need.
Speaker 1 (01:31):
I mean, Peter, it is something that we've spoken about
on this show on numerous occasions. And you know, not
only the costs, but more so the weight times in
parts of Australia like Darwin, you know, even more regional
and remote. You know, talk me through some of the
examples that you found in relation. I guess, first off,
(01:53):
to those specialist costs, it.
Speaker 2 (01:57):
Will half of initial psychiatry consultationations cost more than two
hundred and forty dollars, and for arnos and throat specialists
it's one hundred and sixty dollars. And then a small
number of specialists are charging fees you know, way way
higher than that. So you know, for the fees we
call extreme, which is three times charging a patient three
(02:17):
times what the government pays. That's three hundred and sixty
dollars for cardiologists or pediatrician it's six hundred and seventy
dollars for a psychiatrists And as you mentioned, it's really
a lot of rural and regional communities that are hit
hardest in terms of not being able to get care.
So the level of care per person falls away quickly
(02:39):
once you leave cities, and in half of remote and
very remote areas there's only one specialist service per per year.
And in no part of a major city do you
see those extremely low levels of care.
Speaker 1 (02:56):
Peter talked me through, like, obviously the cost is exorbitant
for a lot of people wanting to go and see
a specialist, but you're sort of touched on this as well.
Then for regional and more remote parts of Australia when
you look at the wait times like that is also
astronomical for people even if they're going through the private system.
Speaker 2 (03:16):
That's right, Yeah, the wait times are really long, even
on the private side, and that's because those levels of
care are just too low to provide the care that
everyone in a community needs. So we found that in
the best served areas of Australia, the area with the
highest level of care that's Eastern Sydney, that's got about
a third more services per person than the worst served areas,
(03:40):
which are places like our back wa out Back End,
TSA and Queensland. So that means, yeah, you're just gonna
have to wait longer because there isn't enough care in
the community and across the country, as you see private
clinics fall away and you have less private care, the
public system isn't stepping up to fill the gap. So
(04:01):
the level of public care it's a bit higher in
those underserved communities, but it's not getting them up to
the level of the rest of the country by any means.
So we've called for a million new appointments and really
importantly that's in the public system. They have to be
targeted in those communities that have too little care because
a lot of the investment is just based on where
(04:21):
it is today. It's not expanding it where it's needed most.
Speaker 1 (04:25):
I mean what you just touched on the you know
what you are calling for as a result of this
report in terms of other recommendations and where you go
to from here with this report, I mean, has it
been presented to the federal government. Is it being presented
to you to state and territory governments as well, so
that they can have a closer look. I guess in
(04:46):
some ways people know what the problems are, but I
don't know whether the issues are exasperated because it's hard
to get specialists to regional and remote parts of Australia,
or whether their costs arising. Did it look into that
kind of thing.
Speaker 2 (05:00):
Yes, it did look into those things, and it is
harder sometimes to get specialists to work in these areas.
We talked about some ways to tackle that, so, you know,
using more virtual and remote care. You know, we set
clinician on the ground to help people, but with specialists
staling in there could be a lot more of that.
And we looked at how public clinics operate across Australia
(05:21):
and it's very very Some of them use a lot
of virtual care, some of them don't, so we think
there's a lot of opportunity to expand that. And yeah,
I mean one of the big challenges is training. So
you know, for we know that one of the best
ways to get doctors in rural and remote communities is
to train them there that way, and they're putting down
(05:43):
routes and they're more likely to stay in the community.
But that's really low for specialists in the last couple
of decades, we've seen more of those undergraduate students doing
their initial medical qualification getting trained in rural areas. And
we're starting to see a growth in you know, in
GPS taking a rural track and so on, but it
hasn't gone for other kinds of specialists. So we're saying
(06:04):
the government needs to get a target, a minimum level
for the different specialties that are in undersupply in rural
areas to be trained in rural areas, and then they
need to type the funding that they give to hospitals
to actually providing that training where it's needed. So that
will help, and the new funding targeted to these communities
will help. And then using the new technology putting that together,
(06:27):
we hope you get a lot more supply of care
in these areas.
Speaker 1 (06:30):
Yeah, look, I think we all hope. So can I
ask Peter in terms of, you know, the cost to
see specialists and you know, whether it means people are
foregoing seeing specialists, and particularly you know, when you look
at at people battling things like cancer, what kind of
impact is it having.
Speaker 2 (06:53):
It's really serious because you've got to remember people don't
go to the specialist out of the blue. They get
a referral from a GP, So a doctor is saying,
you need to go and see this other kind of
specialist to get you know, really focused expertise on whatever
it might be, a cancer, a heart issue, a mental
health issue. So, yeah, they don't give out these referrals
(07:14):
on a whim. And if you miss that care, the
risks are really high. So you might delay a diagnosis
and an underlying get worse. You know, you might be
not on the right medication or not managing a condition
in the best way and you get sicker. So down
the track, you know, there's a real risk that people
end up in hospital or worse because they didn't get
(07:35):
that specialist care.
Speaker 1 (07:36):
Yeah, like, do we think that the reason why you know,
we've seen sort of these costs go up and you know,
not as many specialists. Is it something that sort of
happened post COVID? Is it just something that's happened over
recent years? What do you reckon the reason for it is?
Speaker 2 (07:53):
I think it's been brewing for a long time. We've
actually had a lot of expansion of specialists, but we
haven't had the policy in place to make sure that
that growth in specialists is in the types of specialists
that are undersupplied, so psychiatrists, dermatologists, ophsalmologists. We've had too
few of those being trained for decades now. And then,
as I mentioned, you know, we're not getting a training
(08:14):
in the rural areas either, So I think that's been
a problem. It's kind of been a system left to
run on autopilot. We've been largely investing in public clinics
where they've been before. We've been largely churning out the
trainees that it suits hospitals to train right now to
meet their service delivery needs, and that colleges are willing
(08:37):
to credit the places for. So it just needs much
more planning and a much more assertive effort to sort
of shape the supply of specialists where they work and
the fees they charge, which are currently totally unregulated.
Speaker 1 (08:51):
Well, look, I think it's a really interesting discussion to have.
I think it's, you know, something that a lot of
our listeners are going to be concerned with. I know
someone's just messaged in and said, Katie my son's my
son just had to spend nine hundred dollars for a
short initial appointment with a psychiatrist with a short follow
up appointment. So you know, I guess here in the
(09:12):
end we do see some of those costs, you know,
astronomical for people, but then it's also a matter of
not even being able to get in to see somebody
for quite a long period of time.
Speaker 2 (09:25):
That's right. I think it is reaching a crisis point
for many communities. And it's really important to note that
thieves like that, they're really it's pretty impossible to see
a justification. Certainly some specialists, they might have more experience,
they might have higher rent, they might treat tougher patients,
whatever it is. But it's really hard. There's no evidence
(09:46):
to say that that costly care is better than less
costly care. I mean, that's not borne out by the facts.
And clearly specialists average specialists and a really good income
compared to every other occupation in the country. And then
and then on top of that, you know, these people
who are charging high and an average fees at earning
even more. So it's not a case of them not
being paid enough in my view, at that end, at
(10:08):
extreme end of outlier fees. But yeah, I think we
definitely need change. It's a terrible story to hear. I'm
sure that person who messaged in had to make some
really tough decisions about how to afford that care for
their son.
Speaker 1 (10:21):
Yeah, you're spot on. Well, a really interesting discussion this
morning with you, Peter. I appreciate your time. Thank you
very much for having a chat with me the pleasure. Thanks,
thank you, Thanks so much.
Well, there's a new report which paints a bleak picture
of specialist care in Australia, where people are suffering unnecessary
illness and pain as they q for care or struggle
to pay for it. The report, which has been put
together by the Gratten Institute, found that more than one
in five Australians who saw a specialist in twenty twenty
(00:21):
three were charge a fee deemed extreme, defined as costs
that are on average more than three times the Medicare
schedule fee. Now joining us on the line is the
Gratton Institute Health Program Director Peter Braden. Good morning to you. Peter.
Good morning Peter, Thanks so much for your time. Can
(00:41):
you tell me more about what the report looked into.
Speaker 2 (00:45):
Well, we looked at how many Australians are saying they
can't get the specialist care that typically their GP has
recommended they need, and it's about two million Australians. Half
of those say they're not getting care because of the cost.
And we found that those costs have skyrocketed. So not
only two entry times you go to a specialist clinic
(01:07):
in the private sector you charged a fee. Those fees
have gone up by seventy three percent since twenty ten,
and as you mentioned, in some cases they're really high.
But that's not the only problem. If you've got a
high fee, you might identifind that well. The only alternative
is a really long wait list in the public system
where you might be stuck waiting for months or even
(01:28):
a year for the care you need.
Speaker 1 (01:31):
I mean, Peter, it is something that we've spoken about
on this show on numerous occasions. And you know, not
only the costs, but more so the weight times in
parts of Australia like Darwin, you know, even more regional
and remote. You know, talk me through some of the
examples that you found in relation. I guess, first off,
(01:53):
to those specialist costs, it.
Speaker 2 (01:57):
Will half of initial psychiatry consultationations cost more than two
hundred and forty dollars, and for arnos and throat specialists
it's one hundred and sixty dollars. And then a small
number of specialists are charging fees you know, way way
higher than that. So you know, for the fees we
call extreme, which is three times charging a patient three
(02:17):
times what the government pays. That's three hundred and sixty
dollars for cardiologists or pediatrician it's six hundred and seventy
dollars for a psychiatrists And as you mentioned, it's really
a lot of rural and regional communities that are hit
hardest in terms of not being able to get care.
So the level of care per person falls away quickly
(02:39):
once you leave cities, and in half of remote and
very remote areas there's only one specialist service per per year.
And in no part of a major city do you
see those extremely low levels of care.
Speaker 1 (02:56):
Peter talked me through, like, obviously the cost is exorbitant
for a lot of people wanting to go and see
a specialist, but you're sort of touched on this as well.
Then for regional and more remote parts of Australia when
you look at the wait times like that is also
astronomical for people even if they're going through the private system.
Speaker 2 (03:16):
That's right, Yeah, the wait times are really long, even
on the private side, and that's because those levels of
care are just too low to provide the care that
everyone in a community needs. So we found that in
the best served areas of Australia, the area with the
highest level of care that's Eastern Sydney, that's got about
a third more services per person than the worst served areas,
(03:40):
which are places like our back wa out Back End,
TSA and Queensland. So that means, yeah, you're just gonna
have to wait longer because there isn't enough care in
the community and across the country, as you see private
clinics fall away and you have less private care, the
public system isn't stepping up to fill the gap. So
(04:01):
the level of public care it's a bit higher in
those underserved communities, but it's not getting them up to
the level of the rest of the country by any means.
So we've called for a million new appointments and really
importantly that's in the public system. They have to be
targeted in those communities that have too little care because
a lot of the investment is just based on where
(04:21):
it is today. It's not expanding it where it's needed most.
Speaker 1 (04:25):
I mean what you just touched on the you know
what you are calling for as a result of this
report in terms of other recommendations and where you go
to from here with this report, I mean, has it
been presented to the federal government. Is it being presented
to you to state and territory governments as well, so
that they can have a closer look. I guess in
(04:46):
some ways people know what the problems are, but I
don't know whether the issues are exasperated because it's hard
to get specialists to regional and remote parts of Australia,
or whether their costs arising. Did it look into that
kind of thing.
Speaker 2 (05:00):
Yes, it did look into those things, and it is
harder sometimes to get specialists to work in these areas.
We talked about some ways to tackle that, so, you know,
using more virtual and remote care. You know, we set
clinician on the ground to help people, but with specialists
staling in there could be a lot more of that.
And we looked at how public clinics operate across Australia
(05:21):
and it's very very Some of them use a lot
of virtual care, some of them don't, so we think
there's a lot of opportunity to expand that. And yeah,
I mean one of the big challenges is training. So
you know, for we know that one of the best
ways to get doctors in rural and remote communities is
to train them there that way, and they're putting down
(05:43):
routes and they're more likely to stay in the community.
But that's really low for specialists in the last couple
of decades, we've seen more of those undergraduate students doing
their initial medical qualification getting trained in rural areas. And
we're starting to see a growth in you know, in
GPS taking a rural track and so on, but it
hasn't gone for other kinds of specialists. So we're saying
(06:04):
the government needs to get a target, a minimum level
for the different specialties that are in undersupply in rural
areas to be trained in rural areas, and then they
need to type the funding that they give to hospitals
to actually providing that training where it's needed. So that
will help, and the new funding targeted to these communities
will help. And then using the new technology putting that together,
(06:27):
we hope you get a lot more supply of care
in these areas.
Speaker 1 (06:30):
Yeah, look, I think we all hope. So can I
ask Peter in terms of, you know, the cost to
see specialists and you know, whether it means people are
foregoing seeing specialists, and particularly you know, when you look
at at people battling things like cancer, what kind of
impact is it having.
Speaker 2 (06:53):
It's really serious because you've got to remember people don't
go to the specialist out of the blue. They get
a referral from a GP, So a doctor is saying,
you need to go and see this other kind of
specialist to get you know, really focused expertise on whatever
it might be, a cancer, a heart issue, a mental
health issue. So, yeah, they don't give out these referrals
(07:14):
on a whim. And if you miss that care, the
risks are really high. So you might delay a diagnosis
and an underlying get worse. You know, you might be
not on the right medication or not managing a condition
in the best way and you get sicker. So down
the track, you know, there's a real risk that people
end up in hospital or worse because they didn't get
(07:35):
that specialist care.
Speaker 1 (07:36):
Yeah, like, do we think that the reason why you know,
we've seen sort of these costs go up and you know,
not as many specialists. Is it something that sort of
happened post COVID? Is it just something that's happened over
recent years? What do you reckon the reason for it is?
Speaker 2 (07:53):
I think it's been brewing for a long time. We've
actually had a lot of expansion of specialists, but we
haven't had the policy in place to make sure that
that growth in specialists is in the types of specialists
that are undersupplied, so psychiatrists, dermatologists, ophsalmologists. We've had too
few of those being trained for decades now. And then,
as I mentioned, you know, we're not getting a training
(08:14):
in the rural areas either, So I think that's been
a problem. It's kind of been a system left to
run on autopilot. We've been largely investing in public clinics
where they've been before. We've been largely churning out the
trainees that it suits hospitals to train right now to
meet their service delivery needs, and that colleges are willing
(08:37):
to credit the places for. So it just needs much
more planning and a much more assertive effort to sort
of shape the supply of specialists where they work and
the fees they charge, which are currently totally unregulated.
Speaker 1 (08:51):
Well, look, I think it's a really interesting discussion to have.
I think it's, you know, something that a lot of
our listeners are going to be concerned with. I know
someone's just messaged in and said, Katie my son's my
son just had to spend nine hundred dollars for a
short initial appointment with a psychiatrist with a short follow
up appointment. So you know, I guess here in the
(09:12):
end we do see some of those costs, you know,
astronomical for people, but then it's also a matter of
not even being able to get in to see somebody
for quite a long period of time.
Speaker 2 (09:25):
That's right. I think it is reaching a crisis point
for many communities. And it's really important to note that
thieves like that, they're really it's pretty impossible to see
a justification. Certainly some specialists, they might have more experience,
they might have higher rent, they might treat tougher patients,
whatever it is. But it's really hard. There's no evidence
(09:46):
to say that that costly care is better than less
costly care. I mean, that's not borne out by the facts.
And clearly specialists average specialists and a really good income
compared to every other occupation in the country. And then
and then on top of that, you know, these people
who are charging high and an average fees at earning
even more. So it's not a case of them not
being paid enough in my view, at that end, at
(10:08):
extreme end of outlier fees. But yeah, I think we
definitely need change. It's a terrible story to hear. I'm
sure that person who messaged in had to make some
really tough decisions about how to afford that care for
their son.
Speaker 1 (10:21):
Yeah, you're spot on. Well, a really interesting discussion this
morning with you, Peter. I appreciate your time. Thank you
very much for having a chat with me the pleasure. Thanks,
thank you, Thanks so much.
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