JANUARY

AUSTRALIA
low-income adults, children under 16, and certain veterans); AUD700 (USD456) for parents of school children
and singles; and AUD1,000 (USD651) for all other families.
How is the delivery system organized and financed?
Primary care: In 2013, there were 25,702 GPs, and a slightly higher number of specialists (27,279) (AIHW,
2015a). GPs are typically self-employed, with about four per practice on average (DH, 2015, and DHS, 2015).
In 2012 those in nonmanagerial positions earned an average of AUD2,862 (USD1,864) per week. The schedule
of service fees is set by the federal health minister through the MBS.
Registration with a GP is not required, and patients choose their primary care doctor. GPs operate as
gatekeepers, in that a referral to a specialist is needed for a patient to receive the MBS subsidy for specialist
services. The fee-for-service MBS model accounts for the majority of federal expenditures on GPs, while the
Practice Incentives Program (PIP) accounts for 5.5 percent (ANAO, 2010).
State community health centers usually employ a multidisciplinary provider team. The federal government
provides financial incentives for the accreditation of GPs, multidisciplinary care approaches, and care
coordination through PIP and through funding of GP Super Clinics and Primary Health Networks (PHNs). PHNs
(which replace Medicare Locals) are being implemented in 2015–2016 to support more efficient, effective, and
coordinated primary care.
The number of nurses working in primary care has been increasing, from 8,649 registered or enrolled nurses
primarily working in a general practice setting in 2011 to 11,370 in 2014. Their role has been expanding with
the support of the PIP practice nurse payment. Beyond this, nurses are funded through practice earnings.
Nurses in general practice settings provide chronic disease management and care coordination, preventive
health education, and oversight of patient follow-up and reminder systems (Health Workforce Australia [HWA],
2015).
Outpatient specialist care: Specialists delivering outpatient care are either self-employed in a solo private
practice (6,745 specialists in 2013) or employed in a group practice (5,257) (HWA, 2015). Patients are able
to choose which specialist they see, but must be referred by their GP to receive MBS subsidies. Specialists are
paid on a fee-for-service basis. They receive a subsidy through the MBS of 85 percent of the schedule fee and
set their patients’ out-of-pocket fees independently. Many specialists split their time between private and public
practice.
Administrative mechanisms for direct patient payments to providers: Many practices have the technology
to process claims electronically so that reimbursements from public and private payers are instantaneous, and
patients pay only their copayment (if the provider charges above the MBS fee). If the technology is not in place,
patients pay the full fee and seek reimbursement from Medicare and/or their private insurer.
After-hours care: GPs are required to ensure that after-hours care is available to patients, but are not required
to provide care directly. They must demonstrate that processes are in place for patients to obtain information
about after-hours care, and that patients can contact them in an emergency. After-hours walk-in services are
available, and may be provided in a primary care setting or within hospitals. As there is free access to
emergency departments, these also may be utilized for after-hours primary care.
The federal government provides varying levels of practice incentives for after-hours care, depending
on whether access is direct or provided indirectly through arrangements with other practitioners in the area.
Government also funds PHNs to support and coordinate after-hours services, and there is an after-hours advice
and support line.
Hospitals: In 2013–2014 there were 747 public hospitals (728 acute, 19 psychiatric) with a total of 58,600 beds
and 612 private hospitals (326 day hospitals and 286 other) with 31,000 beds (AIHW, 2014a; AIHW, 2014b).
Private hospitals are a mix of for-profit and nonprofit.
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