Draft legislation released last week includes GPs amidst the specialists whose fees will be published using Medicare data. Slightly more GPs support the government’s plan to publish non-GP specialists’ fees – 56% – versus 50% who support adding GPs fees.
But few think the improved transparency will translate to reduced costs or other benefits for patients, and many worry the proposed methodology won’t provide adequate context.
While the Medical Costs Finder website cost $24 million to build, only 88 doctors had uploaded their fees by the end of last year. If the legislation passes, the government will take matters into its own hands rather than waiting for doctors to voluntarily add their fees.
The proposed amendment will allow the Department of Health, Disability and Ageing to publish information on fees charged by medical practitioners, including specialists and GPs, and likely out-of-pocket costs related to private healthcare. The information will come from Medicare, hospital and insurer billing data collected by government.
To achieve this, the government says it’s developing “an analytical approach for the derivation of a single fee figure that can be published for a medical practitioner’s provision of a service for a given financial year.”
Introducing the bill in parliament last week, Health Minister Mark Butler said the proposed amendments would include publishing bulk billing rates by GPs, as well as fee information for common GP telehealth items – and potentially more information regarding GPs’ fees.
“While the focus is on the charging practices of specialists, the department may also publish information about GPs and other medical practitioners and their charging practices. GPs would be particularly relevant to publish as they are often the first step of a patient journey for specialist treatment,” an explanatory document released alongside the bill states.
“Publication of GP fees would help Australians at the start of this patient journey.”
Just 20% of GPs think publishing fee data will reduce patients’ costs. More than two thirds think there will be no change, while 13% predict an increase in costs.
Twenty eight percent of GPs felt the strategy would improve patients’ ability to choose a GP they can afford, while just 6% felt it would improve access to primary healthcare.
And GPs aren’t the only ones who are sceptical.
University of Melbourne health economists Professor Yuting Zhang and Professor Stephen Duckett, and their colleague Professor Charles Kemp from the school of psychological scientists say the proposed changes might push fees up if people see their peers are charging more – and they say measures of quality such as clinical outcomes and wait times should be included to.
Moreover, “transparency alone won’t be enough to rein in specialists’ fees,” their soon-to-be published peer reviewed research suggests.
Around 1000 GPs answered an open-ended question on what, if any, concerns they had about the proposed bill. The most common themes included concerns about:
The quotes below from GPs in the survey are reflective of many similar responses along these themes.
“I doubt very much that they will also publish the number of GP patients seen daily and length of time spent and complexity of each consultation, so just looking at fees is not an indicator of quality of care and time taken.”
“While I am not opposed to transparency in principle, I am concerned that listing fees in isolation may encourage direct price comparisons between practices without appropriate context. Fees often reflect differences in factors such as the quality of facilities, the level of experience of the GP, the scope of services provided, and the time allocated per consultation. Practices that invest in state-of-the-art facilities and highly experienced clinicians may understandably charge a premium.”
“Fee transparency measures may oversimplify general practice pricing without reflecting consultation complexity, overhead costs, and differences in service models. Public comparison of fees without appropriate context risks misrepresenting value and quality, and may unintentionally pressure practices to prioritise cost over sustainability.”
“While transparency for patients is important, publishing GP fees using Medicare data risks oversimplifying complex clinical encounters. Medicare item numbers do not adequately reflect consultation length, complexity, comorbidities, or non-billable work such as care coordination and documentation.”
“This is not about transparency, rather it appears a step again for universal bulk billing is to lead patients to think first about cost over service.”
“It’s an under handed tactic of the government to force practitioners to bulk bill.”
“This can be viewed as a means to drive more doctors into bulk billing, as it creates the narrative of ‘greedy doctors.’”
“This also leads to unnecessary competition amongst practitioners and introduces another layer of financial threat to the viability of certain practices.”
“While the intention of improving transparency is commendable, my primary concerns relate to potential unintended consequences for general practice sustainability and patient care.”
“Publishing information on a website may easily become outdated and then lead to more questions and arguments with patients over fees which wastes everyone’s time.”
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