2020–25 National Health Reform Agreement (NHRA)

Signed by all Australian governments, the 2020–25 Addendum to National Health Reform Agreement (NHRA) aims to improve health outcomes for all Australians and ensure our health system is sustainable.

About the NHRA

The Prime Minister announced the new 2020–25 National Health Reform Agreement (NHRA) on 29 May 2020, following sign-on by all Australian governments.

The NHRA is an agreement between the Australian Government and all state and territory governments.

It commits to improving health outcomes for Australians, by providing better coordinated and joined up care in the community, and ensuring the future sustainability of Australia’s health system. It is the key mechanism for the transparency, governance and financing of Australia’s public hospital system.

Through this agreement, the Australian Government contributes funds to the states and territories for public hospital services. This includes services delivered through emergency departments, hospitals and community health settings.

All levels of government share responsibility for health services in Australia. The NHRA includes a commitment to a shared long-term vision for health reform and outlines how governments will work together to provide high-quality services.

The NHRA recognises the states and territories as system managers of public hospitals. As such, the states and territories are responsible for:

  • determining the mix of the services and functions delivered in their jurisdiction
  • system-wide public hospital service planning and performance.

The Australian Government will contribute about $133.6 billion between 1 July 2020 and 30 June 2025 for public hospital services.

Goals of the NHRA

The goals of the NHRA are to:

  • deliver safe, high-quality care in the right place at the right time
  • prioritise prevention, and help people manage their health across their lifetime
  • drive best-practice and performance using data and research
  • improve efficiency and ensure financial sustainability.

What’s new in the 2020–25 NHRA

The NHRA will continue to provide increased funding for public hospitals, and sets a new pathway for long-term reform of our health system. It introduces 6 long-term health reforms, and opportunities for states to trial new funding models and models of care.

The NHRA also supports delivery of new lifesaving high-cost therapies. This will provide improved access to treatment for patients with rare conditions who often have few options remaining.

The NHRA reaffirms all governments’ commitment to the Medicare principles, which underpin public hospital services. These principles ensure equitable access to public hospital services for all eligible persons that are free of charge as public patients, based on their clinical need and regardless of their geographic location. They also give patients’ freedom to choose whether they are treated as a public or private patient, in a public hospital.

Australia’s long-term health reforms

All Australian governments have agreed to progress long-term system-wide health reforms under the NHRA.

The long-term reforms will examine how well the different components of the health system interact. Governments will work with the health sector to better understand and remove systemic barriers to improving health care.

The reforms will give local health services the flexibility to try new solutions to address these barriers and improve service delivery. This will ensure health services best suit the needs of their local community.

The 6 reforms outlined in Schedule C of the NHRA are:

  • empowering people through health literacy – person-centred health information and support will empower people to manage their own health well and engage effectively with health services
  • prevention and wellbeing – to reduce the burden of long-term chronic conditions and improve people’s quality of life
  • paying for value and outcomes – enabling new and flexible ways for governments to pay for health services
  • joint planning and funding at a local level – improving the way health services are planned and delivered at the local level
  • enhanced health data – integrating data to support better health outcomes and save lives
  • nationally cohesive health technology assessment – improving health technology decisions will deliver safe, effective and affordable care.

The National Health Reform Agreement Long Term Reforms Roadmap was endorsed by all Australian Health Ministers at the Health Ministers’ Meeting on 17 September 2021.

Why we need reform

The long-term health reforms under the NHRA will support better coordinated care in the community, focus on prevention and keeping people healthier longer, and reduce pressure on hospitals. These systemic reforms will also help improve the experiences of people using services across the health, aged care, disability and mental health sectors.

Overall, the long-term reforms will make it easier for people to manage their health. They will also make it easier for state and territory health services to give Australians the care they need and want, and reduce pressure on hospitals.

Who works with us

The key national and regional organisations who support governments to deliver health services include:

Private and community organisations also partner with governments to help deliver health services to the community.


The NHRA took effect on 1 July 2020 and is operational until 30 June 2025.

Date last updated:

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