Specialist Affordability Reform Requires Broader Action on Systemic Challenges in Women’s Healthcare

Monday 9 November 2026

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG, the College) welcomes the Grattan Institute’s contribution to improving specialist access and affordability and supports action on genuinely excessive and unjustified fees. However, the College stresses that proposed reforms must not overlook the complex and wide-ranging systemic challenges facing women’s healthcare. In order to enact effective and equitable change, reform must include updating the MBS Schedule Fee, indexing specialist MBS items, reviewing private health insurance arrangements, and supporting the viability of the O&G workforce, including investment in training and private and public services.

The Grattan Institute has released a policy brief unpacking some of the contributors to rising Australian specialist fees and calling for systemic reform to improve access and affordability of care, spanning specialist training pipelines, funding and modernising of public clinics, GP access to specialist advice, and reduction of extreme specialist fees.

RANZCOG agrees that affordable, timely, and patient-centred care are foundational for better health outcomes. Patient affordability is affected increasingly by systemic factors, including gender bias, MBS settings, insurer arrangements, workforce distribution, and service viability. Any reform seeking to address affordability must be holistic and recognise these wide-ranging systemic challenges.

Healthcare affordability is directly impacted by outdated systems which were built on gender bias and inequity. As women’s maternity and gynaecological care becomes more complex and individualised, the Medicare Benefits Schedule (MBS) must be modernised to reflect changing patient needs and O&G sustainability.

RANZCOG is calling for a comprehensive gendered review of the MBS to ensure rebates appropriately recognise the complexity and cost of contemporary obstetric and gynaecological care, as well as reconsideration of the Extended Medicare Safety Net caps that further disadvantage women. Current item descriptors, eligibility, schedule fees, and rebates must be examined to ensure they reflect the time, care, resources, and continuity that women need. Where Medicare benefits are inadequate, clinicians face pressure to absorb costs or pass them on to patients, leading to higher out-of-pocket costs and financial barriers for women.

“Women should not have to choose between financial hardship and prolonged waits for essential care. We support ethical billing, meaningful fee transparency, and informed financial consent, alongside action to address the historical undervaluation of women’s healthcare,” says RANZCOG President Dr Nisha Khot.

The Grattan Institute also acknowledges the role of training pathways in improving specialist access and has indicated a shortfall of trainees in the pipeline to service the Australian public in years to come. RANZCOG is dedicated to continued improvement of specialist and subspecialist training pathways. The College is working with the Commonwealth government and jurisdictions to improve training access and workforce support. Several potential workforce reform recommendations were developed as part of RANZCOG’s Women’s Health Roundtable, earlier this year. The College has also recently reviewed its Selection criteria to streamline training pathway efficiency.

The FRANZCOG Rural O&G Specialist Advanced Training Pathway (FROGS) was developed to aid the training and retention of specialist obstetricians and gynaecologists in rural and regional communities. And the Obstetrics and Gynaecology Education and Training (OGET) Project delivers education and skills maintenance to health professionals working in regional, rural, and remote Australia. The project is funded by the Australian Government with current funding unconfirmed beyond February 2027.

“Colleges are developing solutions, but these need sustained government investment. Funding rural specialist training, strengthening public women’s health services, and correcting inequitable Medicare rebates must be part of the response if women are to receive timely, affordable care,” Dr Khot says.

RANZCOG will continue its sustained advocacy addressing the broad range of issues impacting women’s access to timely and affordable care and welcomes ongoing discussions with decision makers to discuss systemic problems and solutions to improve health outcomes for women.

Patient affordability is an urgent issue, however if policy interventions are enacted without a sound evidence-based, risk assessment or sufficient consideration of systemic factors that contribute to out-of-pocket costs, then there may be unintended consequences that further restrict patient access to care.