The cost of an initial dermatology appointment is now up to nearly $300 on average, new data shows. It reflects a broader problem: that Medicare rebates are not keeping up with the pace specialist fees are rising.
Online healthcare directory Cleanbill, which hastracked bulk billing rates among GPs, is expanding to provide data on out-of-pocket costs to see other health professionals, starting with dermatology.
The report, released on Thursday, found the Medicare rebate in March 2017 for an initial appointment with a dermatologist was $72.75, while the out-of-pocket cost was $148.73.
By March 2025, the rebate had risen by $11.40, to $84.15, while the average out-of-pocket costs, at $210.18, were $61.45 more expensive.
Over eight years, average out-of-pocket costs for an initial consultation had increased by over 40%, and average follow-up consultation costs had increased by over 55%. The rebate rose by less than 16%.
Cleanbill compared the 2017 data collected by predecessor MindTheGap for 165 dermatology clinics still currently operating, with its own data collected in October.
Sign up for Guardian Australia’s breaking news email
Based on all 280 dermatology clinics Cleanbill identified currently operating, the average upfront cost of an appointment was $296.71 – more than 3.5 times the Medicare rebate.
Cleanbill’s report highlighted that as private health insurance does not cover out-of-hospital consultations, these out-of-pockets costs are being borne entirely by patients.
Private health insurance mainly covers the cost of private hospital treatment, and may also cover non-Medicare subsidised services such as physiotherapy, psychology and dental services – but not GP or specialist consultations.
“These out-of-pocket costs far exceed the increases that we’ve seen to the Medicare rebate,” Cleanbill’s chief executive, James Gillespie, said.
“In these circumstances, it’s easy to see why the number of Australians putting off specialist care due to cost has risen from 176,000 in2016-17to 900,000 in2023-24,” he wrote in the report, citing Australian Bureau of Statistics data.
Many specialist services are available to patients for free in public outpatient clinics, but patients need a referral from their GP to qualify, and each hospital or specialist clinic has its own process for assessing urgency, accepting referral letters and making appointments.
A GP referral is needed to claim the Medicare rebate at a specialist appointment, meaning a second round of out-of-pocket costs that “stacks one on top of the other”, Gillespie said.
Gillespie said it was reasonable to extrapolate similar price increases across other medical specialists than dermatologists.
Thelatest government dataon medical specialist consultations showed patient out-of-pocket costs in non-hospital settings increased in real terms (adjusting for inflation) from $1.1bn in 2012-13 to $1.9bn in 2022-23 – or “from $213 per patient to $294 (38%)”.
In the same period, Medicare benefits paid by the government increased in real terms from $2.5bn to $2.9bn – or 16%.
The government this yearpromised $7m to expandthe much-derided Medical Costs Finder website, which the former Coalition government spent $24m setting up to see only 70 specialists – out of 11,000 registered to practice –choose to voluntarily display their fee informationas of March 2025.
Prof Yuting Zhang, an expert in health economics at the University of Melbourne, said providing cost information was only a first step – and the government had not outlined a policy to lower fees.
Zhang and her colleagues at the Health Analytics, Leadership and Economics Hubmapped specialist fees in 2023 across different areas, finding on average that rheumatology had the highest fees, followed by neurology and immunology.
Specialist fees have gone up “a lot” but the Medicare schedule fee hasn’t been properly indexed, Zhang said, remaining “quite flat” for about the last 20 years, leaving patients to absorb the increasing gap.
Sign up toBreaking News Australia
Get the most important news as it breaks
after newsletter promotion
Some fees were “super high” at about $1,200 but cost varied widely even within the same specialty for exactly the same services, she said.
“Some people might be willing to pay a lot more to see a specialist and thinking the price might be an indicator for quality – which I can assure you, it’s never the case,” Zhang said. “More expensive doesn’t really mean better.”
A third of people living with chronic diseases say they are not able to attend specialist appointments due to the cost, a studypublished in May in the journal Health Policyfound, with both the upfront cost and out-of-pocket costs being a major barrier to care.
Australian National University researchers analysed the experiences of more than 1,800 Australians living with a range of chronic conditions within 37 studies.
Assoc prof Jane Desborough, the lead author of the study, said while GPs face “consistent pressure” to bulk-bill, backed by policy initiatives, there is “no similar conversation about non-GP specialists who are also trained in the public system, who are also remunerated through Medicare … yet from the evidence, it seems quite uncommon for them to bulk-bill”.
Many Australians with multiple chronic conditions often need to see several different specialists; even a person with a single chronic condition such as psoriatic arthritis needs both a dermatologist and rheumatologist.
Those who struggled to afford specialist appointments reported often choosing who they saw based on “what’s hurting most at the time”, Desborough said.
Chronic illness often impacts people’s capacity to work.
The frustration of not being able to afford specialist visits is compounded by the long wait list for public specialist clinics, she said, as well as an increased trend by specialists towards exclusive private practice.
Those who had full access to the specialist clinics in the public system were “very grateful for what Medicare does,” Desborough said.
But as for others, having to forego important aspects of their life – like food choices, social activities, family holidays, children’s sport, school excursions – to access healthcare: “That’s not in the spirit of Medicare,” she said.
The health minister, Mark Butler, said the private health sector, including insurers and specialists, “need[s] to do more to protect patients for exorbitant bills”.
Zhang said specialist medical colleges could play a role, by developing codes of conduct around fee practices and scrutinising members who consistently charge high fees.
The government could also open more public clinics offering free specialist care for those who cannot afford the gap fees in private clinics, Zhang said.