Aussies paying steep Gaps for specialist care, data shows 

Specialist fees for private hospital care in Australia have increased dramatically – in some cases, by as much as 9 times, new data shows.  

Figures from Private Healthcare Australia, the peak body for the health insurance industry, found that average out-of-pocket fees charged for treating private patients have surged by staggering amounts between 2018-19 and 2023-24.  

Average out-of-pocket fees for double knee-replacement surgery have more than tripled from $1,910 to $4,750 – while spinal fusion surgery has surged from $700 to $2,640. The highest increase was for deep brain stimulation surgery for Parkinson’s disease, which was $790 in 2018-19 but is now $6,000. 

Out-of-pocket fees happen when specialists charge more than the Medicare Benefits Schedule (MBS) Fee for a procedure. For private patients, Medicare pays 75% of the MBS Fee while health insurers will pay the remaining 25%. When a specialist charges above the MBS Fee, the difference is paid by the patient.  

“Doctors are entitled to charge fairly, but fees that double, triple and increase up to 9 times in a few years are unsustainable,” said Private Healthcare Australia CEO Dr Rachel David. “Patients end up facing massive bills or waiting years for treatment in the public system. Neither Medicare nor private health insurers can keep pace without pushing up taxes and premiums.” 

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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