We are saddened but not surprised to read that that almost a million Australians delay or skip a specialist consultation due to the cost, something that should not be happening in one of the world's best health systems. Not only is this problematic for a patient's health, but this will also lead to a mounting pressure on our public hospitals and healthcare systems.
RACS understands the critical issues facing the Australian healthcare system and appreciates how this impacts Australians' access to specialised care. The rising cost of healthcare due to higher wages, growing costs of medical technology and imported devices, increased demand for mental health and chronic disease treatments, and inflationary pressure across pharmaceuticals, diagnostics and hospital services, all have led to increased fees for both specialists and their patients.
Further, specialist care has become increasingly costly due to the absence of a coordinated approach to workforce planning and distribution of specialists. This report highlights the need for systemic change of the distribution of the health workforce, specifically specialists, across Australia. Our healthcare system has more doctors than ever before, yet accessibility remains a problem. In 2022-2023, 8,356 new doctors entered the system, marking the largest influx of new doctors in over a decade. Subsequently, in 2023-2024, 9,490 new doctors registered to practise in Australia.
This highlights not a simple shortage of skilled professionals, but rather a misalignment in the distribution of skills across the health system - particularly between rural, regional and metropolitan areas. The current distribution is not being effectively planned or utilised. We welcome the recommendation for increased coordination and funding to specialist medical colleges to expand training capacity in line with service demand, in collaboration with the Commonwealth and states. To support this, we recommend expanding the Health Workforce Taskforce to formally include specialist medical colleges. It is important to note that training numbers are not solely determined by the colleges; the states and territories are key partners in workforce planning and training.
Where we disagree with the Grattan Institute is the formulation that excessive fees are commonplace. A surgical practice is a multi-disciplinary, high overhead environment. The cost of seeing a specialist must take into account business running costs, growing compliance, regulatory and insurance costs, other medical staff such as nurses and other allied health professionals, administration support staff, and ongoing training and professional development.
As it relates to cost pressures, an inherent flaw in the system is that the Medicare Benefit Scheme (MBS) has not been appropriately indexed or meaningfully kept up with inflation for years. At the same time, wage costs, insurance and equipment costs have all surged. The net impact of this has been that greater cost has been shifted from the MBS to the consumer. There is a failure of Medicare and private health insurers (PHIs) to provide satisfactory rebates in many instances. The rebate system is flawed when it takes no account of complexity or dedicated time spent with patients, and remunerates on occasions of service rather than any meaningful relationship to outcomes. Any commentary on the cost of the system without recognising that costs for surgeons have risen well outside of the MBS system would not be a fair and reasonable discussion.
RACS joins the chorus of opposition to egregious charging and is ready to have a conversation about "excessive fees", what defines this, and its meaning in the context of inadequate patient rebate schedules. It's time to open serious discussion about the flaws in the private and public health systems, the problems associated with dual state and federal health underfunding, and cost shifting. We join with the Australian Medical Association in advocating for an independent health authority to address funding issues that will never be resolved when the funders, government and PHIs are conflicted in their fiscal aims.
