Referred medical specialist attendances

Specialists generally only see their patients after receiving a ‘referral’ from a primary health care practitioner. They provide diagnostic and treatment services in a specific area of medicine, generally for a particular disease or body system. This is distinct from other practitioners, such as specialists in General practice, allied health and other primary care services, where a referral is not usually required.

The referral requirement is only mandatory to claim Medicare benefits for specialist and consultant physician attendance items. In the event a patient attends a medical specialist without the referral in place, the patient would be able to claim a Medicare rebate for an ’other medical practitioner attendance’ item (for example, item 53). It is also possible the patient may receive the attendance outside Medicare completely, and not claim any benefits. Attendances meeting the above 2 criteria are not included on this page.

Common referred specialties include cardiology, dermatology, gynaecology, neurology, obstetrics, oncology, paediatrics and rheumatology. All specialists have completed advanced training and must be registered with the Australian Health Practitioner Regulation Agency in order to practise in Australia.

While many referred medical specialist attendances are rendered in hospital, not all of these are subsidised through the Medicare Benefits Schedule (MBS). Common examples of non-MBS subsidised services include services: 

• provided by hospital doctors to public patients, as these services receive a separate Commonwealth subsidy through the National Health Reform Agreement
• provided under the Department of Veterans' Affairs National Treatment Account 
• covered by third party or workers' compensation.

This page reports on referred medical specialist attendances subsidised through the MBS, and based on the financial year of service rendered between 2012–13 and 2022–23. 

How many Medicare-subsidised referred specialist attendances were provided?

In 2022–23, there were 34.5 million MBS-subsidised referred medical specialist attendances (consultations) in a range of settings (Table 1). These attendances were provided to 8.6 million patients (33% of people). Of these attendances, most (77% or 26.4 million services) occurred in non-hospital settings, such as private consulting rooms and private outpatient clinics and were provided to 8.3 million patients.

Table 1: Medicare-subsidised referred medical specialist attendances^(a) by setting, 2022–23^(b)

(a) Specialist attendances are Medicare-subsidised referred patient/doctor encounters, such as visits, consultations, and attendances by video conference, involving medical practitioners who have been recognised as specialists or consultant physicians for Medicare benefits purposes. Specialist attendances include psychiatry and obstetric care, including antenatal and post-natal attendances. In many cases, antenatal and post-natal attendances can be performed by general practitioners (GPs), and for the purposes of this report, these services have not been regarded as specialist attendances.

(b) Services provided to public inpatients or outpatients are not included in the table.

(c) This is the number of unique patients, with patients being only counted once in the total, even if they have had services across different categories.

(d) The proportion of people receiving a service is calculated by dividing the total patients by the Australian Estimated Resident Population as at 30 June 2022.

(e) Services provided in hospital settings are those involving hospital treatment or hospital substitute treatment (for example, hospital in the home). Most attendances provided to patients in emergency departments of private hospitals do not require hospital treatment and would be classified as non-hospital attendances.

Source: AIHW analysis of MBS data maintained by the Australian Government Department of Health and Aged Care; National, state and territory population, ABS 2023a.

Medical specialties

In 2022–23, 33% of people had at least one Medicare-subsidised referred medical specialist consultation. The most widely accessed specialties (in terms of the percentage of the population receiving at least one service) were: 

• anaesthetics (7.1%)
• cardiology (5.1%)
• ophthalmology (4.9%) 
• general surgery (3.9%)
• dermatology (3.7%) (Figure 1).

Across all referred medical specialties, there was an average of 4.0 specialist attendances per patient in 2022–23 (patients may have seen different types of specialists). The specialties for which patients received the most repeat services (accessed the same type of specialty more than once) on average within the year included: 

• rehabilitation medicine (6.5 services per patient)
• psychiatry (4.9 services per patient) 
• medical oncology (4.6 services per patient).

In 2022–23, the specialties with the highest number of consultations subsidised by Medicare within the year were: 

• cardiology (2.7 million)
• anaesthetics (2.5 million)
• psychiatry (2.5 million)
• obstetrics and gynaecology (2.4 million)
• ophthalmology (2.2 million)
• general surgery (1.8 million)
• general medicine (1.7 million)
• dermatology (1.6 million).

These 8 specialties accounted for half of all specialist consultations subsidised by Medicare (50%). In total there are over 40 specialist specialties. 

Figure 1: Top 10 specialties by various measures, 2022–23

Trends in consultations

The number of patients who had a Medicare-subsidised referred medical specialist consultation increased from 7 million in 2012–13 to 8.6 million in 2022–23. However, the proportion of people who had a consultation with a specialist only increased slightly (30.9% and 33.0% of people respectively). 

The number of specialist consultations per 100 people increased between 2012–13 and 2022–23, from 121 to 133 consultations. After adjusting for differences in the age structure of the population, the number of specialist consultations per 100 people increased very slightly in the 10 years to 2022–23, from 115 to 118 consultations.

Patient characteristics

Older people received more Medicare-subsidised referred medical specialist consultations than younger people. In 2022–23, just under 2 in 3 (64%) people aged 65 and over had at least one Medicare-subsidised referred medical specialist consultation, whereas under 1 in 3 (29%) people aged 16–64 and 1 in 5 (20%) people aged 15 and under had at least one consultation (Figure 2).

Figure 2: Specialist attendances by demography group, 2012–13 to 2022–23

Among all patients regardless of age, a higher proportion of females (36%) had at least one specialist consultation than males (30%). Even without pregnancy-related consultations, females still had a higher proportion (35%) than males.

The proportion of Australians who received at least one referred medical specialist consultation varied depending on where they lived. The proportion of people who had at least one referred medical specialist consultation was similar for residents of Inner regional and Major cities areas (35% and 33%, respectively), but decreased with increasing remoteness to 13% of people living in Very remote areas. The lower use of Medicare-subsidised referred medical specialist attendances in Remote and very remote areas may be partly attributed to these populations relying more on general practitioners (GPs) to provide health care services due to less availability of local specialist services (see Medicare funding of GP services over time).

The utilisation of specialist consultations was also affected by where people lived in terms of the socioeconomic status of their area. The percentage of Australians having at least one specialist consultation increased in areas with less disadvantage. In the least disadvantaged areas (quintile 5), 43% of residents had at least one specialist consultation, compared to 25% of residents living in the most disadvantaged areas (quintile 1). Although areas of higher disadvantage have a lower rate of specialist consultations, residents of these areas may receive these services though public outpatient clinics or as public inpatients, which are not subsidised through MBS arrangements. 

Spending

In 2022–23, $5.3 billion was spent on Medicare-subsidised referred medical specialist consultations. By funding source:

• $2.9 billion in Medicare benefits was paid by the Australian Government
• $2.3 billion in out-of-pocket costs was paid by private patients.

The $2.3 billion is comprised of the following out-of-pocket costs by clinical setting:

• $1.9 billion was paid by patients for services rendered in non-hospital settings (for example, specialist consulting rooms)
• $469.5 million was paid by patients for services rendered in-hospital or hospital-substitute settings (for example, hospital in the home).

In 2022–23, 59% or $1.7 billion of Australian Government spending on referred medical specialist consultations was accounted for by 10 specialties (Table 2). Table 2 also shows the top 10 specialties ranked by out-of-pocket costs paid by patients, which accounted for $1.6 billion (or 69%) in total out-of-pocket costs being paid to these 10 specialties.

Table 2: Top 10 specialties by Medicare benefits paid and by patient out-of-pocket costs, 2022–23

Source: AIHW analysis of MBS data maintained by the Australian Government Department of Health and Aged Care.

In 2022–23, 39% (10.3 million services) of non-hospital Medicare-subsidised referred medical specialist consultations were bulk-billed (indicating that patients did not incur costs for these services). For those who did pay out-of-pocket costs (77% of patients or 6.4 million people), on average a patient paid $294 for all non-hospital specialist attendances they received in the year (an average of $117 for one service for those who incurred out-of-pocket costs).

In 2022–23, 2.5% (206,000 services) of in-hospital Medicare-subsidised referred medical specialist consultations were bulk-billed. For those who did pay out-of-pocket costs (92% of patients or 2 million people), the average cost per patient for in-hospital specialist attendances was $232 for all services received in the year (an average of $60 per service for those who incurred out-of-pocket costs).

Trends in spending

Overall, spending on Medicare-subsidised referred medical specialist consultations has increased since 2012–13:

• Medicare benefits paid by the Australian Government increased in real terms (after adjusting for inflation), from $2.5 billion in 2012–13 to $2.9 billion in 2022–23 (Figure 3). When accounting for changes in the number of patients, spending had slightly decreased in real terms from $349 to $341 per patient. 
• Patient out-of-pocket costs in non-hospital settings increased in real terms from $1.1 billion in 2012–13 to $1.9 billion in 2022–23. On a per patient basis, there was an increase in real terms from $213 per patient to $294 (38%) during this period ($81 to $117 on a per service basis, an increase of 45%). 
• Patient out-of-pocket costs in hospital settings increased in real terms from $346.6 million in 2012–13 to $469.5 million in 2022–23. On a per patient basis, there was an increase in real terms from $197 per patient to $232 (18%) during this period ($53 to $60 on a per service basis, an increase of 12%). 

In the 10 years to 2022–23, the average referred medical specialist fee per service increased 0.9% per year (on average) in real terms, from $140 in 2012–13 to $153 in 2022–23. The proportion of provider fees covered by Medicare for specialist attendances decreased by 9 percentage points, from 64% in 2012–13 to 55% in 2022–23. This can be attributed to a faster growth in provider fees (37%) than growth in Medicare benefits (19%).

Figure3: Spending on specialist attendances, constant prices, 2012–13 to 2022–23

How many specialist attendances were delivered via telehealth?

Since 2002 telehealth items have been introduced to the MBS to facilitate telehealth attendances with medical specialists through 3 main initiatives:

• telepsychiatry program introduced from 2002
• telehealth program introduced from 2011
• COVID-19 temporary MBS telehealth services introduced in 2020 as part of the Australian Government’s response to the COVID-19 pandemic (many COVID-19 temporary items are now permanent).

The purposes of the telepsychiatry program and the original telehealth program were to improve patient access to medical specialists through videoconferencing for patients living in remote locations. In 2022, the Medicare items for telehealth attendances with medical specialists were consolidated into a single telehealth program. As a result, many of the preexisting telehealth items, some of which had specific eligibility criteria were discontinued.

Figure 4: Telehealth specialist attendances, 2002–03 to 2022–23

The take up rates for the telepsychiatry services introduced from 2002 were initially very low (Figure 4). It was not until the start of the telehealth program in 2011 that the number of services rendered started to increase, and by 2015–16 over 100,000 telehealth consultations with medical specialists were being rendered each year.

The next major change occurred in March 2020, when the COVID-19 temporary-MBS telehealth services were introduced in response to the COVID-19 pandemic. Up until this point existing telehealth items only supported services being rendered through videoconferencing (not over the telephone) and had strict eligibility criteria mainly based on the patient's location and distance from the specialist. Through the COVID-19 telehealth initiative, new Medicare items supporting telephone attendances, and new items supporting videoconferencing attendances with wider patient eligibility criteria were introduced. This resulted in 2.6 million telehealth services being rendered in 2019–20, and peaked at 6 million telehealth services rendered in 2021–22, when widespread COVID-19 lockdowns in New South Wales, Victoria and the Australian Capital Territory were introduced.

The take-up of the new telephone attendance items from their introduction in March 2020 to the end of the financial year in June 2020 exceeded the total videoconferencing attendances rendered in the whole 2019–20 financial year (1.8 and 0.7 million attendances respectively). Telephone attendance items drove the overall increase in telehealth attendances rendered during the COVID-19 pandemic (for example, telehealth services increased from 47,000 rendered during the second quarter of 2019 to 2.2 million rendered in the second quarter of 2020, of which 76% were delivered through telephone). After reaching a peak of 4.3 million telephone attendances in 2021–22, the volume of telephone attendances decreased substantially in 2022–23 to 1.8 million once the COVID-19 lockdowns and other public health interventions were lifted, and medical specialist clinics (some of which were only rendering services through telehealth) returned to more standard operations. In contrast, the number of attendances delivered through videoconferencing continued to increase with 1.7 and 1.8 million attendances rendered in 2021–22 and 2022–23 respectively.

Socioeconomic and remoteness areas

Adjusting for the difference in age structure of the population, telehealth services for medical specialist attendances had the highest take up rates in areas of least disadvantage and in Major cities, once Medicare telehealth items without patient eligibility criteria were introduced. For example, in 2022–23 there were 18.2 telehealth attendances per 100 people in areas of least disadvantage, with attendance rates declining for areas of increasing disadvantage, with the most disadvantaged areas receiving 9.2 telehealth attendances per 100 people. 

While the original telehealth items had criteria that largely limited their claiming to patients in more remote areas, at the height of the COVID-19 pandemic in 2021–22, patients in Major cities (many of which were in lockdown) had the highest rate of telehealth attendances with referred medical specialists, with 22.9 attendances per 100 people. This number declined steeply in 2022–23, down to 12.9 services per 100 people. Remote and Very remote areas however experienced a much shallower decline in the rate of telehealth services, indicating the lasting appeal of telehealth to Australians in remote areas.

What were patients’ experiences of specialist attendances?

The 2022–23 Patient Experience Survey (ABS 2023b) estimated that for people aged 15 and over who needed to see a medical specialist (in both hospital and non-hospital settings) in the previous 12 months:

• 22.5% delayed their appointment at least once or did not see a medical specialist when needed. Of this 22.5%, 10.5% of patients cited cost as a reason for delaying or not seeing the medical specialist.
• 27.9% waited longer than they felt acceptable to get an appointment with a medical specialist.
• A high proportion reported that the medical specialists they saw ‘always’ listened carefully, spent enough time with them and showed respect (77.9%, 78.9%, and 82.8% respectively). Smaller proportions reported that the specialists they saw ‘often’ displayed these behaviours (13.8%, 11.9%, and 11.1% respectively).

Where do I go for more information?

For more information on specialist attendances, see:

• Medicare-subsidised GP, allied health and specialist health care across local areas: 2022–23

For more on this topic, visit Medical specialists.