Working Better for Medicare Review

This review examines how effective our current health workforce ‘distribution levers’ are. These levers consist of policies and geographic classifications that are intended to distribute health workforce across areas that need them most.

Survey now closed

We thank everyone who took part in the survey. We are collating and evaluating all submissions.

About the review

The Working Better for Medicare Review examines the effectiveness of our current distribution levers. These are laws and policies that we use to encourage or require health professionals to work in areas of workforce shortage. These levers include:

The review is part of our 2023–24 Strengthening Medicare Budget measures (Supporting health, care and support services in thin markets). The term ‘thin markets’ refers to areas where access to healthcare services and workers is limited.

The review will run until July 2024. Read more in the media release about Improving the uneven spread of doctors and health workers.

Distribution levers

Section 19AA

This section of the Act was introduced in 1996. It requires all doctors who are Australian permanent residents or citizens to hold fellowship of a specialist college before they can access Medicare rebates for their patients. In 1996 there were approximately 1,300 medical graduates per year; now there are around 4,000.

Learn more about section 19AA requirements.

Section 19AB

This was introduced as part of the same amendment that established section 19AA. To access Medicare benefits when working in Australia, overseas trained doctors must work for at least 10 years in a DPA (for general practitioners), or a DWS (for non-GP specialists).

The aim was to direct these doctors to public hospitals or areas where there was a shortage of medical workforce. In 1996 there were approximately 600 overseas trained doctors entering Australia each year; now there are around 2,000.

Learn more about section 19AB requirements.

District of Workforce Shortage measure

This measure was established in 2000–01 to support the operation of section 19AB. It is the subject of ongoing friction with the private health sector, with the grounds for exemption expanding over the past 26 years.

Learn more about the DWS.

Monash Modified Model

The government introduced the MMM in 2015 based on work by Dr John Humphries to develop a more effective framework for providing support and incentives to general practices. The MMM is now used broadly across a range of health, aged care and disability programs as a measure of rurality.

Learn more about the MMM.

Distribution Priority Area classification

The DPA classification was established in 2018–19 in response to criticism by general practitioners that the DWS did not effectively reflect patient flows and access to general practice services. The sector is concerned about a series of automatic rules being applied.

Learn more about the DPA.

Why the review is important

The government uses distribution levers to better target health workforce programs and direct health professionals to areas of greatest need.

The recommendations from the review will help us direct critical health workforce to those areas with the greatest need.

Goals

The review will consider all aspects of the distribution levers and their interplay with each other. Goals include:

  • confirming the original objectives of the distribution levers
  • evaluating how appropriate and robust the assumptions underpinning the levers are
  • considering and reporting on the value of retaining the levers
  • assessing how the levers align with current health workforce policies and priorities
  • identifying key factors and barriers impacting appropriateness and effectiveness
  • if appropriate, identifying opportunities to improve the way the levers achieve current medical workforce policy aims
  • considering, and where appropriate making recommendations on, alternative approaches for us to achieve these aims
  • identifying the future role of the levers.

Lead reviewers

Adjunct Professor Mick Reid and Professor Sabina Knight have been appointed as independent lead reviewers. The reviewers are guiding the review and will draw the findings about each lever together to support a clear future direction.

They are supported by expert consultants Healthcare Management Advisors Pty Ltd, and Health Consult Pty Ltd.

The roles of the reviewers are to:

  • develop a high-level understanding of the 5 levers and how they intersect with each other
  • help the consultants to understand broader health systems so they can think outside the scope of their own review
  • facilitate a way to check and synthesise the findings with consultants as the process evolves
  • develop a paper summarising the findings, after receiving the component parts of this review.

Mick Reid

Adjunct Professor Mick Reid has undertaken many roles in the Australian and international health systems during a career that spans 4 decades. His experience as a bureaucrat, consultant and academic gives him a broad and deep knowledge of the healthcare system. Mick was Director General of Health in 2 states. He has consulted on macro health systems development and evaluation, health workforce reform, services planning, culture reviews, Indigenous health, and many other areas. Learn more about Mick.

Sabina Knight

Professor Sabina Knight has a detailed knowledge of health systems and health reform in Australia. She has been a key figure in the development of rural and remote health workforce policy and health reform. Sabina has served on a wide range of state, territory and national ministerial advisory bodies over the past 25 years. She has received several awards for her contribution to remote health and education. Learn more about Sabina.

Terms of reference

Have your say

The Review Team would like to thank you for the submissions through our online survey. The survey period has now concluded, and the team are collating and evaluating these submissions.

The lead reviewers and supporting consultancies will continue to run targeted workshops with key stakeholder groups throughout the review. In the later stages, they will hold workshops to test the validity of recommendations. These workshops will inform the final report and way forward.

Newsletter

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Previous newsletters

Read past editions of the Working Better for Medicare review newsletter.

Contact

Working Better for Medicare Review team contact

Contact us for information about the Working Better for Medicare Review, which is examining the effectiveness of laws and geographic classifications we use to distribute the health workforce across areas of need.
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