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AMA says no place for ‘exorbitant’ fees

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The AMA has defended the right of doctors to charge “appropriate” fees for their services, particularly given the failure of the Medicare rebate to keep pace with the rising cost of providing care.

Amid claims that some patients are being hit with enormous out-of-pocket expenses as high as $60,000, AMA President Associate Professor Brian Owler said there was no call for specialists to charge “exorbitant” fees.

But A/Professor Owler said the failure of successive governments to ensure the Medicare rebate kept pace with the cost of running a medical practice had left many doctors with little choice but to charge out-of-pocket expenses.

“The AMA does not support any specialist charging any fees that are exorbitant. But I do support the ability of a doctor to charge a fee that they feel is appropriate for their services,” he said. “More and more doctors have been charging gaps because the distance between the [Medicare] schedule fee and what it is costing them to run their practices is increasing.”

On 1 July the Medicare rebate for a standard level B GP consultation inched higher to $37.05 after being frozen for an extra nine months, but it still almost $36 less than what AMA considers to be a fair payment for GP services.

In the specialties, the gap is even larger. The AMA estimates that the decision by Government to freeze indexation of the rebate for specialist consultations for two years will push the gap out to $97.72 next year.

So far, the vast majority of patients have been shielded from the full effects of the Government’s failure to properly index Medicare rebates. In general practice, the bulk billing rate has reached above 82 per cent, while 89 per cent of specialist services are covered by private health insurer no-gap arrangements, and a further 4 per cent are covered by known gap arrangements.

But the Federal Government’s plan to slash the Medicare rebate for GP, pathology and diagnostic imaging services by $5 and introduce a mandatory co-payment is expected to drive bulk billing rates down.

The Royal Australian College of Surgeons has expressed consternation at media reports that some patients are being hit with very large out-of-pocket expenses.

The College said that extortionate fees, which were manifestly excessive and bore little relationship to the skills, resources or time used in providing care, were “exploitative and unethical” and in breach of its Code of Conduct.

College President Professor Michael Grigg said revelations of very high charges damaged the standing of surgeons and the health system.

“These stories affect confidence in private health care, private hospitals, the surgical profession and surgeons,” Professor Grigg said.

The College said it was working with the Australian Competition and Consumer Commission on ways to increase the disclosure of surgeon fees while still being compliant with the Trade Practices Act.

A/Professor Owler said it was important that all practitioners employed informed financial consent.

“Patients need to understand that they do have the ability to go an seek another opinion, to see whether another doctor might be able to provide a service at a cost that is more appropriate for that particular patient,” he said.

A/Professor Owler said doctors needed to be able to charge appropriately to cover the multitude of costs of running a practice – staff, property, equipment, insurance – as well as earn a fair income.

“But, by the same token, [we need to ensure] patients are not put under financial distress from accessing health care,” he said.

Adrian Rollins