GP's pioneering website shows fee transparency is not brain surgery

This article first appeared on Medical Observer, to read the original click here.

Dr Richard Zhu’s pioneering SeekMedi website, listing specialist fees, is a breakthrough.

While coverage is not nationwide and, presumably, some specialists are yet to be included, it’s a breakthrough in terms of publishing in one place the fees that specialists charge.

What the GP has achieved in a relatively short time also demonstrates that such a service in the interests of consumers is not brain surgery.

When we consider all that surgeons and other specialists achieve these days, their failure to provide a simple platform for consumers to view and compare fees — particularly at a time of often very high costs — does them no credit.

The Consumers Health Forum has urged the establishment of a website similar to Dr Zhu’s after research in the MJA earlier this year revealed that the difference in average out-of-pocket costs between the least and most expensive practitioners was $100 or more for eight out of 11 specialties.

As I said then: 

“The paucity of publicly available information about the range of fees for specific services does not serve patients and informed patient choice well. It is an unacceptable feature of Medicare which should and can be fixed urgently. The at-times stark differentials in fees for the same operation exposes patients to a random maze of costs for which there is no transparent explanation or justification.”

Doctors’ reasons for resisting this simple way of disclosing medical fees include many that don’t wash: that it might penalise surgeons who charge more because they do the toughest cases; that treatment outcomes and therefore charges are unpredictable; that publication would breach privacy.

AMA President Dr Michael Gannon has cautiously welcomed the concept, at least if it was “doctor-facing”. But he has also warned that it could have an inflationary impact as some doctors don’t like to look as if they are the “cheapest on the street”.

We would still argue for transparency. The AMA argument cuts both ways: it’s likely that doctors would equally not wish to be seen as charging extreme costs compared with their peers.

CHF has proposed the establishment of an independent and authoritative website to list fees and ultimately data on the performance of specialists such as measures of outcome. 

Quite apart from the expectation of consumers in the 21st century to be able to ascertain the cost and reportable performance of services, it is reasonable to expect that an evidence-based profession whose incomes are heavily reliant on the taxpayer and health fund members should have their fees openly and easily accessible.

There are a range of practical options for such a website to provide consumer-friendly information on specialists’ fees:

  • That it be established by an authoritative body acceptable to the medical profession such as Government, or even under the aegis of the Council of Presidents of Medical Colleges;
  • That they be published on a regional basis, perhaps giving mean or average fees and high/low indices without identifying practitioners by name;
  • That if individual practitioners were to be named, the figure given be based on a mean/average of their previous year’s fees;
  • That practitioners make available their fees data as part of requirements for eligibility to receive Medicare payments;
  • That performance indicators be developed to enable consumers to compare practitioners.

It is time for medical leaders to respond to this fees issue. The profession has been critical of health insurers yet lack of fee transparency is a central issue impairing health insurance.

Unexpected and unduly high fees hit patients at their most vulnerable, contribute nothing to the quality of the health system and do not reflect well on the medical community whose prime duty is to supply best medical care.

Quite apart from bill shock, there is no way the patient can gauge whether higher fees represent higher quality. It is also important that patients do not think that higher fees equate to superior outcomes.

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About the author

Leanne Wells

Leanne Wells

Chief Executive of the Consumers Health Forum of Australia