One in five people aged over 15 delayed or avoided seeing a GP in Newcastle and Lake Macquarie due to cost - a 211 per cent rise in four years, new research shows.
People aged over 65, couples with dependent children and those on low incomes were most affected.
An even worse problem was those who did not see a specialist or dentist due to cost, with 27 per cent of people affected.
This represented a rise of 240 per cent since 2020.
The NSW Council of Social Services [NCOSS] released the data on Wednesday in a report that found healthcare was "out of reach for too many people".
The report called on federal and state governments to "improve affordability and out-of-pocket healthcare costs", particularly for the vulnerable.
NCOSS chief executive Cara Varian said "this report illustrates that the health system is broken".
"When people can't afford the most fundamental medical care, it leads to bad health outcomes and puts pressure on hospitals," Ms Varian said.
She called for healthcare access and availability to be boosted in regional areas, with "targeted support" to the worst affected groups.
Dr Max Mollenkopf, of Whitebridge Medical Centre, said the federal government had not "kept up with GP costs" for many years due to stagnant Medicare rebates.
"Those who can afford to see a GP receive care and those who can't are left in the lurch and get sicker. They're having to turn to other places such as emergency departments.
"They're missing out on preventative care. It's a deeply unfair two-tiered system."
University of Newcastle health economist Francesco Paolucci said there was "piling evidence that our system is not coping".
"This is true for every aspect of healthcare," Professor Paolucci said.
"The issue is why. We have a long-term structural workforce issue - how we train and fund them.
"The question is how will we pay for that education when the university sector is being slammed dramatically as well.
"There are fundamental public policy issues that go to the heart of the political spectrum. Healthcare and education are not being interpreted as goods that are essential for people to live, thrive and survive."
Professor Paolucci said a "crowd-out effect" was occurring in the health sector, with people waiting longer in the public system or paying more out of pocket privately.
He added that the private insurance sector was "forbidden from operating in GP care", which was adding to costs "upstream" at the hospital level.
Many Hunter GP clinics now charge more than $100 for a standard consultation, with a Medicare rebate of $42.85.
These fees are expected to rise as high as $120 due to the NSW government hitting contracted doctors with payroll tax.
Specialist fees are also rising, with demand often outstripping supply.
The NCOSS report found that 35 per cent of people in Newcastle/Lake Macquarie "wait longer than acceptable to see a specialist".
This was higher than the state rate of 23 per cent and the second highest rate across all NSW regions.
Further, a quarter of people in the area attended an emergency department "because their GP was unavailable".
The report found that 59 per cent of people in Newcastle/Lake Macquarie and 65 per cent in the Hunter Valley had a long-term health condition.
The report, titled Access Denied: Australians Locked Out of Quality Healthcare, was commissioned by NCOSS and done by the University of Canberra, with data sourced from the Australian Bureau of Statistics.
The purpose was to explore the relationship between patient experience and socioeconomic disadvantage in NSW.
NSW Minister for Regional Health Ryan Park said "we know that it's becoming harder to access a GP - whether that's finding an available appointment, or being able to afford one".
"We are particularly concerned that people are putting off care and management, particularly of chronic conditions," Mr Park said.
"This is leading to their conditions deteriorating to a point where they become very unwell and need to present to an ED requiring critical care."
He said access to primary care and GPs was a federal responsibility, but "the NSW government is playing our part by investing in new pathways to care which are free of charge and prevent people from having to wait in busy emergency departments".
"These services are available via Healthdirect."
While in the Hunter on Tuesday, federal Health Minister Mark Butler said "there's more to do to strengthen Medicare".
"We've got to turn around a decade of cuts and neglect and a six-year freeze in the Medicare rebate, particularly for general practices," Mr Butler said.
"In just two years, we increased the Medicare rebate by more than the former government did in nine years. That's some relief to general practices in particular, and on top of that, we tripled the bulk billing incentive."
