What we're doing about Medicare

We work with agencies and committees to advise the Australian Government on Medicare policy and subsidies. We support patients and healthcare providers through various programs and initiatives. We protect the system’s integrity through a strong compliance program.

Policies and strategies

We advise the Australian Government on:

We jointly fund public hospitals with the state and territory governments, under the National Health Reform Agreement.

We conduct independent reviews and reforms to make sure our healthcare system stays up to date with the latest research and practices.

Legislation and regulation

Medicare is governed by laws that cover:

  • what can be claimed
  • who can claim
  • the amount of benefits
  • who manages payments and services
  • who administers Medicare.

These are the:

Accreditation and standards

To access Medicare benefits, pathology and diagnostic imaging services listed on the MBS must be accreditated and meet standards.

We develop policy and hold regulatory responsibilities for accreditation.

The Australian Commission on Safety and Quality in Health Care develops the standards and oversees the accreditation process.

Read more about accreditation and standards for Medicare eligibility for diagnostic imaging and pathology.


All health practitioners in Australia must meet certain requirements to bill their patients under Medicare.

We have a strong program that protects Australia’s health payments system from incorrect claiming, inappropriate practice, and fraud.

Read more about what we’re doing to ensure compliance with Medicare obligations. This includes identifying and investigating potential fraud, inappropriate practice and incorrect billing under Medicare through different types of compliance activities.

Initiatives and programs

We have several initiatives and programs to support patients and healthcare providers under Medicare, including:

See all our Medicare initiatives and programs.

Stakeholder engagement

We consult stakeholders and the public about matters related to Medicare through our Consultation Hub.

This includes when we conduct reviews and reforms of various aspects of Medicare.

Who we work with

Medical Services Advisory Committee

The MSAC assesses a range of medical services, technologies and programs and provides advice on whether they should be publicly funded, and what circumstances, if any, should apply to such funding.

Using the best available evidence, MSAC considers their:

  • comparative safety
  • clinical effectiveness
  • cost effectiveness.

The MSAC advises on whether they should be listed on the MBS, or subsidised through other programs.

Pharmaceutical Benefits Advisory Committee

The PBAC assesses medicines and vaccines for clinical effectiveness, safety and cost effectiveness (‘value for money’) compared with other treatments. It advises on whether an item should be listed on the PBS Schedule or funded under the National Immunisation Program.

Australian Commission on Safety and Quality in Health Care

The Australian Commission on Safety and Quality in Health Care helps improve health care in Australia through:

  • national safety and quality standards
  • clinical care standards.

Professional Services Review

The Professional Services Review (PSR) reviews possible inappropriate practice by health practitioners when they provide MBS services or prescribe PBS medicines. This is part of our compliance program to ensure the integrity of our healthcare system.

Services Australia

Services Australia supports patients and health practitioners to access Medicare through:

Date last updated:

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