WRITER Katrina Ronne

Doctors are bearing the brunt of a health system that’s under pressure from private health insurers and government alike, argues Katrina Ronne.

Every few months, another report lands accusing Australia’s specialists of charging too much. The headlines are predictable, the commentary is familiar, and the fingerpointing is always the same.

But the truth is this: the private health system isn’t being brought down by doctors’ fees. It’s being crushed under the weight of rising costs, shrinking rebates, and an insurance model that’s losing touch with the people it’s meant to serve.

Right now, the private sector is showing cracks that can’t be papered over.

In the past six months alone, major private hospitals have closed or gone into administration. Healthscope, the nation’s second-largest private hospital group, entered receivership in May. Toowong Private Hospital in Queensland shut its doors soon after. In Tasmania, the Hobart Clinic, the state’s only private inpatient mental health facility, is at risk of closure.

Since 2023, more than 300 private mental health beds have been lost across Australia. Behind those numbers are real people: doctors, nurses and patients left stranded in a system that no longer works for them.

And yet, rather than address these structural failures, some insurers have chosen the easier route: to blame the very professionals keeping the system afloat.

If high doctor fees were the cause of this instability, you’d expect to see it reflected in consumer complaints. But the latest data from the Private Health Insurance Ombudsman tells a very different story.

In the 2024–25 financial year, the Ombudsman received 3,411 complaints, including 903 in the June quarter alone. The top grievances weren’t about specialist bills, but they were about insurer behaviour, including poor customer service, policy cancellations, and disputes over pre-existing conditions. Two insurers, Medibank and BUPA, were responsible for more than half of all complaints lodged.

These aren’t isolated hiccups. They reflect a pattern of dissatisfaction that points squarely at insurer practices, not medical ones.

The Ombudsman has also flagged an alarming tactic known as ‘policy phoenixing’, where insurers quietly close an existing policy and reopen an almost identical one at a higher premium. It’s a manoeuvre that skirts regulation and leaves loyal customers worse off.

So, while doctors are being painted as profiteers, insurers are quietly reshaping the market to their advantage.

At the same time, the backbone of Australia’s health system, Medicare, is no longer fit for purpose. Rebates have failed to keep pace with inflation for decades. The result is a system that expects specialists to deliver 21st century medicine on 1980s prices.

Specialists face rising costs in staff wages, compliance, rent, insurance, and equipment. Many of these costs have increased by 30 to 50% in the past few years, yet Medicare rebates remain stagnant.

When a specialist charges a fee above the rebate, it’s arithmetic. It’s what keeps practices open, staff paid, and services available, particularly in regional areas where operating costs are often higher.

TRANSPARENCY SHOULD BE A TWO-WAY STREET

Specialists have long supported fee transparency. The Australian Medical Association’s Medical Costs Finder and the Informed Financial Consent Guide are practical tools helping patients understand their likely out-of-pocket expenses.

But transparency shouldn’t stop there. Insurer rebate information is often buried deep in websites, hidden behind spreadsheets, or expressed in ways that are nearly impossible for consumers to interpret. Patients deserve to know, clearly and easily, how much of their surgery, anaesthetic, or consultation their policy will actually cover.

It’s time for insurers to meet the same standard of openness that’s demanded of doctors.

The ASO and the medical community aren’t against reform. In fact, we’re calling for it. But reform must be grounded in evidence, not rhetoric. It must recognise that sustainability won’t come from forcing doctors to work for less, but from rebalancing a system that’s become lopsided.

That means fairer insurer contracts, modernised Medicare rebates, and a shared commitment to transparency. It means seeing healthcare as a partnership instead of a battlefield.

Blaming doctors may make for an easy headline, but it does nothing to help patients. Every hospital closure, every cancelled policy, and every exhausted specialist is a warning sign that the current approach is failing.

Katrina Ronne is the Chief Executive Officer of the Australian Society of Ophthalmologists.