title: Variation in outpatient consultant physician fees in Australia by specialty and state and territory.
abstract: OBJECTIVE
  To determine the mean, median and 10th and 90th percentile levels of fees and out-of-pocket costs to the patient for an initial consultation with a consultant physician; to determine any differences in fees and bulk-billing rates between specialties and between states and territories.
  
  
  METHODS
  Analysis of 2015 Medicare claims data for an initial outpatient appointment with a consultant physician (Item 110) in 11 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, geriatric medicine, haematology, immunology/allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology).
  
  
  METHODS
  Mean, median, 10th and 90th percentile levels for consultant physician fees and out-of-pocket costs, by medical specialty and state or territory; bulk-billing rate, by medical specialty and state/territory.
  
  
  RESULTS
  Bulk-billing rates varied between specialties, with only haematology and medical oncology bulk-billing more than half of initial consultations. Bulk-billing rates also varied between states and territories, with rates in the Northern Territory (76%) nearly double those elsewhere. Most private consultations require a significant out-of-pocket payment by the patient, and these payments varied more than fivefold in some specialties.
  
  
  CONCLUSIONS
  Without data on quality of care in private outpatient services, the rationale for the marked variations in fees within specialties is unknown. As insurers are prohibited from providing cover for the costs of outpatient care, the impact of out-of-pocket payments on access to private specialist care is unknown.
authors.affiliation: Centre for Health Policy, University of Melbourne, Melbourne, VIC gary.freed@unimelb.edu.au.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Freed
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Allen
mesh_terms: D000328:Adult; D001315:Australia; D005249:Fees and Charges / Q000706:statistics & numerical data*; D058006:General Practice / Q000191:economics*; D006801:Humans; D009313:National Health Programs / Q000191:economics; D009819:Office Visits / Q000191:economics* / Q000706:statistics & numerical data; D010045:Outpatients / Q000706:statistics & numerical data*; D010350:Patient Credit and Collection / Q000379:methods / Q000706:statistics & numerical data*