Greater transparency on specialist fees: a no-brainer

$7 and a Medicare card

The question as to whether medical specialists should make their fees more transparent has long ruffled a few feathers.

The debate is raging afresh this week, sparked by a new study of billing data that reveals wide variations in specialist fees. The study, published in the Medical Journal of Australia, finds fees can vary up to five-fold within a single specialty.

As with any service, of course, some providers are of higher quality. But this is unpredictable. And as the study authors note, the rationale for fee variations is opaque without data on quality of care in private outpatient services.

An accompanying commentary cites unpublished research by the Royal Australasian College of Surgeons which finds “no correlation between the size of the fee charged and the quality of the surgery”.

Commenters have been quick to react, noting that the cost variation may reflect differences in office rental costs, the time spent per appointment, and the experience of the practitioner.

While these may be valid arguments for the existence of cost variation, they do little to counter the contention that costs should be made more transparent for consumers.

As a rule, transparency is the grease that keeps supply-and-demand systems running smoothly, and the confusion of the specialist fee system should be no exception.

Let’s say a GP suggests my child sees a dermatologist for acne, and recommends three good specialists. Whether or not I’d admit it to the GP, I’d have some curiosity as to the likely fee. It’s not the GP’s job to know, so I might end up phoning those three, plus a couple of other local dermatologists.

Yet that’s not how I compare prices of anything much else these days — by making a series of calls. Spending half-an-hour on the phone won’t help me decide on service quality. It will merely provide the exact sort of cost transparency which the study authors argue should be already available.

And I’m better off than most consumers. I speak good English, I’m used to conversations with receptionists, and I have the capacity to pay even a very high consultation fee — albeit reluctantly.

It won’t be easy to formulate a system of transparency. Maintaining an up-to-date website with comprehensive information would be a considerable impost on thousands of small businesses.

But surely health consumers are justified in pushing for something better than we have now.

A minimum standard might be mandating that practice websites state the fee for an initial consultation in a standardised format. Many do that already.

Specialists who worry that patients won’t understand why their costs are so high could, if they wished, add an explanation.

Although the two topics are often conflated, whether specialists are ‘worth’ their fees is an entirely separate discussion — one which does not need to be debated, let alone resolved, before moving on transparency.

In my view, there is little argument against making it easier for health consumers to become more informed about impending medical fees.

This article was first published in Medical Observer, March 2017

About Dr Justin Coleman

Justin is a GP working in Aboriginal health in Brisbane, Australia. He is also a medical writer, editor and blogger. Further details at https://drjustincoleman.com/
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