Private health insurers push for action on rising specialist fees
05 Feb 2026
The survey of over 4,000 Australians, including 2,300 who had recently been referred to a specialist, found that 30% had postponed or skipped specialist care in the past three years due to cost. It also found specialist fees for in-hospital care have jumped 22% since 2022, with the median gap fee now $222, and some patients asked to pay up to $1,000 up-front for a single specialist appointment outside hospitals.
Rural Australians are particularly affected, with 61% reporting difficulty getting timely appointments due to shortages of specialists in regional areas.
Private Healthcare Australia is calling for tools to help GPs show patients local specialists and typical fees, stronger consumer protections, and strategies to increase specialist availability in regional areas.
RACGP President Dr Michael Wright said the findings reflect what GPs see in everyday practice. “GPs continue to bridge gaps in the health system,” he said, noting that GP visits are rising as care becomes more complex and referrals to specialists increase. He also cautioned that any measures to increase fee transparency should not add an extra compliance burden on GPs.
Private Healthcare Australia CEO Dr Rachel David said out-of-pocket costs are reshaping how Australians use healthcare and could lead to more severe illness presenting in hospital emergency departments.
However, Australian Society of Anaesthetists President Dr Vida Viliunas said most anaesthetists already use known-gap or no-gap arrangements where possible. She warned that failing to properly fund Medicare and rebate schemes makes it harder for doctors to provide safe, high-quality care, and reforms should not disadvantage parts of the health system.
The report comes after Federal Health Minister Mark Butler indicated that tackling non-GP specialist fees is a priority, describing current costs as “completely a rip-off” due to lack of consistency.
https://www1.racgp.org.au/
