Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026

Senator ANANDA-RAJAH (Victoria) (12:54): I rise to speak on the Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026. Australians have been approaching their medical specialist care with trepidation. They are fearful of bill shock, burnt by highly variable out-of-pocket fees that are declared too late in the patient journey, often once the therapeutic alliance between doctor and patient has been forged.

The effect has been an erosion of confidence in the private health system and, worse still, delayed care, because the current financial consent process is not working for them. This is exposing Australians to financial toxicity when they see medical specialists for care. Let's take a knee replacement.

Private Healthcare Australia has the median fee for that operation last year at $1,080, but one in 10 patients was charged more than $5,300, nearly five times that price. So what does that uncertainty actually do? The ABS Patient Experiences survey found that more than 1.9 million Australians delayed or did not see a specialist due to cost in 2024-25.

The increase in specialist out-of-pocket costs over recent years has outpaced general price growth. For example, the average out-of-pocket cost for an initial specialist consultation went from around $94 in 2016, 10 years ago, to $158 in 2025, a 67 per cent increase. By comparison, the CPI or inflation rose by 32 per cent over the same time.

Specialists will argue that their costs have increased over time, and they have, due to a number of factors: rent on rooms; consumables; equipment; staff wages; medical indemnity, which tends to track with litigation across the entire medical profession; and income protection—to name a few. They may also argue that the Medicare rebate is insufficient for some procedures, such as complex surgeries that may sometimes take between eight and 10 hours at a time.

I can think of several, such as a AAA repair. That is when an aortic aneurysm is repaired. It is very long surgery.

Ivor Lewis oesophagectomy is usually surgery for cancer of the oesophagus. It is a major operation. And there are types of reconstructive surgery, such as head and neck, or even other types, to name a few.

They are usually for cancer. The Department of Health, Disability and Ageing released its consultation paper on specialist affordability, and the numbers in it are telling. On six million occasions, Australians were charged between three and five times the benchmark fee to see a specialist.

But on 1.24 million occasions last year, Australians were charged more than five times the benchmark fee. Out-of-hospital out-of-pocket costs have jumped by roughly 67 per cent since 2019. I want to be clear that excessive out-of-pocket fees are confined to a very small minority of specialists.

The vast majority are doing the right thing. Providers recognise their ethical obligation to ensure the fees they charge are reasonable. This is shared by the AMA, who have stated that they do not support egregious charges—fees that the majority of practitioners would consider unacceptable.

However, existing guardrails like professional standards and frameworks and, indeed, peer review and peer pressure for ethical billing are not preventing this behaviour. The risk here is that excessive out-of-pocket fees can become normalised, driving up fees across the entire market. A Consumers Health Forum survey released in February found consumer fees were the single biggest cost worry when dealing with a new health issue, with 86 per cent of respondents citing it as a concern.

Patients with complex chronic health conditions are particularly exposed to the cumulative impact of financial burden. These may be, for example, patients with chronic complex conditions like psychiatric conditions or cancer care. Patients with these conditions will often have limited ability to shop around or to even change providers.

Often, once a therapeutic alliance is forged, it is almost impossible to change. When I say that, I mean it's difficult. Patients and doctors—it's a special bond.

They become wedded. Patients become wedded to their specialist. They have confidence and so on and so forth, but they're then also, in some cases, exposed to excessive fees, particularly when public services are limited in a region or there is limited competition.

Information asymmetry is another issue, with patients having limited knowledge of what a service should cost. They may have to shop around or rely on their GP, who is also, to some degree, in the dark. The combined effect of limited transparency, the imbalance of power between provider and patient and excessive fees is compromising access to and affordability of specialist services and is undermining confidence in private health insurance.

People are questioning whether they are getting value for money from their private health insurance, and this is all occurring in the context of cost-of-living pressures. When we came to government, we thought this problem had been fixed. The coalition spent around $24 million of taxpayers' money building the Medical Costs Finder, a website whose entire purpose was to tell Australians what their specialist would charge, and then they made it voluntary.

By the end of 2022, out of roughly 6,300 eligible specialists across the 11 specialities on that site, six had published their fees—not six per cent but six doctors. Three years after, it was about 88. Again, it was not 88 per cent but 88 individual doctors, or somewhere around 1.4 per cent.

On the insurer's side, it was every bit as voluntary and every bit as ignored. Only about three insurers ever bothered to volunteer their data. That's three.

That is what happens when you build a website, cut a ribbon and then disappear. This bill finishes the job. Instead of waiting for specialists to volunteer, the government will now publish the Medicare hospital and insurer billing data it already collects, backed by a $7 million investment in the technical capability to do that.

There is no new paperwork for doctors. The data already exists. We are simply going to show it to the people who are paying those bills.

What does it look like? Mock-ups were sought at our committee hearing on 7 April, and that's freely available, if anyone wants to have a look at them. The department has provided these to our committee, and these are early drafts, built on years of research and extensive consultation with the colleges, craft groups, consumers and insurers.

These stakeholders all participated in multiple meetings helping to co-design this website and co-design this law. You search by service or by specialists. You put in your postcode and your fund, and what comes back is not one number.

It is the typical specialist fee, then what Medicare pays, then what the insurer pays and then what is actually left up to you, with a low, a typical and a high side shown side by side, so there is a bit of a range there. There are filters for distance, for gender, for language spoken and for speciality. There is a 'last updated' date on the page, and there is a tool that lets you compare how often each insurer has a no-gap arrangement in your state.

It's a range. It's not just a single figure. I did ask the department something else during that hearing: alongside the aggregate fee and the range, would there be qualitative information—something the specialists themselves can craft—and how easy would it be for them to update it?

There will be a free-text box, limited in size, for the specialist doctor to give context to their published fees. If you see more complex patients, you say so, and the provider portal already exists. It will have information like fellowships, meaning the qualifications, teaching practices, participation in clinical quality registries—all fields built off feedback from the profession itself.

I think this context is actually important. All specialists are not equal. Specialists tend to then subspecialise into very niche areas in medicine.

I can give you a couple of examples. For example, there may be only a couple of people in an entire state who will have the expertise to remove pacemakers when they become infected, which is highly dangerous and very risky and can cause, for example, ventricular rupture and occasionally need to be done when pacemakers become infected. These people are not just down the road.

They usually work in tertiary hospitals. They might also be in private practice, but there's only a handful of them in an entire state. That's one example.

Another example might be orthopaedic surgeons who specialise in removing infected joints. Again, these don't happen very often, but if a joint becomes infected it is a catastrophe. It is a catastrophe for the patient.

It is a catastrophe for the treating surgeon and for the entire treating team, because it can take up to two years to actually gain control of an infection. What often does happen is that that joint needs to be removed and antibiotic-impregnated cement put in, and then the patient is on prolonged courses of antibiotics, which often have some pretty awful side effects.

The surgeons who remove those joints, again, are a minority. They are dealing with complex patients and prolonged surgeries. Sometimes these patients need multiple surgeries.

Those are only two examples. There is complexity in medicine. Even amongst, say, surgeons, there will be those who have to deal with the more complex of the complex cohort of patients.

This is not all that this bill does. Insurers must currently get ministerial approval before they lift a premium—that is a safeguard—so some funds have simply closed a popular gold or silver product and opened a near-identical one under a new name at a higher price. Loyal members go looking for the cover they have paid into for years and find that it no longer exists.

It's called product phoenixing, and it is a rort. This bill calls time on that. From here, funds will need to get approval not just for annual rate rises but for new products and for any change that reduces the value of an existing one.

While only a minority of specialists charge excessive fees, the cost impact on affected patients is significant, and there is the risk that this could become normalised and spread to the whole market. This bill improves fee transparency and gives patients more control over their healthcare choices while also protecting the integrity of doctors and confidence in private health insurance.

I commend this bill to the Senate.