This paper describes the current position of shared decision-making (SDM) within the Australian health care system. Australian health care includes a mixture of public and private practice governed by both regional and national policy. Support for SDM exists through guidelines and support for interventions to increase participation. However, there is no clear overall policy framework for SDM in Australia. The result is recognition that consumer involvement is important yet there are limited resources and infrastructure, and no clear strategy to support implementation. Barriers to SDM at the macro, meso and micro levels of health care are described. Efforts to support consumer involvement to date have been targeted to the supply side of health care. There is now awareness of the need to target the demand side by educating consumers to ask for information and involvement in their health care.