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Speaker 1: From The Australian, here's what's on the front.
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Speaker 2: I'm Claire Harvey.
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Speaker 1: It's Monday, November 2, 2026. A new front in the immigration debate, British backpackers. Anthony Albanese wants them to spend time working in the bush, but he'll need to get the UK's Andy Burnham to agree at this week's Commonwealth Leaders' Meeting in the Caribbean. That's an exclusive live now at theaustralian.com.au. If you've been to see a medical specialist lately, you'll know fees are sky high and the rebate often feels paltry. So why can't the government get this under control? And why are the doctors digging in? That's today's story.
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Speaker 3: Specialist care is becoming a luxury and the poorest are hit the hardest.
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Speaker 4: This card says that if you get sick, you'll be looked after.
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Speaker 3: Some specialist doctors now charging triple the Medicare rate. It's forcing two million Australians every year to delay or even avoid care. The government has committed to putting thousands of specialist doctor's fees online so you can shop around.
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Speaker 1: Penny Timms is a health reporter with The Australian, and she's been reporting on one of the biggest changes to come through Australian health care for decades. It's about how much specialists charge. Penny, it's funny, isn't it? We're all so used to being empowered consumers these days, but one area of life where I would feel a bit hesitant in asking how much this is going to cost, or maybe two, a fancy dress boutique where there are no prices on anything, and a specialist's office when you're worried about something and you're seeking the advice of an expert. There's a huge change going on.
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Speaker 2: What is it?
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Speaker 4: Look, this is, as you said, a huge area of reform right now. So the Albanese government is really making this issue of specialist fees a huge component of its second term. It really has addressed this and said that this is a priority area of the government. It wants to essentially make sure that there are no specialists who are charging excessive fees. And this is where we start to get into this really complicated story of what is an excessive fee and what can actually be done to rein in those costs. Because at the moment, our doctors are free to charge what they see fit within reason.
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Speaker 1: Mm-hmm. Yeah, I think we've all had that experience of going for the initial consultation and then you.
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Speaker 2: Never discuss this with the doctor.
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Speaker 1: You get a letter from the receptionist telling you what the fee schedule is and you're left thinking, I mean, I wonder if this is negotiable. Is there some sort of discount for paying early?
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Speaker 2: What's the deal?
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Speaker 1: How much are people paying to go and see specialists and how much are those prices varying at the moment?
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Speaker 4: The greatest data that we have at the moment is that Grattan Report has shown that since 2010, out-of-pocket costs for specialist feet. So that is how much the gap is that the patients cost have risen by 73%. That's an extraordinary number. And there are real consequences of this, that it's costing people a huge amount of money to go and get something checked out, especially when there's a huge rise in chronic disease at the moment. And a really important part of getting on top of chronic disease is ensuring that you're going and getting the best medical advice so that you know can you catch it early? Is there something that you can do intervention-wise to stop the disease or illness progressing so that you can remain part of society, healthy and fit and active and involved? And so if we are seeing these costs going up, it obviously has a huge economic consequence then for the Purely, this is just anecdotal, my own experience recently. So I go to a neurologist. I have chronic migraine. And I recently went to my neurologist and I was left with a gap fee of $ 203. So that's pretty standard for when I go to see my neurologist. So his charge was $ 340. Medicare paid $ 136 of that. And so, yeah, I was left out of pocket a bit over $ 200.
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Speaker 1: Have you ever shopped around to find out how much it would cost to go to a different neurologist?
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Speaker 4: Not for this particular one, but because finding a neurologist for the type of migraine I have is actually really difficult. And so when I found one that was recommended, I just jumped at it. And it's been great. Medically, it's been revolutionary and I cannot fault him at all. But previously, I did actually shop around. I shopped around once when I was trying to get to the bottom of it all. Part of migraine is that sometimes it can.
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Speaker 2: Give you vertigo as a symptom. And I was having that.
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Speaker 4: And so I went to a ENT and the first one quoted was extraordinarily high. I think it was around about $ 600. And I just thought, I'm going to see if I can actually find somewhere else.
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Speaker 2: And I did. And it was purely.
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Speaker 4: a matter of me then calling around and trying to find the different specialists.
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Speaker 2: I'm lucky I'm in Sydney. I could do that.
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Speaker 4: I have that flexibility to do that. But it's really tough. And you've got to have the ability to know that you can actually do that. You've got to know where to call, who to call. I'm a health journalist, I know.
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Speaker 2: Yeah, that's right.
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Speaker 1: So there's all sorts of reasons why you want to see a specialist, especially as you develop a relationship with them. But that means you're very vulnerable to the pricing, doesn't it? It's not really a market in which price comparison is possible, I think.
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Speaker 2: It's not.
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Speaker 4: It's a very, very difficult thing to tackle, which is why this has been such a bugbear for governments. Every
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government has known this has been a problem, as we said, since 2010.
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Speaker 2: We can see the data.
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Speaker 4: It's getting worse and worse and worse. And no one's been able to really tackle this because it is just such a huge beast. if it can be tackled, this is going to be monumental. Like it will be a real game changer for health.
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Speaker 1: It sounds to me as though the Australian Medical Association and the various specialist colleges are resisting this change. Why? I mean, specialists are driving around in BMWs. They don't seem to be struggling. Surely they can cope with a little bit of price transparency.
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Speaker 2: Yeah.
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Speaker 4: So in this entire discussion, there's two elements to it. So there is this price transparency, which specialists will have to put their pricings on a website. And that one, I think a lot of people are okay-ish with that happening.
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Speaker 2: So that's in the process of being set up at the moment.
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Speaker 4: And previously, there's been a voluntary call for people to do this.
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Speaker 2: Not too many took up that offer. Surprise. Shock, horror.
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Speaker 3: It's meant to give patients the power to shop around, but this $ 20 million government website hasn't lived up to expectations. Of 11,000 specialists nationwide, only 70 doctors have signed up to it.
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Speaker 2: So now it will be mandated.
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Speaker 4: The other element of this is just how it is determined what an excessive fee is. And this is the really complicated area that the doctors are getting very upset about. So at the moment, the government has been seeking feedback. One of the options could be that it looks at the market and analyses whether or not this is a reasonable cost, given the grand scheme of things. Another option would be comparing fees across countries.
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Speaker 2: Peers.
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Speaker 4: So other specialists in that area. And the third option, which seems more problematic, is assessing how vastly different a fee is compared to how much you get back from Medicare. That is hugely unpopular, even in its own setting out of this document.
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Speaker 2: The government has flagged this.
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Speaker 4: As an issue because the Medicare rebate just hasn't kept pace with society doesn't reflect now what.
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Speaker 2: You should be expected to pay. So there's a huge.
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Speaker 4: Amount of fear as to what would happen if that actually was to stay in play. It doesn't seem like it will because it has already been flagged that that has problems to it. And if it was, then perhaps other tactics would also have to be introduced.
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Speaker 1: The government's under pressure to cut spending. Medicare is obviously a giant proportion of government spending and it's a beloved Labor Party reform that they're very proud of. Every Australian, from newborn babe to Prime Minister, can share in the cheapest, simplest and fairest health insurance scheme Australia's ever had. But the Medicare rebate is supposed to be a price signal to the doctor, right?
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Speaker 2: It's supposed to be, well, the rebate here is $ 250.
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Speaker 3: So....
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Speaker 1: Is the purpose of this kind of cost cutting by the government or is it cutting the cost of living or what are they trying to get to?
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Speaker 4: They're trying to stamp out any specialist charging beyond what is reasonable. It's been widely acknowledged that there is a problem of price gouging, for lack of better terms. But it is also identified that it's not hugely widespread.
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Speaker 2: It is a problem and it needs to be addressed.
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Speaker 4: It needs to stop because it not only means that patients are being charged huge amounts of money, it leads to the entire industry being discredited by a few.
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Speaker 2: So the voluntary code didn't really work.
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Speaker 1: No. government's tried and failed to kind of rein in the specialists or the medical colleges in terms of who's allowed to train the next generation to break this stranglehold they have on their own profession. They would say, well, look, it's the existing orthopaedic surgeons and the College of Orthopaedic Surgeons or whatever we're talking about, you know, breast specialists. who know how to do the training, we can set the exams and we can run the registration of the next generation. The government would say, well, maybe we should open that out to universities or TAFEs to be able to offer this kind of registration. They seem extremely powerful, the doctors. Can the government win?
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Speaker 2: It's going to be a tough battle. It's going to be a very tough battle for them to win this.
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Speaker 4: I think that they are putting all options on the table so that the colleges and the profession as a whole is forced to pick one.
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Speaker 2: There's been an option.
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Speaker 4: On the table where you can go and you can try and sort this out amongst yourselves and it hasn't worked.
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Speaker 2: So now... the government's having to intervene.
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Speaker 4: And I think that there is a lot of concern in the medical industry about what will actually happen. And so I think that it could force some of the hand of different medical groups to do things that perhaps in the past have been a little bit on the nose. I was speaking quite recently to the incoming president of the Australian Medical Association.
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Speaker 2: And I just said, you know, what do you see for specialist fees?
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Speaker 4: And he said, it's going to be my first huge battle. I know I'm coming into a huge fight right now.
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Speaker 2: He's having to fight.
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Speaker 4: For his colleagues who have voted him to be the next president and to represent them and their interests. At the same time, he said to me, there's so many different cost pressures. One of the biggest problems is that doctors fear that they are basically going to become the scapegoats of huge amounts of money it takes to deliver healthcare in this country. So when you look at overhead costs, when you look at the Medicare rebates not keeping up with everyday reality, these are huge problems. And so he knows that this is something that he'll have to tackle. And he did say, you know, there does need to be an increase in training of specialists as well.
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Speaker 2: So I think that, yeah. More supply equals lower prices, right? That's it.
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Speaker 4: But one of the other issues is that it takes so long to be able to get those trained specialists through the system. So this will not be an easy fix, won't be a quick fix. And efforts previously to try to get more specialists into different fields haven't really.
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Speaker 2: Resulted in lower fees. So it's going to have to be very targeted. It's a huge issue.
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Speaker 1: Well, lots of great stories to come, I'm sure.
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Speaker 2: Penny, thank you. Thank you.
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Speaker 1: Penny Timms is a senior health reporter with The Australian. You can check out our ongoing coverage of this dispute and all the rest of the best news in health right now at theaustralian.com.au slash health.