The AMA says that rising out-of-pocket medical costs are ‘fundamentally’ caused by long-term government underinvestment.
State and federal governments have no one to blame but themselves for rising non-GP specialist fees and wait times, according to the AMA.
In a submission to the parliamentary inquiry into access and affordability of medical specialists – which is separate to the simultaneous, Department of Health, Disability and Ageing-run consultation on specialist affordability and access – the AMA did not deny that Australia’s medical system was in peril.
The DoHDA-run consultation is specifically considering fee caps; the parliamentary inquiry is somewhat broader.
One in five Australians, the AMA said, delayed or avoided a medical specialist appointment in 2024-25, while one in four Australians waited longer than they felt was acceptable.
But if politicians want to know what the root cause is, they can find the nearest mirror.
“Medicare has failed to keep up with the costs of providing services, while the significant increase in medical school places has not been matched by increased specialist training places in our public hospitals and the private sector,” the association’s submission read.
“Hospital funding is not meeting community need and access to outpatient services are being rationed.
“Private health insurance has also received insufficient attention as a contributor to affordability issues, including whether insurer benefits have kept pace with the cost of care.”
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The AMA went on to note that the Medicare freeze meant that specialist consultation rebates were not indexed between 2013 and 2018, while specialist procedure rebates were not indexed between 2013 and 2019.
It also pointed out that the indexation since that time has often been below inflation, even though the Independent Health and Aged Care Pricing Authority cost estimates for some public outpatient appointments have risen significantly since 2020.
“This matters because governments themselves recognise a significantly increasing cost of delivering specialist outpatient care when funding public hospitals,” the AMA wrote.
“Medicare benefits for patients accessing care outside that system have not kept pace.
“The resulting gap between the cost of providing care and the government contribution is increasingly left to medical practices and patients.”
In fact, the increase in specialist consultation fees have grown more slowly than wages since the turn of the millennium.
In relation to accessibility, the AMA noted that the government had not matched the increase in medical school places with an increase in funding for accredited training, and that there was no nationally consistent standard for reporting how long patients wait from GP referral to their first public specialist outpatient appointment.
“Addressing workforce shortages requires action from all levels of government,” the submission recommended.
“Medical workforce training is a shared responsibility between the federal government and the states and territories.
“While the federal government largely funds medical school places and supports specialist training through programs such as the Specialist Training Program, state and territory governments fund most public hospital training positions, consultant appointments and supervision capacity.
“The next National Health Reform Agreement should include clear commitments from jurisdictions to fund sufficient prevocational and specialist training positions to meet future workforce needs and ensure growth in medical graduates translates into improved patient access to care.”
The association also warned against meddling too much with the “imperfect” referral framework, arguing that GP oversight remained essential to patients with chronic illness.
Longer referral validity periods, it said, could potentially undermine the coordinating role of GPs.
At the same time, it supported models providing GPs with “rapid access” to specialist advice via dedicated telephone or email advice lines, without requiring the need for the patient to have a face-to-face specialist appointment.
“Such models can help GPs determine whether a formal referral is required, identify the appropriate urgency of the referral, commence preliminary investigations or treatment, and continue managing suitable patients in general practice with specialist support,” the submission said.
“This can reduce avoidable referrals, improve the quality of referrals that do proceed and preserve limited specialist appointments for patients who need direct specialist assessment.”
