Summary: The health care cost problems that plague the United States are not unique. Australia’s system has some of the same issues, as Professor Lesley Russell writes: “The impact of specialist fees on government and patient budgets has received little reform attention. This is despite the government’s push for controls in health-care spending and growing evidence of the affordability problems faced by sick Australians.” Keep reading for more, or…



“A high-quality specialist sector is an essential component of an effective health-care system; patients rely on specialist doctors when they are sickest and most vulnerable. And when their treatment inevitably involves expensive treatment options. But specialist care in the community is increasingly hard for many Australians to access, due to geography and cost.

“In 2011-12, the number of people who reported seeing a medical specialist in the preceding year varied nearly two-fold across Medicare Local populations nationally, from 22% to 42%. But there was no strong association between health status and seeing a specialist. And up to 14% of people reported they had delayed seeing a specialist because of cost….

“So what should be done? The list of issues to be tackled includes:

“• More publicly available data and analyses to inform an expert, well-resourced and on-going review of the items and fees on the Medicare Benefits Schedule. To date only about 3% of these items has been reviewed since 2010.

“• Investment in a Choosing Wisely focus to assess low- and high-value services and an education and awareness program to ensure that the findings are acted upon. The medical colleges can play a key role here.

“• Incentives to address geographic need and affordability. The current situation has led to major inequities in access to health-care services.

“• A program to tackle inappropriate variations in services. This will deliver not just cost savings but improved quality.

“• More transparency around specialist charges so referring GPs and patients can make informed decisions. This might go so far as to name and shame the extreme outliers.” — Lesley Russell adjunct associate professor, Menzies Centre for Health Policy at University of Sydney, Australia, via For real health reform, turn the spotlight on specialists’ fees, The Conversation, Feb. 15, 2015.

Jeanne Pinder

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...