The health minister says specialist doctor gap fees ‘take off like a rocket’, often for ‘no obvious rational reason’.
Just in case more confirmation is needed, health minister Mark Butler outright tells delegates at the AMA national conference last week that his second term as health minister is more firmly focussed on non-GP specialist care than on primary care.
“I think if I took an experience or a lesson from my time as a junior health minister in the last Labor government, it was that that we tried to bite off too much at once,” he said.
“While we were doing a whole lot of, I think, really important work in primary care, in aged care, and mental health, we then went into the very energy-sapping process of trying to fix hospitals.
“So the idea [this time around was to] work out where the burning platforms were and sequence our attention to them. I still think it is the right way to go in a portfolio as broad and complex as this.
“And at the time, I might have said to you, I didn’t see private hospitals and private health as that burning platform at the front of the queue. But over the course of that term in parliament, that changed.”
Mr Butler has often described non-GP specialist fees as a “barbecue stopper” issue – and at the AMA conference, he revealed that a relative’s experience of specialist fee bill shock had, in fact, interrupted the Butler family barbecue on Christmas day.
“Out-of-pocket costs, generally, for specialists’ consults and procedures have climbed quite significantly over the [past] five years,” he said.
“They’ve pretty much doubled to about $2.3 billion dollars out of patients’ pockets. But unlike general practice, where [out-of-pockets] were fairly steady across the system, they’re quite variable.”
According to Mr Butler, there are about 1.6 million payments each year where the patient pays between three and five times the average out-of-pocket. An additional 220,000 out-of-pocket payments that are more than five times the average fee.
“This is an issue where there are outliers, where the 95th percentile and above tends to take off like a rocket, and often for no obvious rational reason that I can see,” he said.
“… The fees charged for procedures like colonoscopies, knee replacements, and such are pretty steady until you hit that 95th percentile, and then they take off like a rocket.”
He thanked the AMA for its support of the Medical Costs Finder, which he admitted had not lived up to its original promise.
“Using [the Medical Costs Finder] as an opt-in system has been an abject failure to rival that of the COVIDSafe app, frankly,” Mr Butler said.
“And [former AMA president Professor] Steve Robson tried to energise people’s enrolment in it on a voluntary basis – and thank you, Steve, for doing that – but that didn’t work either.
“I think still we’ve got around maybe 100 people who’ve enrolled. So, we’re going to make that mandatory.
“We also are looking at other things that there will be different views about, [like] changes to referral systems … all options are on the table for us about this.”
Minister Butler also confirmed that the MBS review advisory committee report on GP time-tiered rebates would drop in the coming months.
His exact words were that the review team was due to report back “in the second half of this year” and that it would “kick off a very detailed discussion about how the current delineation of consults is dealt with in the MBS”.
“And so it should – I look forward to that discussion,” he said.
Work on the review, which covered issues like the number and consistency of time-tiered GP consult items, commenced just over two years ago.
The health minister finished his address by thanking outgoing AMA president Dr Danielle McMullen for her service over the past six years; first as AMA NSW president, then as federal vice president and most recently as federal president.
Mr Butler also gave a nod to the AMA president’s impressive red-and-gold formal academic robes: “no one quite has a set of gowns like the AMA. Not even the Pharmacy Guild … and they’re not known for their humility”.
The AMA’s 2026 national conference was held on August 28 and 29 at Pullman Melbourne East.
