Monique Ryan (Kooyong, Independent) Share this | Hansard source

The cost of accessing health care in this country is not just a wellbeing issue; it is a cost-of-living issue, it is a labour market productivity issue and it is an economic issue for any treasurer who is serious about Australia's long-term prosperity. When Australians can't afford health care, they delay or forgo it. Improving health outcomes is therefore not just desirable for our wellbeing; it's an important determinant of Australia's productivity and growth.

Healthy people are more likely to participate in the workforce, to contribute to society and to spend into our economy, and they require less expensive care. Over decades, Australia has been drifting away from the universal promise of Medicare and back towards a user-pays healthcare system, which is increasingly pricing Australians out. Gap fees for non-bulk-billing GPs and specialists, bills from private hospitals and the increasing cost of some prescription medications—these kinds of out-of-pocket healthcare costs are now exceeding $33 billion annually for Australia. That is a higher share of total health spending than in the UK, Canada or the United States.

Cost pressure is most acute in specialist care. On average, patients' bills for specialist appointments are $300 a year. Australian patients are now paying out of pocket for two-thirds of all specialist appointments in this country. The average out-of-pocket gap payment for specialist attendances increased from $49 in 2010-11 to more than $115 in 2023-24. That's a 136 per cent increase over a period in which the consumer price index increased by only 40 per cent.

It is increasingly common for Australians to be charged $1,000 for an initial specialist appointment, $650 to see an obstetrician, $600 to see a cardiologist and $1,000 to see a psychiatrist. It's a similar situation in private hospitals. Out-of-pocket payments for private procedures rose 300 per cent in the five years to 2025. As many as 40 per cent of private hospital patients find themselves with bills of $1,000 or more after inpatient treatments. Disadvantaged Australians are rarely bulk-billed when they see a specialist. Three quarters of people who are earning less than $500 a week in this country paid a bill for at least one specialist visit in 2023.

These are extraordinary costs at a time of personal vulnerability for patients. It's not surprising that the 2025 Australian Healthcare Index found that 49 per cent of Australians have delayed seeking medical support due to increasing out-of-pocket costs. A recent cross-country comparison found that Australia ranks second-last amongst wealthy nations on access to care; we're now only ahead of the United States. That is a sobering finding for a country that has rightly prided itself for a long time on the universal promise of Medicare.

It's not just the high gap fees and out-of-pocket costs that worry patients. As an MP, I hear all the time from constituents that I represent about bill shock—unexpected bills that take constituents by surprise. At least one in two Australians receiving specialist care receive unexpected bills. I'm also hearing of hidden booking and administrative fees, some of which are unlawful, which violate the spirit of informed financial consent. Informed consent is enshrined in medical care but it's also a basic consumer right. It's ridiculous, remarkable and unacceptable that we demand it in other parts of our medical practice but not this one.

For many Australians, private specialist care is increasingly the only timely option. In many parts of Australia, public waitlist times for specialists are now stretching from months into years. Fifty specialities across our major cities have public waiting times of longer than a year. For a child in regional Australia who needs to see a paediatrician, waitlist times are between 18 months and four years.

We need a market for specialist medical care that works. Price is part of the story. Patients should be able to compare prices before they arrive at a consultation. GPs should know what specialists charge. Specialist fees in turn need to be fair, transparent, reasonable and proportionate. That's why I'm pleased to see the government legislating reform to the Medical Costs Finder website. Just to remind the House: in 2019 the Morrison government spent $24 million on a tool to give Australians a way of understanding the cost of specialist services before they committed to their care. The website relied on voluntary fee disclosure, and it was a profound failure. Of approximately 11,000 eligible specialists, only seven chose to publish their fees by the end of 2022. The price transparency tool was, in effect, entirely devoid of prices. Three years later, only 88 doctors had voluntarily disclosed their fee information; that represents a participation rate which rounds down to zero.

The website did contain some useful aggregate data about average out-of-pocket costs for consultations across different specialities and about bulk-billing rates by speciality. At least half a million patients have used the site since its launch, but its central purpose—helping patients to understand what their doctor will charge them—has never been realised. Voluntary disclosure will always reflect a self-selected cohort of the most competitively priced practitioners. It will therefore present a skewed picture that further disadvantages consumers.

So, in 2025, this government invested another $7 million to deliver the technological capacity to analyse Medicare, hospital and insurer data. This bill now legislates those changes by amending the Health Insurance Act and the Private Health Insurance Act to allow the department to publish information about doctors and their billings, including the use of gap cover arrangements with insurers.

It will also allow publication of information about healthcare facilities and insurers, including the proportion of policy holders who experience different gap cover arrangements and the out-of-pocket costs associated. That data already exists—it's in Medicare—but this bill allows Medicare, hospital and insurer billing data to be published cumulatively, helping patients make informed decisions and allowing them to compare costs against the fees charged by other doctors.

But I'm still concerned that the bill as drafted is not going to deliver on its stated objective. The EM for the bill proposes that the data presented will be a single figure against the medical practitioner's provision of a service. We've been told that the department is going to develop an analytical approach for the derivation of that figure, but we have no visibility into the derivation of that fee. A price which might be brought down by discounting for some but not all consumers could give an inappropriately low cost point on the website, and the complexity of billing practices could well render the interpretation of fee schedules quite challenging for many individuals.

It doesn't matter what the cost of the service is if you still can't afford it. To be effective, the Medical Costs Finder has to put downward pressure on specialist fees. As it's drafted, the single fee given will be a static snapshot of the previous year's charges. That figure needs to be updated more regularly if we're truly to drive prices down. While I recognise that price is an important metric, high-quality medical services can't be adequately qualified or quantified by a simplistic price comparison tool. There is a common misconception that doctors who charge more provide better quality care. As a medical specialist of 30 years standing, I know this to be untrue. While this bill is an important step in informed decision-making, it doesn't contemplate the publication of quality markers. Publication of complication rates, readmission or patient-reported outcomes could well support patient safety and more informed decision-making, and that's been used with success in other jurisdictions.

But, by addressing the structural drivers of the increasing cost, we're still not driving care. We know that the Medicare Benefits Schedule has not been appropriately indexed for years, nor has it meaningfully kept pace with inflation. During that time, wage and equipment costs—and increasingly restrictive private health insurance policies—have shifted the cost burden from Medicare onto the consumer. Fee transparency will reveal the size of the gap, but it cannot of itself close it. If the underlying cause is a Medicare rebate which is frozen in real terms while operating costs escalate, publishing fees will tell patients how bad the problem is, but will not equip them to solve it.

The government has to consider other policy levers to manage the cost-of-care crisis. I'm proposing two to this House. The first is Medicare rebates. The second is workforce. Medicare rebates have long been underindexed. That has driven higher out-of-pocket costs. The schedule should undergo ongoing review, and it should more accurately reflect the cost of care. At the same time, we should ensure that no specialists are engaging in excessive or exploitative billing.

The bill does not address the ongoing maldistribution of specialist supply. Specialist billing has actually fallen by 10 per cent over the last five years, while the Australian population has grown by more than seven per cent. Doctors charge based on the competition in the areas in which they work. People living in areas with fewer doctors, like those in regional areas, face higher fees. You can't comparison-shop for a specialist if there isn't one in your region. The inadequacy of training positions in multiple specialities has been repeatedly identified by inquiries and studies. Australia needs to ensure that we are producing a pipeline of doctors able to provide the services required.

The existing Health Workforce Taskforce is not designed for or tasked with development of the national workforce strategic directions and priorities. Because health regulation operates at a state and territory level, new initiatives must be legislated in multiple jurisdictions. This deficiency has been identified by a number of inquiries, including the Snowball Review, the 2017 Accreditation Systems Review and most recently the 2022 to 2031 National Medical Workforce Strategy, which called for creation of joint medical workforce planning and advisory structures with sufficient authority and expertise to make recommendations in relation to the size and structure of the national medical workforce. I have long argued for national coordination of specialist training positions.

This bill also addresses a second systemic issue in the healthcare system—the practice known as product phoenixing—wherein private health insurers close the product and then reopen identical one at a higher price or reduce the value of that product. Insurers will be required to seek ministerial approval for premiums on new products and for changes that reduce cover or the value of existing products. The issue with this is that we have seen, as was demonstrated by CHOICE just this week, that the price of many private health insurance packages, particularly of a gold level, has increased well beyond the level of inflation despite the measures that the government believes that it has put in place to keep those costs in line.

This bill doesn't compel any reduction in specialist fees. It doesn't cap gap payments. It doesn't require bulk-billing by specialists. It doesn't mandate that the information displayed on the website is presented in a way that will be genuinely comprehensible to patients with low health literacy. And with only $7 million allocated for its implementation against the $24 million already spent on the failed initial model, questions about platform quality and data integration are legitimate.

The voluntary Medical Costs Finder was an expensive policy fiction. It was a website that looked like transparency but delivered almost none. Moving to mandatory publication of data that the government already holds, it would appear to be a straightforward correction of a structural error. But it would be a mistake to allow this bill to serve as a substitute for the deeper and bigger reform that the specialist market requires—meaningful Medicare rebate indexation, regulation of those extreme fee outliers, expansion of public specialist clinic capacity and genuine workforce planning tied to community need.

Australians deserve a healthcare system that is accessible, affordable and genuinely centred on patients. With those principles in mind and without declining to give this bill a second reading, I commend this bill to the House, and I move amendments (1) to (4) in my name:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House notes that:

(1) while the government is advancing broader economic and health reforms, out-of-pocket costs of receiving specialist medical care continue to rise in a way that exacerbates cost-of-living pressures;

(2) consumer price indexation figures show that 'medical and hospital services' increased by 4.2 per cent in the 12 months to January 2026, outpacing headline inflation;

(3) medical and hospital services should be non-discretionary items, however costs have resulted in approximately one million Australians missing out or delaying specialist care every year; and

(4) while the measures in this Bill will improve price transparency, further reforms are needed to keep specialist healthcare affordable for all Australians, including fixing specialist billing practices, extending Medicare rebates across specialists, indexing Medicare rebates in line with inflation and reviewing gap fee limits".

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