Australia's Specialist Fee Failure: Three Principles for a Way Forward

ABSTRACT Background Setting Medicare Schedule Fees for specialist services in Australia is a pressing challenge. As specialist charges increasingly exceed government rebates, rising out‐of‐pocket costs threaten the core objective of universal health care. Objective To define a fair fee structure that balances equitable compensation for highly trained professionals with affordable access for patients. To ensure that this balance is guided by three principles: sustainability (reflecting training and resource costs), quality (incentivizing high‐quality care) and accessibility (remains affordable and accessible for all patients). Methods This analysis evaluates the current system against three guiding principles: sustainability, quality and accessibility. We present criteria for assessing how well each principle is satisfied and discuss what specialist fees might look like if Australia followed each principle. Findings Australia's current system fails to meet all three principles. Recommendations We propose a three‐pillar reform strategy: 1. Regulated pricing : Set fair Medicare Schedule Fees and limit rebates to specialists who adhere to these fee standards. 2. Transparency : Mandate public reporting of specialists’ fees, quality indicators and waiting times. 3. Increase public capacity : Expand public sector capacity and general practitioner support to reduce reliance on private specialist care.