Grattan Institute report on access to specialist care

The recommendations are:  

1. Train the specialists Australia needs

• Governments establish a national health workforce planning body to set targets for specialist training, including a mix of specialties and rural training.  
• Federal funding for specialist training tied to those targets, increasing by $A155 million a year.
• Federal government paying specialist colleges an extra $9 million a year to develop and expand flexible training models.

2. Invest in public clinics where they are needed most

• Governments investing at least $500 million a year to expand public specialist clinics in areas with the least care.

3. Modernise public clinics

• National Health Reform Agreement (NHRA) specifying the role of public clinics, and how they will change to provide more and better care.
• NHRA providing $60 million to spread best practices across the system.
• Independent hospital pricing authority reviewing specialist clinic funding to ensure prices encourage best practices.
• Governments agreeing to shift current Medicare Benefits Schedule (MBS) funding to activity-based funding.

4. Reduce unnecessary specialist referrals

• Governments setting up a system that makes it easy for GPs to get advice from other specialists.

5. Reduce extreme fees

• Withdrawing all Medicare funding from specialists who charge extreme fees (fees that are, on average, more than three times the schedule fee).
• Federal government initiating a review of MBS rebates to ensure they reflect the cost of care.

Clarification (30 July 2025)

In a previous comment on this website news item, ANZCA said we broadly support the report.

ANZCA recognises that extreme private billing is a concern for both the public and the medical community. The Grattan Institute review suggests a x3 Medicare rebate threshold for extreme billing. 

With feedback from fellows and advice from the Australian Society of Anaesthetists and the Australian Medical Association we recognise that a x3 multiplier of Medicare rebates does not represent extreme billing. This is due, in part, to the limited indexation of Medicare rebates. 

ANZCA firmly believes that the vast majority of fellows are highly professional in their billing practices. 

ANZCA supports the establishment of a national health workforce planning body, increased specialist training and flexible training model funding and funding that is more reflective specialist training workforce needs.  

The report also confirms that anaesthesia is one of the specialties that is undersupplied and growing more slowly than average. This is a consistent message across all recent government reviews.