1 00:00:00,080 --> 00:00:03,279 Speaker 1: Well, there's a new report which paints a bleak picture 2 00:00:03,320 --> 00:00:07,640 Speaker 1: of specialist care in Australia, where people are suffering unnecessary 3 00:00:07,680 --> 00:00:11,240 Speaker 1: illness and pain as they q for care or struggle 4 00:00:11,280 --> 00:00:14,400 Speaker 1: to pay for it. The report, which has been put 5 00:00:14,440 --> 00:00:18,040 Speaker 1: together by the Gratten Institute, found that more than one 6 00:00:18,079 --> 00:00:21,320 Speaker 1: in five Australians who saw a specialist in twenty twenty 7 00:00:21,360 --> 00:00:26,080 Speaker 1: three were charge a fee deemed extreme, defined as costs 8 00:00:26,160 --> 00:00:29,440 Speaker 1: that are on average more than three times the Medicare 9 00:00:29,680 --> 00:00:32,839 Speaker 1: schedule fee. Now joining us on the line is the 10 00:00:32,920 --> 00:00:37,760 Speaker 1: Gratton Institute Health Program Director Peter Braden. Good morning to you. Peter. 11 00:00:38,800 --> 00:00:41,519 Speaker 1: Good morning Peter, Thanks so much for your time. Can 12 00:00:41,560 --> 00:00:44,080 Speaker 1: you tell me more about what the report looked into. 13 00:00:45,720 --> 00:00:48,720 Speaker 2: Well, we looked at how many Australians are saying they 14 00:00:48,800 --> 00:00:52,400 Speaker 2: can't get the specialist care that typically their GP has 15 00:00:52,600 --> 00:00:56,240 Speaker 2: recommended they need, and it's about two million Australians. Half 16 00:00:56,280 --> 00:00:58,760 Speaker 2: of those say they're not getting care because of the cost. 17 00:00:59,440 --> 00:01:02,520 Speaker 2: And we found that those costs have skyrocketed. So not 18 00:01:02,560 --> 00:01:07,120 Speaker 2: only two entry times you go to a specialist clinic 19 00:01:07,840 --> 00:01:10,480 Speaker 2: in the private sector you charged a fee. Those fees 20 00:01:10,480 --> 00:01:13,520 Speaker 2: have gone up by seventy three percent since twenty ten, 21 00:01:14,640 --> 00:01:17,120 Speaker 2: and as you mentioned, in some cases they're really high. 22 00:01:17,720 --> 00:01:19,880 Speaker 2: But that's not the only problem. If you've got a 23 00:01:20,000 --> 00:01:23,160 Speaker 2: high fee, you might identifind that well. The only alternative 24 00:01:23,280 --> 00:01:25,560 Speaker 2: is a really long wait list in the public system 25 00:01:25,880 --> 00:01:28,119 Speaker 2: where you might be stuck waiting for months or even 26 00:01:28,280 --> 00:01:30,800 Speaker 2: a year for the care you need. 27 00:01:31,560 --> 00:01:34,040 Speaker 1: I mean, Peter, it is something that we've spoken about 28 00:01:34,040 --> 00:01:37,760 Speaker 1: on this show on numerous occasions. And you know, not 29 00:01:37,840 --> 00:01:41,680 Speaker 1: only the costs, but more so the weight times in 30 00:01:42,520 --> 00:01:46,080 Speaker 1: parts of Australia like Darwin, you know, even more regional 31 00:01:46,240 --> 00:01:49,920 Speaker 1: and remote. You know, talk me through some of the 32 00:01:50,040 --> 00:01:53,280 Speaker 1: examples that you found in relation. I guess, first off, 33 00:01:53,320 --> 00:01:57,040 Speaker 1: to those specialist costs, it. 34 00:01:57,160 --> 00:02:01,360 Speaker 2: Will half of initial psychiatry consultationations cost more than two 35 00:02:01,480 --> 00:02:05,240 Speaker 2: hundred and forty dollars, and for arnos and throat specialists 36 00:02:05,320 --> 00:02:08,280 Speaker 2: it's one hundred and sixty dollars. And then a small 37 00:02:08,360 --> 00:02:11,200 Speaker 2: number of specialists are charging fees you know, way way 38 00:02:11,280 --> 00:02:14,080 Speaker 2: higher than that. So you know, for the fees we 39 00:02:14,160 --> 00:02:17,200 Speaker 2: call extreme, which is three times charging a patient three 40 00:02:17,280 --> 00:02:20,919 Speaker 2: times what the government pays. That's three hundred and sixty 41 00:02:20,960 --> 00:02:24,600 Speaker 2: dollars for cardiologists or pediatrician it's six hundred and seventy 42 00:02:24,639 --> 00:02:28,799 Speaker 2: dollars for a psychiatrists And as you mentioned, it's really 43 00:02:29,240 --> 00:02:32,000 Speaker 2: a lot of rural and regional communities that are hit 44 00:02:32,040 --> 00:02:35,160 Speaker 2: hardest in terms of not being able to get care. 45 00:02:35,840 --> 00:02:39,040 Speaker 2: So the level of care per person falls away quickly 46 00:02:39,880 --> 00:02:43,760 Speaker 2: once you leave cities, and in half of remote and 47 00:02:43,880 --> 00:02:48,960 Speaker 2: very remote areas there's only one specialist service per per year. 48 00:02:49,320 --> 00:02:51,920 Speaker 2: And in no part of a major city do you 49 00:02:52,000 --> 00:02:54,320 Speaker 2: see those extremely low levels of care. 50 00:02:56,160 --> 00:02:59,560 Speaker 1: Peter talked me through, like, obviously the cost is exorbitant 51 00:02:59,600 --> 00:03:01,280 Speaker 1: for a lot of people wanting to go and see 52 00:03:01,320 --> 00:03:03,880 Speaker 1: a specialist, but you're sort of touched on this as well. 53 00:03:04,200 --> 00:03:07,720 Speaker 1: Then for regional and more remote parts of Australia when 54 00:03:07,720 --> 00:03:10,200 Speaker 1: you look at the wait times like that is also 55 00:03:10,400 --> 00:03:16,400 Speaker 1: astronomical for people even if they're going through the private system. 56 00:03:16,520 --> 00:03:19,000 Speaker 2: That's right, Yeah, the wait times are really long, even 57 00:03:19,040 --> 00:03:21,720 Speaker 2: on the private side, and that's because those levels of 58 00:03:21,760 --> 00:03:25,040 Speaker 2: care are just too low to provide the care that 59 00:03:25,120 --> 00:03:28,840 Speaker 2: everyone in a community needs. So we found that in 60 00:03:29,160 --> 00:03:31,960 Speaker 2: the best served areas of Australia, the area with the 61 00:03:32,040 --> 00:03:36,120 Speaker 2: highest level of care that's Eastern Sydney, that's got about 62 00:03:36,120 --> 00:03:40,320 Speaker 2: a third more services per person than the worst served areas, 63 00:03:40,360 --> 00:03:43,760 Speaker 2: which are places like our back wa out Back End, 64 00:03:43,840 --> 00:03:48,400 Speaker 2: TSA and Queensland. So that means, yeah, you're just gonna 65 00:03:48,400 --> 00:03:50,120 Speaker 2: have to wait longer because there isn't enough care in 66 00:03:50,160 --> 00:03:53,640 Speaker 2: the community and across the country, as you see private 67 00:03:53,680 --> 00:03:58,040 Speaker 2: clinics fall away and you have less private care, the 68 00:03:58,080 --> 00:04:00,880 Speaker 2: public system isn't stepping up to fill the gap. So 69 00:04:01,040 --> 00:04:03,240 Speaker 2: the level of public care it's a bit higher in 70 00:04:03,280 --> 00:04:06,280 Speaker 2: those underserved communities, but it's not getting them up to 71 00:04:06,360 --> 00:04:08,680 Speaker 2: the level of the rest of the country by any means. 72 00:04:09,120 --> 00:04:12,680 Speaker 2: So we've called for a million new appointments and really 73 00:04:12,680 --> 00:04:16,080 Speaker 2: importantly that's in the public system. They have to be 74 00:04:16,160 --> 00:04:19,880 Speaker 2: targeted in those communities that have too little care because 75 00:04:19,880 --> 00:04:21,800 Speaker 2: a lot of the investment is just based on where 76 00:04:21,800 --> 00:04:24,960 Speaker 2: it is today. It's not expanding it where it's needed most. 77 00:04:25,520 --> 00:04:27,800 Speaker 1: I mean what you just touched on the you know 78 00:04:27,839 --> 00:04:30,200 Speaker 1: what you are calling for as a result of this 79 00:04:30,400 --> 00:04:35,040 Speaker 1: report in terms of other recommendations and where you go 80 00:04:35,120 --> 00:04:37,880 Speaker 1: to from here with this report, I mean, has it 81 00:04:37,960 --> 00:04:41,240 Speaker 1: been presented to the federal government. Is it being presented 82 00:04:41,279 --> 00:04:44,480 Speaker 1: to you to state and territory governments as well, so 83 00:04:44,520 --> 00:04:46,560 Speaker 1: that they can have a closer look. I guess in 84 00:04:46,600 --> 00:04:49,359 Speaker 1: some ways people know what the problems are, but I 85 00:04:49,400 --> 00:04:52,200 Speaker 1: don't know whether the issues are exasperated because it's hard 86 00:04:52,240 --> 00:04:55,440 Speaker 1: to get specialists to regional and remote parts of Australia, 87 00:04:55,600 --> 00:04:58,520 Speaker 1: or whether their costs arising. Did it look into that 88 00:04:58,640 --> 00:04:59,159 Speaker 1: kind of thing. 89 00:05:00,680 --> 00:05:02,960 Speaker 2: Yes, it did look into those things, and it is 90 00:05:03,520 --> 00:05:06,560 Speaker 2: harder sometimes to get specialists to work in these areas. 91 00:05:07,160 --> 00:05:10,039 Speaker 2: We talked about some ways to tackle that, so, you know, 92 00:05:10,360 --> 00:05:13,080 Speaker 2: using more virtual and remote care. You know, we set 93 00:05:13,120 --> 00:05:16,120 Speaker 2: clinician on the ground to help people, but with specialists 94 00:05:16,160 --> 00:05:18,480 Speaker 2: staling in there could be a lot more of that. 95 00:05:18,960 --> 00:05:21,640 Speaker 2: And we looked at how public clinics operate across Australia 96 00:05:21,680 --> 00:05:24,680 Speaker 2: and it's very very Some of them use a lot 97 00:05:24,680 --> 00:05:26,680 Speaker 2: of virtual care, some of them don't, so we think 98 00:05:26,680 --> 00:05:31,960 Speaker 2: there's a lot of opportunity to expand that. And yeah, 99 00:05:32,000 --> 00:05:34,120 Speaker 2: I mean one of the big challenges is training. So 100 00:05:35,000 --> 00:05:37,120 Speaker 2: you know, for we know that one of the best 101 00:05:37,160 --> 00:05:40,440 Speaker 2: ways to get doctors in rural and remote communities is 102 00:05:40,480 --> 00:05:43,040 Speaker 2: to train them there that way, and they're putting down 103 00:05:43,120 --> 00:05:45,000 Speaker 2: routes and they're more likely to stay in the community. 104 00:05:45,560 --> 00:05:48,520 Speaker 2: But that's really low for specialists in the last couple 105 00:05:48,600 --> 00:05:51,719 Speaker 2: of decades, we've seen more of those undergraduate students doing 106 00:05:51,720 --> 00:05:55,640 Speaker 2: their initial medical qualification getting trained in rural areas. And 107 00:05:55,720 --> 00:05:58,240 Speaker 2: we're starting to see a growth in you know, in 108 00:05:58,360 --> 00:06:00,960 Speaker 2: GPS taking a rural track and so on, but it 109 00:06:00,960 --> 00:06:04,440 Speaker 2: hasn't gone for other kinds of specialists. So we're saying 110 00:06:04,480 --> 00:06:07,880 Speaker 2: the government needs to get a target, a minimum level 111 00:06:08,279 --> 00:06:11,320 Speaker 2: for the different specialties that are in undersupply in rural 112 00:06:11,360 --> 00:06:15,000 Speaker 2: areas to be trained in rural areas, and then they 113 00:06:15,040 --> 00:06:17,960 Speaker 2: need to type the funding that they give to hospitals 114 00:06:18,279 --> 00:06:20,560 Speaker 2: to actually providing that training where it's needed. So that 115 00:06:20,600 --> 00:06:24,400 Speaker 2: will help, and the new funding targeted to these communities 116 00:06:24,400 --> 00:06:27,360 Speaker 2: will help. And then using the new technology putting that together, 117 00:06:27,760 --> 00:06:30,080 Speaker 2: we hope you get a lot more supply of care 118 00:06:30,120 --> 00:06:30,880 Speaker 2: in these areas. 119 00:06:30,960 --> 00:06:33,320 Speaker 1: Yeah, look, I think we all hope. So can I 120 00:06:33,360 --> 00:06:36,760 Speaker 1: ask Peter in terms of, you know, the cost to 121 00:06:36,839 --> 00:06:41,680 Speaker 1: see specialists and you know, whether it means people are 122 00:06:41,800 --> 00:06:45,599 Speaker 1: foregoing seeing specialists, and particularly you know, when you look 123 00:06:45,600 --> 00:06:50,880 Speaker 1: at at people battling things like cancer, what kind of 124 00:06:50,920 --> 00:06:52,400 Speaker 1: impact is it having. 125 00:06:53,720 --> 00:06:56,880 Speaker 2: It's really serious because you've got to remember people don't 126 00:06:56,920 --> 00:06:59,440 Speaker 2: go to the specialist out of the blue. They get 127 00:06:59,480 --> 00:07:01,960 Speaker 2: a referral from a GP, So a doctor is saying, 128 00:07:02,080 --> 00:07:03,960 Speaker 2: you need to go and see this other kind of 129 00:07:03,960 --> 00:07:08,040 Speaker 2: specialist to get you know, really focused expertise on whatever 130 00:07:08,040 --> 00:07:10,640 Speaker 2: it might be, a cancer, a heart issue, a mental 131 00:07:10,640 --> 00:07:14,560 Speaker 2: health issue. So, yeah, they don't give out these referrals 132 00:07:14,600 --> 00:07:17,080 Speaker 2: on a whim. And if you miss that care, the 133 00:07:17,160 --> 00:07:20,520 Speaker 2: risks are really high. So you might delay a diagnosis 134 00:07:20,560 --> 00:07:24,400 Speaker 2: and an underlying get worse. You know, you might be 135 00:07:24,920 --> 00:07:27,679 Speaker 2: not on the right medication or not managing a condition 136 00:07:27,760 --> 00:07:29,920 Speaker 2: in the best way and you get sicker. So down 137 00:07:29,960 --> 00:07:31,920 Speaker 2: the track, you know, there's a real risk that people 138 00:07:32,040 --> 00:07:35,200 Speaker 2: end up in hospital or worse because they didn't get 139 00:07:35,200 --> 00:07:36,120 Speaker 2: that specialist care. 140 00:07:36,320 --> 00:07:40,600 Speaker 1: Yeah, like, do we think that the reason why you know, 141 00:07:40,640 --> 00:07:43,600 Speaker 1: we've seen sort of these costs go up and you know, 142 00:07:44,280 --> 00:07:46,880 Speaker 1: not as many specialists. Is it something that sort of 143 00:07:46,880 --> 00:07:49,840 Speaker 1: happened post COVID? Is it just something that's happened over 144 00:07:49,960 --> 00:07:52,640 Speaker 1: recent years? What do you reckon the reason for it is? 145 00:07:53,560 --> 00:07:55,680 Speaker 2: I think it's been brewing for a long time. We've 146 00:07:55,680 --> 00:07:58,840 Speaker 2: actually had a lot of expansion of specialists, but we 147 00:07:58,920 --> 00:08:02,120 Speaker 2: haven't had the policy in place to make sure that 148 00:08:02,120 --> 00:08:05,000 Speaker 2: that growth in specialists is in the types of specialists 149 00:08:05,080 --> 00:08:10,200 Speaker 2: that are undersupplied, so psychiatrists, dermatologists, ophsalmologists. We've had too 150 00:08:10,280 --> 00:08:12,960 Speaker 2: few of those being trained for decades now. And then, 151 00:08:13,000 --> 00:08:14,800 Speaker 2: as I mentioned, you know, we're not getting a training 152 00:08:14,840 --> 00:08:18,040 Speaker 2: in the rural areas either, So I think that's been 153 00:08:18,040 --> 00:08:20,920 Speaker 2: a problem. It's kind of been a system left to 154 00:08:21,080 --> 00:08:26,200 Speaker 2: run on autopilot. We've been largely investing in public clinics 155 00:08:26,240 --> 00:08:29,880 Speaker 2: where they've been before. We've been largely churning out the 156 00:08:29,960 --> 00:08:34,240 Speaker 2: trainees that it suits hospitals to train right now to 157 00:08:34,280 --> 00:08:37,559 Speaker 2: meet their service delivery needs, and that colleges are willing 158 00:08:37,600 --> 00:08:41,360 Speaker 2: to credit the places for. So it just needs much 159 00:08:41,440 --> 00:08:45,400 Speaker 2: more planning and a much more assertive effort to sort 160 00:08:45,400 --> 00:08:48,320 Speaker 2: of shape the supply of specialists where they work and 161 00:08:48,360 --> 00:08:51,400 Speaker 2: the fees they charge, which are currently totally unregulated. 162 00:08:51,960 --> 00:08:54,760 Speaker 1: Well, look, I think it's a really interesting discussion to have. 163 00:08:54,840 --> 00:08:56,840 Speaker 1: I think it's, you know, something that a lot of 164 00:08:56,880 --> 00:08:58,720 Speaker 1: our listeners are going to be concerned with. I know 165 00:08:58,840 --> 00:09:01,920 Speaker 1: someone's just messaged in and said, Katie my son's my 166 00:09:02,400 --> 00:09:05,160 Speaker 1: son just had to spend nine hundred dollars for a 167 00:09:05,240 --> 00:09:09,400 Speaker 1: short initial appointment with a psychiatrist with a short follow 168 00:09:09,520 --> 00:09:12,440 Speaker 1: up appointment. So you know, I guess here in the 169 00:09:12,520 --> 00:09:15,520 Speaker 1: end we do see some of those costs, you know, 170 00:09:15,960 --> 00:09:19,280 Speaker 1: astronomical for people, but then it's also a matter of 171 00:09:19,320 --> 00:09:22,000 Speaker 1: not even being able to get in to see somebody 172 00:09:22,280 --> 00:09:23,960 Speaker 1: for quite a long period of time. 173 00:09:25,600 --> 00:09:28,000 Speaker 2: That's right. I think it is reaching a crisis point 174 00:09:28,040 --> 00:09:30,880 Speaker 2: for many communities. And it's really important to note that 175 00:09:31,000 --> 00:09:34,920 Speaker 2: thieves like that, they're really it's pretty impossible to see 176 00:09:34,920 --> 00:09:39,239 Speaker 2: a justification. Certainly some specialists, they might have more experience, 177 00:09:39,360 --> 00:09:42,280 Speaker 2: they might have higher rent, they might treat tougher patients, 178 00:09:42,360 --> 00:09:45,920 Speaker 2: whatever it is. But it's really hard. There's no evidence 179 00:09:46,080 --> 00:09:48,880 Speaker 2: to say that that costly care is better than less 180 00:09:48,880 --> 00:09:51,080 Speaker 2: costly care. I mean, that's not borne out by the facts. 181 00:09:51,760 --> 00:09:56,600 Speaker 2: And clearly specialists average specialists and a really good income 182 00:09:56,640 --> 00:09:59,959 Speaker 2: compared to every other occupation in the country. And then 183 00:10:00,000 --> 00:10:01,840 Speaker 2: and then on top of that, you know, these people 184 00:10:01,880 --> 00:10:04,040 Speaker 2: who are charging high and an average fees at earning 185 00:10:04,080 --> 00:10:06,000 Speaker 2: even more. So it's not a case of them not 186 00:10:06,040 --> 00:10:08,720 Speaker 2: being paid enough in my view, at that end, at 187 00:10:08,800 --> 00:10:11,920 Speaker 2: extreme end of outlier fees. But yeah, I think we 188 00:10:12,280 --> 00:10:15,280 Speaker 2: definitely need change. It's a terrible story to hear. I'm 189 00:10:15,320 --> 00:10:18,200 Speaker 2: sure that person who messaged in had to make some 190 00:10:18,200 --> 00:10:20,840 Speaker 2: really tough decisions about how to afford that care for 191 00:10:20,920 --> 00:10:21,320 Speaker 2: their son. 192 00:10:21,679 --> 00:10:25,640 Speaker 1: Yeah, you're spot on. Well, a really interesting discussion this 193 00:10:25,679 --> 00:10:28,120 Speaker 1: morning with you, Peter. I appreciate your time. Thank you 194 00:10:28,320 --> 00:10:31,880 Speaker 1: very much for having a chat with me the pleasure. Thanks, 195 00:10:31,920 --> 00:10:33,000 Speaker 1: thank you, Thanks so much.