의료진, 버틀 장관의 전문의 수수료 '책임 전가' 비난

Doctors said the minister was playing a blame game and neglecting real reform, as Butler said he was exploring whether the government could cap how much medical specialists charge for their services.

Australian doctors are fighting back against Health Minister Mark Butler’s assertion that specialist fees are “out of control” and might require government regulation, accusing him of pumping money into incentives while neglecting real Medicare reform.

The Australian Medical Association on Thursday said Butler was playing a “continuing blame game” about out-of-pocket costs to see specialists, which have gone up by as much as 300 per cent in five years for some procedures.

Their pointed rebuke came after the minister told this masthead he would push laws to their limits to bring down prices for many specialist services because he was concerned Australians were putting off critical care due to cost.

In a further interview about the issue on the ABC on Thursday, Butler said he was exploring whether the government could cap how much medical specialists charge for their services – effectively regulating medical fees.

“For a colonoscopy in Sydney, many, many people will be charged ... either nothing or $20. The average is $280. But many people are being charged more than $700 with no rhyme, no reason to the difference between those charges,” he said.

“There’s no quality difference between the specialist who is giving you that colonoscopy and, more worryingly, people are often not informed about that cost until they rock up for the procedure. There’s a lot of bill shock happening.”

According to the government’s Medical Cost Finder website, there is significant variability in gap fees for dozens of popular medical procedures.

For knee replacements, for example, people typically paid $1000 out-of-pocket, with an extra $1,900 picked up by Medicare and $1,800 covered by private health insurers. However, this gap fee was as low as $250 for some patients, while it was as high as $4,800 for others.

The government is moving to mandate that specialists disclose their charges, after it was revealed that few doctors were voluntarily uploading their own fees for consumers to evaluate on the Medical Cost Finder website. However, Butler said this was still not enough.

“It’s all well and good to have the fees published, but if they’re effectively so high that big parts of the population simply cannot afford to get procedures done, then government has to act,” he said.

“That’s what I’ve said to the AMA and that’s what I’ve said to all of the colleges of specialists as well. We can’t sit back as a government and see people simply not accessing the care that they need because of cost.

“I think they understand as well that something’s got to change. There are too many outliers in the profession who are charging, frankly, outrageous amounts of money for common medical procedures.”

AMA president Danielle McMullen said the profession was pushing the government to expand public hospital services, review Medicare safety nets and tighten oversight of private health insurers and their premiums so they delivered better value to consumers.

But chief among her demands was for the government to boost Medicare rebates, which she said had stagnated over many years, including during a six-year freeze, while inflation and health costs picked up pace.

“While recent government injections into Medicare bulk billing incentives are positive and have improved access to care, these relate to a tiny fraction of the more than 5,000 [Medicare] items,” she said, referring to the government’s decision to triple bulk-billing incentives paid to GPs who don’t charge their patients.

“These are ‘bolt-on’ incentives, not Medicare reform. And they don’t do anything if you need to see a specialist for a consultation, a privately billing GP, or need surgery. The continuing attacks on doctors are neither helpful nor focused on the kinds of significant reforms that would make a difference.”

Butler said all options were on the table – including setting upper limits to how much doctors can charge.

“There have long been these views that constitutional limitations exist to stop the government from setting a ceiling on a medical fee. That goes back to a debate back in the 1940s ... The constitutional provision there has been argued, mainly by medical colleges, to prevent the Commonwealth from being able to do something like that,” he said.

“We want to test the boundaries of that because we think we’re getting to a point where a minority of specialists are charging fees that are so outrageous that the only way we might be able to deal with them is regulation.”

He rejected the AMA’s argument that raising rebates would fix the issue. “The freezing of the rebate over the previous decade did impose a lot of pressure on medical businesses ... I do accept there’s been that pressure over the last 10 or 15 years,” he said.

“But that doesn’t explain the wild variability between those specialists [prices].”

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