The challenge
Excessive specialist fee variation is a significant problem for patients and the healthcare system. For patients, it creates price opacity, access barriers, and the risk of "bill shocks," leading to financial hardship and forgoing care due to cost. It undermines the healthcare system by exacerbating health inequity and eroding public trust. It also presents ethical and reputational dilemmas for specialists, who must balance practice costs with the need to provide affordable care to less well-off patients.
The research
Specialist fee variation in Australia has not been well understood due to historical data limitations. Leveraging the recently available Person Level Integrated Data Asset (PLIDA) from the ABS, this study aims to improve the knowledge base on this issue. Our research aims to quantify the extent to which fee variation is driven by differences between regions, specialties, and individual physicians. We also evaluate how doctors set their fees, and how this related to competition, GP referral patterns, waiting time, and quality of care. We also examine how doctors set different fees for different types of patients and what drives this disparity.
The impact
This study decomposes the sources of specialist fee variation to help establish an evidence base for policy. By clarifying the relative importance of regional, specialty, and physician-level drivers, the findings will help inform the design of effective interventions to curb excessive fee variation and enhance price transparency of the specialist care market.
Our researchers
Melbourne Institute - Yuting Zhang, Ou Yang, Jongsay Yong, Susan Mendez, Ryan Liang.
Publications
- Sources of specialist physician fee variation: Evidence from Australian health insurance claims data
- Medical Pricing Decisions: Evidence from Australian Specialists
- “It's not a one operation fits all”: A qualitative study exploring fee setting and participation in price transparency initiatives amongst medical specialists in the Australian private healthcare sector
- 'Charge what you think you're worth’: a qualitative study exploring the gender pay gap in medicine and the role of price transparency
Media
- Medicare is covering less of specialist visits. But why are doctors' fees so high in the first place?
- Think your specialist is expensive? Look at what others are paying
- Psychiatric specialist services in Australia: alarming increase in wait times and regional disparities
- Australians can wait at least 258 days for their first psychiatry appointment, our new study shows
- The consultation of fees of specialist doctors in Australia have soared. How can people compare and choose? (SBS Mandarin, podcast)