Doctors treating private patients in Canberra hospitals have been accused of greed by one of the country's leading experts on the health care system.
Dr Stephen Duckett of the Grattan Institute said "egregious" charging of patients was the only way to explain figures showing that bills to privately insured hospital patients in Canberra were much higher than in any other part of the country.
Egregious is defined by the Oxford English Dictionary as: "shocking".
Dr Duckett said that the ACT government could and should do something about it.
It's often thought that states and territories had no power over health bills, he said, but the ACT government could use consumer protection law against excessive charging.
He said it could also raise the matter in the regular meetings of health ministers from the Commonwealth and states and territories.
Recently published official figures for the three months to June show that more than 18,000 medical procedures covered by private insurance in the ACT were billed at more than double the fee decreed by the government.
This cannot be explained by differences in cost. It can only be explained by the difference in greed.
Dr Stephen Duckett
That means that 17 per cent of these hospital procedures and treatments in the ACT were billed at double the stipulated official rate or more.
In Australia as a whole, the proportion was only seven per cent.
The government sets out fees for hundreds of different types of treatment under what's called the Medicare Benefits Schedule. The government pays the bulk of those fees, leaving the rest to the patient and to his or her insurance company.
Doctors in the private system can charge what they like. In the ACT, the gap between what's billed for hospital treatment and what the insurance company will pay towards it is higher than elsewhere - leaving the patient to pick up the excess.
Not only is the charge higher in the ACT but the figures also show that a much higher proportion of insured patients have to dip into their own pockets because insurance policies don't cover the full hospital bill.
According to the latest figures, private hospital patients in the ACT pay an average of $271.40 more out of their own pocket per procedure where the insurance company doesn't pay the full bill.
That figure compares with $151.51 for Australia as a whole. In NSW, it's $209.40 and in Victoria, it's $103.99 - less than half the ACT gap.
Doctors respond that hospital bills are higher in the ACT because it's different from the rest of Australia. Patients may be having more expensive treatments, for example.
Dr Duckett said that this explanation was unconvincing because the costs of treatment in the ACT weren't that different from elsewhere.
"This cannot be explained by differences in cost. It can only be explained by the difference in greed," he said.
The Health Care Consumers Organisation echoed the claim that doctors' fees were higher in the ACT.
Its president, Darlene Cox, said that a treatment which might cost $3500 in Sydney or Melbourne could cost $5,000 in Canberra. "The doctors are charging us higher amounts than if they were in other jurisdictions," she said.
The president of the Australian Medical Association in the ACT, Dr Antonio Di Dio, said that the amount paid by the insured patient could be low. It depended on the procedure - in a tonsillectomy, for example, it might be from $500 to $1500 but for anti-obesity surgery, it might be $15,000.
He was adamant that no "egregious" charging was done by doctors.
"The surgeon plus the anaesthetist plus the hospital all charge a fee," he said.
"When a patient had to pay that fee on top of what Medicare and the health fund pays, it is important that the patient knows exactly what they are paying for and to whom."
"The vast majority of doctors in the ACT work very hard and bill a fair and reasonable fee, and often no fee.
"The vast majority also conduct themselves very decently and compassionately in fees as well as other factors in relation to patients."
