15/06/2026
There's been a lot of debate recently about specialist fees, and it's a conversation worth having honestly — but it needs to engage with the full picture, not a partial one.
It's true that MBS indexation alone doesn't explain everything. Nobody is claiming it would. But over the past decade, MBS rebate indexation has averaged around 1.6 per cent growth annually, against wages and inflation growth of roughly 3.1 per cent. That's not a rounding error — it's a structural gap that compounds every year, and it doesn't close itself.
There's also a less-discussed side to this: private health insurance. The federal AMA's own analysis shows that for identical procedures, the same doctor, same hospital, two policies both labelled "gold" can pay out-of-pocket variances of hundreds of dollars depending purely on which insurer the patient holds.
And under "no gap" arrangements, a difference of just a few dollars in a doctor's fee — set by the insurer, not the doctor — can blow out a patient's out-of-pocket cost by hundreds more, while the insurer pockets the saving. Despite this, more than 97 per cent of in-hospital procedures are delivered under no-gap or known-gap arrangements — doctors are absorbing enormous complexity to protect patients from exactly this kind of variability.
Meanwhile, premiums have risen faster than the medical benefits insurers actually pay out, and management expenses and profits now represent a larger share of premium dollars than the amount that goes to doctors' care.
None of this means individual fee-setting is beyond scrutiny — informed financial consent matters, and the AMA has published national guidance on it, endorsed by 30 medical bodies. But framing this purely as a question of individual doctors' pricing choices, while ignoring two decades of policy settings and a private health insurance system riddled with structural gaps, doesn't serve patients.
The AMA has a detailed plan to modernise Medicare and fix these structural issues — including changing payment flows so patients only pay the gap upfront, setting minimum insurer benefits for like-for-like procedures, and fixing the "no-gap cliff." We are happy to engage constructively with anyone serious about solving this issue including participating in next week’s parliamentary inquiry into access and affordability of medical specialist services in Australia.
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The continuing blame game about specialist fees is ignoring the realities of what’s driving cost for patients, the Australian Medical Association said today.
