THE former Howard government adviser who reignited the co-payment debate is back. In his sights: exorbitant out-of-pocket expenses being charged by overpaid specialists.

Terry Barnes has called for the fees that surgeons and other specialists can charge to be capped at their AMA-recommended rates. And if they charge too much they should be refused access to Medicare, he told Medical Observer.

“If the AMA schedule is considered fair and reasonable, then any out-of-pocket in excess of that is, by definition, unreasonable,” Mr Barnes said.

“What I propose is that if the government gives ground on cutting the GP rebate [for the co-payment], the quid pro quo is that the government works together with the AMA to reduce patient out-of-pockets.”

Mr Barnes showed MO a recent anaesthetist’s bill that saw him pay four times the rebate he was entitled to under the MBS.

“She should have delivered an anaesthetic with her [bill],” he said.

The proposal is backed by the Grattan Institute’s Dr Stephen Duckett, a prominent health economist who gave evidence to the recent Senate inquiry into out-of-pocket costs.

In his submission to the inquiry, Dr Duckett reported that for people in the lowest disposable income decile, average fees for specialists were nearly four times the average GP fee.

“I think it’s a good idea,” he said of Mr Barnes’s call.

“I think the profession has to have some responsibility for moderating out-of-pocket costs. There is an issue here about professional responsibility.”

The comments follow a statement from the Royal Australasian College of Surgeons (RACS) expressing concern about reports of “excessive… even extortionate” and “unethical” surgical fees being charged to patients by its own members.

RACS president Professor Michael Grigg said the reported fees were “damaging to the health system and to the standing of surgeons and the surgical profession”.

“RACS believes that extortionate fees, where they are manifestly excessive and bear little if any relationship to utilisation of skills, time or resources, are exploitative and unethical. As such, they are in breach of the college’s code of conduct and will be dealt with by the college,” the statement said.

But an RACS spokesman said the college does not support a cap on fees.

An AMA spokesman said: “The AMA is currently in talks with the government on the disastrous and hugely unpopular budget co-payments proposal, and doubts that the government would be rushing to adopt any other ‘thought bubbles’ from the author of that policy.”