Specialist fees will now publish by default: inside the Medical Costs Finder overhaul

On 16 September 2026 the government announced that the Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026 had passed. The bill amends the Health Insurance Act 1973 and the Private Health Insurance Act 2007. It lets the Department of Health, Disability and Ageing publish individual specialists' fees and out-of-pocket costs on the Medical Costs Finder. The figures come from billing data the government already holds, without each specialist's input.

The bill ends a voluntary disclosure regime that ran for seven years and produced fee data from 106 doctors out of roughly 6,300 eligible specialists. This piece sets out what the amendments authorise, where the published figures will come from, and the three things the law leaves unsettled.

What the law publishes: fees, benefits, gap arrangements

Schedule 1 of the bill inserts Part VE into the Health Insurance Act 1973 (proposed section 124ZY) and Division 324 into the Private Health Insurance Act 2007 (proposed section 324-5). Together they let the Secretary publish fees charged for particular kinds of professional services and the Medicare benefits paid for them, the extent of bulk billing, and practitioner details including name, qualifications, specialties and languages spoken. They also cover the locations and hospitals where services are provided, insurer benefits paid for covered treatment, and gap cover arrangements between particular insurers and medical practitioners.

Patient information stays off the site: proposed subsections 124ZY(7) and 324-5(7) forbid publishing personal information about anyone who is not a medical practitioner. The department is developing an analytical approach to derive a single publishable fee figure per practitioner, service and financial year. The 2025-26 Budget committed $7 million over five years to the work.

The bill's second schedule outlaws product phoenixing, the practice of closing a policy and reopening a near-identical one at a higher premium. The Commonwealth Ombudsman's December 2024 public statement found one insurer's new Gold policies averaged 21 per cent higher than the closed equivalents in 2023, and 14 per cent higher in 2024.

The Medical Costs Finder's voluntary regime: 106 of 6,300

The Medical Costs Finder launched in December 2019 at a build cost of $24 million. It relied on specialists volunteering indicative fees through a portal.

Six doctors had published fee information by the end of 2022. That reached about 88 by the end of 2025 and 106 by September 2026, out of around 6,300 eligible specialists in the 11 specialties the site covers. Insurer participation sat at 10 per cent as of December 2025, against 1 to 2 per cent of specialists. The explanatory memorandum concedes the point: the site provides high-level averages from administrative data but little practitioner-level information, which is the gap the amendments close.

Where the fees come from: HCP1 and Medicare claims data

The site's existing administrative layer already works from two sources. In-hospital services run on Hospital Casemix Protocol 1 (HCP1) data supplied by private health insurers; out-of-hospital services run on Medicare claims data from Services Australia. Results appear as medians by Primary Health Network, suppressed wherever a person, hospital or provider could be identified.

The amendments add the practitioner layer. The department will match MBS claims data with the Centralised Register of Medical Practitioners and HCP1 data, under matching powers the bill makes explicit in proposed sections 124ZZ and 324-10. From the match it derives per-specialist fee figures for publication.

The gap record: $1,595 million and rising

The bill passed into a market where gap payments are growing faster than volume. APRA's Quarterly Private Health Insurance Statistics show the annual gap bill, the amount charged above Medicare and insurer benefits, reached $1,595 million for calendar 2025, up 134 per cent on 2015. Services grew 21 per cent over the same decade. In the June 2026 quarter the bill was $446.5 million across 11.09 million in-hospital services, and the average gap where a gap was paid was $260.74. Services charged above 200 per cent of the MBS fee carried 91.3 per cent of the gap dollars.

The no-gap share of in-hospital services fell from 88.4 per cent in June 2023 to 84.6 per cent in June 2026, falling in all eight jurisdictions. About one in 6.5 services now leaves a patient bill. The Grattan Institute's June 2025 report, Special Treatment, put the growth in specialist out-of-pocket costs at 73 per cent in real terms since 2010. The average bill for those who paid one was $300 in 2023. The explanatory memorandum cites 2024-25 survey data showing 8.6 per cent of people, more than 800,000, delayed or missed specialist care because of cost.

Timing, downloads, scope: what the law leaves unsettled

Three things remain open. First, timing: the department has announced no date for practitioner-level data appearing on the site. The Senate Community Affairs Legislation Committee reported on 15 April 2026 and expected implementation details to be settled through consultation. The Royal Australasian College of Surgeons has pressed for accuracy and correction rights before publication proceeds.

Second, machine readability: the bill authorises publication on the Medical Costs Finder website, with the manner of publication left to a legislative instrument that has not been made. The bill and the explanatory material commit to no bulk download or API, and today's site offers no dataset download. Third, scope: the department has said the focus is non-GP specialist fees, though the drafting allows GPs to be added later.

The Ombudsman's complaints record: 3,411 complaints, no gap category

The Commonwealth Ombudsman, as the Private Health Insurance Ombudsman, received 3,411 complaints about private health insurance arrangements in 2024-25, down 20 per cent on 2023-24. The report traced the earlier year's spike to Defence Health's 2023 system transformation. The 21st annual State of the Health Funds report, published in March 2026, tracks three complaint issues: benefits, service and membership. Gaps are not one of them; gap disputes sit inside benefits complaints, which the report describes as typically about the amount paid or not paid and the time to process a claim.

The complaint record does not yet track gaps as a distinct issue, even as the billing data shows them growing. Practitioner-level fee publication will make that visibility question harder to avoid: once patients can see a specialist's typical fee before referral, complaints that name the gap directly become more likely.

Where the AMA, PHA and RACS land

The Australian Medical Association and Private Healthcare Australia supported the bill. The Royal Australasian College of Surgeons sought safeguards on accuracy, timeliness and clinician correction before practitioner-level publication, with the Senate committee noting these as implementation matters. Researchers writing in The Conversation argue transparency alone will not rein in specialist fees. None of these sources disputes what the amendments do; the disagreement is whether publication will change pricing.

Sources

Minister for Health, More transparency and choice for Australian patients, February 2026 (health.gov.au) and Better transparency and choice in health care, 16 September 2026 (health.gov.au).

Parliament of Australia, Bills Digest 26bd050 (aph.gov.au); Medical Costs Finder, data sources and disclaimer (medicalcostsfinder.health.gov.au).

Commonwealth Ombudsman, State of the Health Funds Report 2024-25, March 2026 (ombudsman.gov.au); Grattan Institute, Special Treatment, June 2025 (grattan.edu.au).

APRA, Quarterly Private Health Insurance Statistics, June 2026 quarter (Medical Gap workbook); RACS Surgical News, 2026; The Conversation, 2026; Explanatory Memorandum to the bill.