Media Release - Ophthalmologists hit back. Cheap shots at specialists' fees a distraction from bigger problems

IMAGE CAPTION: ASO President Dr Peter Sumich & Board Member Professor Ashish Agar are calling out Private Health Insurers and the government on their false narrative on specialists' fees.

Billions in private health insurer profits. Medicare rebates underwater for decades. A public hospital system where you can't get an appointment. Medical small-business expenses are going through the roof with rampant inflation.

"Surgeons refuse to be scapegoated for systemic failures," says Professor Ashish Agar, board member of the Australian Society of Ophthalmologists.

While headlines fixate on "price gouging" surgeon fees, the Australian Society of Ophthalmologists is calling out the real culprits: a federal government that has let Medicare wither on the vine, and private health insurers cashing in on the chaos while under-rebating patients. Doctors didn't break this system. Canberra did.

"We didn't create this situation," said Professor Agar, an eye surgeon with decades of experience. "But somehow we're being made to wear it because it plays well in the news."

Professor Agar says there's a more urgent question at the heart of this out-of-pocket crisis: why are so many patients in the private system at all?

Australia's public hospital waitlists have hit record highs. The AMA's 2025 Public Hospital Report Card found patients are routinely waiting beyond clinically safe timeframes, and for eye patients, that wait has consequences that can't be undone.

"Glaucoma doesn't wait. Diabetic retinopathy doesn't wait. Eyelid cancer doesn't wait. When someone loses vision because they couldn't get timely public care, no amount of out-of-pocket coverage makes that better," Professor Agar said.

"We are absorbing the overflow of a system that is buckling. We are there for patients when the public system can't be. Running costs of small businesses are skyrocketing, and we're being blamed for the inflationary pressures that come with that."

"Eye surgeons run small businesses. Not multinationals, not hedge funds — small businesses, subject to every inflationary pressure that every other small business in Australia is grappling with right now," said Professor Agar.

"What the government regards as specialist fees is actually business revenue that keeps the show on the road. If you have never run a small business, these things may not occur to you."

Medical small businesses in Australia are feeling the inflationary squeeze. Electricity, rent, insurance, higher wages, sophisticated technology, cybersecurity and IT infrastructure, compliance and registration fees — the cost of running a modern ophthalmology practice has risen sharply across every line item.

The Australian Medical Association's data shows that while average wages and the consumer price index have more than quadrupled since 1985, Medicare rebates have barely doubled over the same period (see graph below).

While patients and practitioners are being squeezed, private health insurers had a very good year.

A record $2.13 billion in profit in 2024–25. Premium increases of up to five per cent — the biggest ask since 2017. And a return of just 84.25 per cent of premium revenue to hospitals and healthcare providers, against an industry benchmark of 88 per cent.

Since 2022, that gap has accumulated into a $4 billion shortfall — $4 billion that was paid in premiums by 12.5 million Australians and never made it to frontline medical care.

"Health insurers are profiting more and paying themselves more, and somehow the story is about specialist fees," ASO President Dr Peter Sumich said. "I'd like someone to explain that logic to me."

For cataract patients, the situation is even more pointed. Cataract surgery is only covered by Gold-level policies — the most comprehensive, most expensive tier. Yet patients are told Silver policies cover "eye surgery," when the fine print excludes cataract surgery, the most common eye procedure.

Insurers have spent years nudging customers toward cheaper cover because it represents their profit sweet spot. As a result, patients arriving at the point of surgery discover their policy won't help them.

"The insurer collected the premium. The insurer recommended the downgrade. The insurer posted the profit," Dr Sumich said.

"And when the patient can't afford their surgery, who gets made out as the villain? The surgeon!"

 

 

Further reading: AMA Private Health Insurance Report Card 2025 | Australian Medical Association