From the Patients Perspective

They are already feeling stressed.  They only need to see a Specialist if there is something wrong.  Then they learn that their appointment is a long distance away and can't be arranged for days (or weeks) and their anxiety increases.

The cost of getting the patient to the Specialist may be perceived as cheap.  A bit of fuel in the car and a couple of hours.  But what if the patient cannot drive themselves?  What if they do not have a car?

What if the distances are measured in hundreds of Kilometers, or require a plane flight?  What if there is a fracture to contend with, or if mental health is a factor?

It doesn't take much to make this a VERY expensive appointment.