Over the past three months, the Royal Australasian College of Surgeons (RACS) has developed a targeted advocacy program through the work of its Health Policy and Advocacy Committee (HPAC) and staff. These include engagement in public consultations with government, developing key legislative responses, and positioning surgery at the centre of national health reform activity. A major focus of the HPAC has been to highlight the complexity associated with surgical billing, as well as the potential risks of implementing simplified forms of fee transparency through RACS submission to the Health Legislation Amendment (Improving Choice and Transparency for Private Health Consumers) Bill 2026 consultation. As part of these reforms, it is critical to ensure that proper clinical context is maintained in order to prevent these reforms from inadvertently leading to misleading decisions, misinterpreting value, or limiting access to patient care in a health care system that is already struggling financially. 

At the same time, HPAC has also been involved as an active participant in responding to the policy pertaining to the Combatting Antisemitism, Hate and Extremism Bill 2026 and associated Royal Commission, working with the Trauma Committee and Professional Standards Committee. This work has sought to ensure trauma-informed principles are included in the implementation of the laws and health workforce safety policies. Furthermore, HPAC has emphasised that strong evaluation frameworks should be established so that health and justice outcomes can be assessed over time.  

After meeting with the Commonwealth Department of Health, RACS has achieved a significant breakthrough in their desire to collaborate with the department on private sector reform regarding surgical care delivery. The department has requested ongoing collaboration with RACS regarding system design—an acknowledgement of the College's growing influence in the field of policy development. 

The primary focus of the discussions will be enhancing doctors' comprehension of the effects that contracting arrangements and financial incentives have on the delivery of surgical care. Further understanding is also needed regarding the broader ways in which these factors affect surgical care.  

According to RACS National Surgeons’ Survey, more than 40 per cent of respondents indicated that there has been disinvestment (i.e., reduced or cancelled surgical lists) in the past and more than 50 per cent stated the financial pressures they have experienced have resulted in subpar levels of care provided to patients. 

The findings of this study have led to concerns about profitability issues influencing the patient mix assigned to each surgeon. There is also concern about whether profit from surgical procedures influences clinical decision making. 

The Department of Health has also asked advice from RACS concerning the improvement of clinical governance within the private sector. HPAC is currently examining a clinically based governance framework that includes improved credentialing for surgeons, improved collection and use of outcome data, mechanisms for addressing differences in quality of care, and improved quality of service with the assistance of RAAS and ASERNIP-S. However, it is critical that all of the above efforts to achieve higher standards of care do not create financial hardship for private sector providers or cause unintended disruption to the delivery of health services.

HPAC has prioritised several areas requiring policy development which are: 
• workforce shortages and geographic maldistribution 
• rising medical indemnity premiums 
• funding and pricing issues within the Medical Benefits Schedule 
• increasing volatility in the private sector. 

New issues are being identified including Artificial Intelligence in surgical care and new models of service delivery such as ‘hospital in the home’. HPAC acknowledges further work needs to be done on transitioning from identifying the problems to developing a new system through the development of appropriate reform pathways, aligning surgical advocacy with greater health systemic priorities, and collaborating with all stakeholders for coordinated policy solutions across Medicare, private health insurance, and hospital funding. Collaboration is essential as HPAC continues to work with other stakeholders while maintaining RACS' position as an independent and evidence-based voice for our membership. There is a clear acknowledgment that many issues facing the system, including but not limited to incentives, access, and sustainability cannot be addressed by looking at them in isolation.

RACS would like to take this opportunity to welcome Dr David King to the role of Chair, effective from May 2026. He will build on Professor Mark Frydenberg’s long-standing advocacy legacy with the HPAC Committee, through the ongoing hard work of the Health Policy and Advocacy staff, RAAS and ASERNIP-S in building on RACS’ advocacy efforts. As an evolving organisation, RACS clearly communicates to the Australian government that as it identified trends within the healthcare system, it will actively participate in the system’s solutions as part of their continuous commitment to patient safety, equity of care, and sustainability into the future.