A Grattan Institute report estimates that 2.2 million Australians paid “extreme” specialist fees in 2025, with psychiatrists and paediatricians among those most likely to charge well above their peers.

The report, released Nov. 8, defines an extreme fee as at least three times the government’s Medicare schedule fee. According to reporting by Melissa Davey in Guardian Australia, the thinktank found that an additional 250,000 patients are paying such fees each year.

The institute concluded that declining government rebates and business operating costs explain only a fraction of specialist fee increases. Between 2012 and 2025, Medicare rebates fell by $9 in real terms, while specialists increased patient fees by an average of $37. Average specialist fees rose another 4% above inflation in 2025.

Among the most expensive 5% of psychiatrists, the median out-of-pocket charge for an initial consultation was $669. The corresponding figures for high-cost paediatricians and cardiologists were $362 and $265.11. All amounts are in Australian dollars.

The report recommends requiring specialists whose annual fees average more than three times the Medicare schedule fee to repay the government for all rebates claimed that year. Patients would retain their rebates.

That proposal would affect about 2,000 doctors, or roughly 6% of specialists nationwide, according to the institute.

Lead author and health economist Peter Breadon said greater price transparency would help but would not be enough to address a market constrained by specialist shortages, long public waits and limited information for patients.

Legislation passed in September will allow the government to publish all specialists’ fees on its Medical Costs Finder website beginning in 2027. Only about 100 of 6,300 eligible specialists had voluntarily disclosed their fees through the site since its establishment in 2019, the Guardian reported.

The institute also called for federal and state governments to invest $500 million annually in public hospital outpatient clinics, expand specialist advice lines for general practitioners and impose binding training quotas on medical colleges.

Federal Health Minister Mark Butler told Guardian Australia that “all options are on the table to rein in climbing specialist fees.” The government has established a specialist affordability working group, which includes Breadon.

Dr. Julian Kelly, president-elect of the Royal Australasian College of Physicians, said the organization would support regulation addressing extreme charging and did not defend excessive fees that create barriers to care.

Sources