A new report highlights the massive differences between fees charged by medical specialists.

Bills vary by a factor of five for some specialties and localities, according to research published in the Medical Journal of Australia.

Researchers looked at Medicare claims data from 2015 for an initial outpatient appointment with a consultant physician in the following specialties: cardiology, endocrinology, gastroenterology, geriatric medicine, haematology, immunology/allergy, medical oncology, nephrology, neurology, respiratory medicine, and rheumatology.

They found marked differences within specialties in the fees charged for consultations.

On average, the range of charges varied by over 70 per cent. The specialty with the greatest difference in the range of fee levels was neurology, where the difference among doctors was approximately $189, or a 125 per cent difference. The narrowest range was $62.50 (15 per cent) for geriatric medicine.

Out-of-pocket costs - the difference between the charged fee and the Medicare rebate amount - were shown to vary by more than 400 per cent for many specialties.

“As there is no publicly available information about the quality of care in the outpatient setting or any validated outpatient quality measures available in Australia, these fee variations are not based on any objective information about the care provided by individual doctors,” the authors wrote.

“Further, because information on the range of fees for outpatient consultations was not previously available, patients have not been aware that their out-of-pocket payments could vary markedly according to the private consultant physician they visit.

“In light of our data, and the failure of increases in the Medicare Benefits Schedule fee schedule to keep pace with inflation, the policy of prohibiting insurance coverage for outpatient care may need to be reconsidered. It appears that the goal of this policy — to limit outpatient fees — has met with limited success at best,” they concluded.