Seeing a private specialist increasingly comes with massive gap payments. On average, out-of-pocket fees to see a specialist amount to about $300 a year. But many spend hundreds on each appointment.

Costs quickly add up, especially if you need surgery or other treatments in hospital. Many patients are left struggling to pay.

Others rely on the public hospital system, where care is free but outpatient clinic wait times to see a specialist can be up to six years.

It’s not just wealthy Australians who see private specialists. And you don’t need private health insurance for an outpatient consultation in a specialist’s private rooms. For some regions and specialties, seeing a private specialist is the default, or only, option.

Health Minister Mark Butler has vowed to make specialist fees more affordable in his second term of government. So what exactly is the problem? And how can it be fixed?

Unlike in other comparable nations, the government doesn’t regulate how much specialists can charge in Australia. Specialists set their own fees.

But relying on the free market fails because of two fundamental flaws:

1) Market power

Specialists are a scarce resource. For example, there are currently only around 130 doctors currently undergoing specialist training to become a........

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