Specialist healthcare is out of reach for too many Australians, with some specialist doctors charging two or even three times the Medicare schedule fee, and some patients waiting months or even years for an appointment.
A new Grattan Institute report, Special treatment: Improving Australians' access to specialist care, finds that as a result, every year about 1.9 million Australians delay or skip getting the care they need, causing missed diagnoses, avoidable pain, and added pressure on hospitals.
Fees for private specialists are far too high: 10 per cent of patients pay almost $600 a year in fees, and fees have soared by 73 per cent in real terms since 2010.
Waitlists for public specialist clinics are far too long: in some parts of Australia, wait times for urgent appointments extend months beyond the clinically recommended maximum.
People living in the poorest parts of Australia receive about a third fewer specialist services than people in the wealthiest parts. Public clinics aren't where they're needed most to fill the gaps.
For years, training numbers for some specialties, such as psychiatry, ophthalmology, and dermatology, have been far too low.
For decades, there has been too little rural specialist training to meet the needs of people who live in rural and remote areas.
'The specialist system isn't working and Australians - especially poorer Australians - are paying the price,' says report lead author and Grattan Institute Health Program Director Peter Breadon.
The system has been on autopilot for far too long. The report recommends a five-point national plan to make sure every Australian can get the specialist healthcare they need:
1. Governments should expand public specialist appointments in areas that get the least care, providing one million extra services each year.
2. The federal government should remove Medicare funding from specialists who charge excessive fees - and name them publicly.
3. Governments should set up a system where GPs can get written advice from other specialists. This could avoid 68,000 unnecessary specialist referrals each year.
4. Governments should modernise public specialist clinics across the country, spreading best practices.
5. Governments must train the specialist workforce Australia needs. They should provide an extra $160 million to expand training, and the funding should be linked to targets for undersupplied specialties and rural training.
'As Australians gets older and sicker, more of us will need specialist care more often,' Mr Breadon says.
'This report sets out the actions required to ensure every Australian can get the specialist care they need when they need it.'
