Higher Gaps forcing many people to delay care, survey finds 

Increased out-of-pocket costs for specialists are leading many Australians to delay or cancel specialist care, a recent study has found.  

A survey of 4,000 people by Private Healthcare Australia – peak body for the health insurance industry – found that 55% of people received a higher specialist bill than expected in the past 3 years, and almost one in 3 people had delayed or cancelled specialist care due to costs. 

The survey – which included 2,300 people who had been referred to a specialist – also found that in-hospital specialist fees had jumped 22% in the past 3 years.  

“People are delaying care they have been told they need because they are worried about the cost, can’t afford the fees or cannot find a specialist near home,” said Private Healthcare Australia CEO Dr Rachel David. “The alternative is joining a waiting list to see a specialist at a public hospital clinic free of charge, which can take years. In some cases, there may not even be a suitable specialist available nearby in the public system.” 

But doctors say rebates paid by Medicare and health insurers are too low, forcing them to charge out-of-pocket fees. 

“Healthcare costs are going up and patients are paying more and we know that’s causing patients to delay care,” said Dr Danielle McMullen, president of the Australian Medical Association (AMA).  

Meanwhile, the AMA has also accused private health insurers of abusing market power when negotiating no Gap or known Gap agreements with specialists.  

“Doctors are being asked to sign contracts that do not reflect the current costs of providing care,” Dr McMullen said. “This is deceptive and unfair and leads to higher out-of-pocket costs for patients.” 

Read the ABC story about rising specialist fees. 

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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