Psychiatrists and paediatricians among specialists most likely to charge ‘extreme’ fees, thinktank finds
Summary
A Grattan Institute report says 2.2 million Australians paid specialist fees at least three times the Medicare schedule fee in 2025, and the number is rising. It says psychiatrists and paediatricians are among the specialties with some of the highest fees and recommends requiring specialists who routinely charge above the threshold to repay their annual Medicare rebates, while patients keep theirs.Key Facts
- The report defines an extreme fee as at least three times the government’s Medicare schedule fee.
- About 250,000 more patients paid extreme fees each year, reaching 2.2 million patients in 2025.
- From 2012 to 2025, Medicare rebates fell by an inflation-adjusted $9 per service while specialists’ fees rose by an average of $37.
- The most expensive 5% of psychiatrists charged a median out-of-pocket fee of $669 for an initial consultation; the equivalent figure was $362 for paediatricians and $265.11 for cardiologists.
- The report proposes that specialists whose annual fees average more than three times the Medicare schedule fee repay all Medicare rebates claimed that year.
- The proposed rule would affect about 6% of specialists, including more than 60% of private dermatologists and a quarter of obstetrician-gynaecologists.
- Fewer than one in four initial specialist consultations were bulk-billed in 2025, and the rate was below 10% in urology, dermatology, ear, nose and throat care, and psychiatry.
- Legislation passed in September allows the government to publish all specialists’ fees on the Medical Costs Finder website starting in 2027.
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