Australia’s healthcare system

The Australian healthcare system has many different types and tiers of services available to help you. This article provides you
with some information to help you understand the different types of healthcare available and how you can access them.

An overview of Australia's healthcare system

The Australian healthcare system provides a wide range of services, from population health and prevention through to general
practice and community health; emergency health services and hospital care; and rehabilitation and palliative care.

General practitioners (GPs) and emergency departments (EDs) act as the main gateways to other health services, including
diagnostic tests, specialist consultations, hospital admission and inpatient care.

General practice and primary healthcare

Primary health care is the first point of call for most people for most illnesses. It's delivered in a variety of settings, including at
general practices, community health centres and at home.

Primary care is provided by doctors, along with community nurses, dentists, pharmacists and other allied health professionals.

Allied health
Allied health practitioners are trained professionals who are not doctors, dentists or nurses.

They can help you manage your physical or mental health, through services including diagnosis, treatment or rehabilitation.
Learn more about allied health practitioners.

After-hours general practitioner services

Many general practices are only open during business hours. However, there are several after-hours options if you can't find a
general practice open.

The free government-funded after-hours GP helpline can help. You can speak to a registered nurse who will ask you questions
about your health. They will provide you with information and advice. If needed, a GP will call you back within the hour.

After-hours doctor call-out services are available in major cities and centres. These are private services and a doctor can come
to your home. In some cases, this service may be covered by Medicare.

Emergency departments
EDs are able to treat patients who need urgent medical or surgical care. Most EDs are located in, and operated by, public
hospitals throughout Australia.

EDs are designed to deal with acute, sometimes life-threatening medical emergencies. Non-acute, less serious conditions are
best dealt with by a general practice.

If you are not sure whether your medical condition is urgent, contact your doctor or call healthdirect on 1800 022 222 for advice.

If you think you have a medical emergency, immediately dial triple zero (000).

Specialist services
Medical specialists work in a specific area of medicine, such as cardiology or dermatology. They may work in private practice,
and within a private hospital, and/or in the public hospital system. For a specialist visit to be covered by Medicare, either partly
or completely, you will need a referral from your doctor or other healthcare provider.

Public and private hospitals

Hospital services in Australia are provided by both the public and private sectors. Public hospitals are owned and managed by
state and territory governments.

Medicare provides access to free treatment and accommodation in a public hospital for Australian residents and overseas
visitors from countries with a reciprocal arrangement.

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 You can choose to have Medicare cover only, or a combination of Medicare and private health insurance coverage.

If you have private health insurance, you get some funding to cover the costs of care in a private hospital. You are also able to
use a public hospital, although you will be charged for it. Your private health insurance will cover some of the costs.

Medicines and prescriptions

The Pharmaceutical Benefits Scheme (PBS) ensures that Australians have access to affordable medicines. The PBS
subsidises the cost of prescription medicines so that Australians can access a wide range of medicines without having to pay
full price.

Medicines are also available over the counter, without a prescription, but these are generally not subsidised.

Medicines on the PBS must first be approved by the Therapeutic Goods Administration (TGA), which also regulates vaccines,
sunscreens, vitamins and minerals, medical devices, blood and blood products.

My Health Record
My Health Record is an online summary of your medical information that can be shared with healthcare providers across
different settings. The information is secure and you have control over who sees the information.

Primary health networks (PHNs)

Primary health networks (PHNs) are independent, government-funded organisations. They aim to improve the efficiency and
effectiveness of health services, particularly for disadvantaged groups, and improve the coordination of medical care across the
healthcare system.

There are 31 PHNs across Australia. Learn more about PHNs.

Local hospital networks (LHNs)

Local hospital networks (LHNs) are responsible for a group of local hospitals, or an individual hospital, linking services within a
region.

LHNs are known by different names in different states. For example, they are known as ‘local health districts' (LHDs) in NSW
and ‘hospital and health services' in Queensland. The National Health Reform Public Hospital Funding website has a LHN
directory.

Differences across Australia

While some aspects of the Australian healthcare system are the same nationwide – for example, Medicare is the same
wherever you are – others vary depending on where you live. There are differences between states, and there are differences
between the city and the bush.

For example, both city and country people have good access to nurses but doctors, and especially specialists, are
concentrated in the cities.

Where can I find more information?

You can find more information about the Australian health system at the Department of Health website.

Last reviewed: October 2016

Understanding the Australian

health system
Here are some links that will help you find information about the Australian health  system:

 Tell me about healthcare in   Australia

 What is Medicare and how does it  work?
 How does Private Health Insurance   work?
 Where would I go to find out information about  hospitals?

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 I have heard about health reform, what does it  mean?
 What is eHealth and a Personally Controlled eHealth   Record?

Tell me about healthcare in Australia

If you are new to Australia, the Australian Government Department of Immigration and Citizenship provides a short overview of the
Australian health system and the financial assistance that is available: http://www.immi.gov.au/living-in-australia/settle-… (link is external)
Information on services and assistance provided by the Australian Government is available at:  http://www.health.gov.au/ (link is external)
For information on State and Territory services, visit

 ACT   Health (link is external)

 NSW  Health (link is external)
 Northern Territory Government Department of  Health (link is external)
 Queensland  Health (link is external)
 SA .gov.au, Health and  Wellbeing (link is external)
 Tasmanian Department of Health and Human   Services (link is external)
 Department of Health,  Victoria (link is external)
 Government of Western Australia, Department of   Health (link is external)

What is Medicare and how does it work?

Medicare provides financial assistance from the Australian Government to help Australians access free or lower-cost medical, optical and
hospital care. This allows you, where you are eligible, to claim benefits and payments for healthcare services. Find out more about
Medicare benefits and how to get them at Medicare Australia (link is external).

How does Private Health Insurance work?

Consumers can purchase private health insurance to cover some of the costs of healthcare as a private patient. There are two types of
private health insurance cover available: hospital and general (also called ‘ancillary’ or ‘extras’ covering things like physiotherapy and
dental services). Visit Privatehealth.gov.au (link is external) to learn more about private health insurance and to compare the policies that
are available.

Where would I go to find out information about hospitals?

MyHospitals (link is external) is an Australian Government website that provides  information on hospitals throughout Australia.  It
includes information about the hospital including the services offered and waiting  times.

I have heard about health reform, what does it mean?

The Commonwealth and State Governments are working in partnership under the National Health Reform Agreement to improve
healthcare for all Australians.
Previously, the health system was paid for and managed by individual States and Territories with the assistance of the Commonwealth
Government. The Commonwealth Government will contribute more funding to help hospitals respond better to the needs of local
communities. The Commonwealth Government will also contribute more funding to primary care. Primary care is the healthcare people
get when they first seek medical help; this can be in the form of GP services, pharmacy services and other first steps of care not provided
through a hospital. Primary care is important in the prevention of poor health and the management of long-term health problems.
Other programs are also being introduced to improve healthcare.  These include  GP Superclinics, After-Hours  GPHelpline and Personally
Controlled Electronic Health Records.  You can learn more about health reform and these initiatives at health.gov.au (link is external)

What is eHealth and a Personally Controlled eHealth Record?

eHealth is the use of technology to improve healthcare.  It is being used to improve communication between our health professionals and
to offer you new services such as telehealth (link is external) which will bring specialist video consultations to Australians living outside of
major cities.
Personally Controlled Electronic Health Records are being introduced so that Australians can choose to have a secure online summary
of their healthcare information that is easy to access and share with their healthcare team.   You will be able to choose what information
is added to your electronic health record by your doctor and other health professionals and which health professionals are allowed to
access it.  Learn more about eHealth and the Personally Controlled Electronic Health Record at  eHealth.gov.au (link is external)
Information and links provided on OurHealth are not intended as a substitute for professional medical   advice.

Health Care Around the World: Why Australia is #1

March 31, 2014 Scott HarrahHealth Care Around the World, Obamacare, UMHS News

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HEALTH CARE DOWN UNDER: Australia’s medical system is considered #1 in the world
Americans love to boast that we have the greatest health-care system worldwide. This has been one of the biggest arguments against
Obamacare (the popular term for the Affordable Care Act), but the World Health Organization (WHO) actually ranked the USA a
shocking 37th in the world in a study (http://www.businessinsider.com/best-healthcare-systems-in-the-world-2012-6?op=1). So which
country actually has the best health care system? Many say Australia.
In this first installment of a new series, Health Care Around the World, profiling medicine in different countries, the UMHS Pulse looks at
Australia and why their medical system is considered a model for others.

AUSTRALIAN HEALTH CARE: Accessible to people regardless of income or type of insurance. Photo: Wikipedia.com
American vs. Australian Medicare
Australia may only have a population of 22 million, but it is like a parallel version of America if you’ve ever visited. It is English-speaking
(with the famous twangy accent, of course), vast, and has similar geography, with modern cities and great beaches. What sets Australia
apart from the USA (besides better weather and opposite seasons) is the way public health care (Australian Medicare) is guaranteed to

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everyone. While Medicare is a seniors-only government program in the USA, Australia’s Medicare is a public health insurance available
to all.
PolicyMic.com says the state encourages people with the financial means to use a private system, “enforcing an additional 1% tax on
those who fall above a certain income level but use the public system anyway.” (http://www.policymic.com/articles/46063/7-countries-
that-show-us-how-health-care-should-be-done)
The method is the best in the English-speaking world. It works because Australia had a death rate from medical care conditions “50%
less than America’s in 2003 and 25% less than the United Kingdom’s,” based on a report from the Commonwealth Fund
(http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx?page=all).

An Aussie’s Take on Health Care

The UMHS Pulse asked Brian Peel, publisher of The Aussie Word (www.theaussieword.com) in Melbourne, Australia to tell us why the
medical system Down Under is so outstanding.
“I think we are lucky in a way that we have ‘Medicare,’” Peel says. “Most of the health care is paid for by the ‘governing bodies’. Then
people have health insurance on top of that – with dental, optical, surgical, hospital etc. … extras for a charge per quarter. This is what I
have as it helps to bring our overall taxation down per calendar year. We’re very, very lucky in Australia.”
Best of all, the Australian health-care system is readily accessible to people regardless of income or type of insurance.
“Yes, the wait times are long for most hospital procedures but it seems the people of our country get looked after no matter whether
they are private or public patients,” Peel says.
Pros & Cons of Australian Health Care
Pros
Following are “pros” of Australian health care from the Commonwealth Fund (http://www.commonwealthfund.org/Fellowships/Australian-
American-Health-Policy-Fellowships/The-Health-Care-System-and-Health-Policy-in-Australia.aspx)
• Australian “Medicare” is a tax-funded public insurance program that is free to everyone and covers physician and hospital services and
part of the cost of prescriptions.
• Health services are financed and regulated by federal Australian government, but states and territories have responsibility for public
hospital care.
• The Australian government primarily funds, but does not actually provide health care, meaning the quality of medicine is determined
by doctors and hospitals.
• Half of Australians receive additional coverage through private insurance, which the government subsidizes and which covers such
services as dental care and private hospitals.
• Most doctors operate in private practice and are paid on a fee-for-service basis, and GPs act as gatekeepers to specialized care.
• Physicians in public hospitals either earn a salary and can receive additional fees for seeing private patients, or are in private practice
and receive hourly compensation for treating public patients
• Death rate from medical care is one of the lowest in the English-speaking world. It is lower than that of the USA and UK
Cons
• Long waiting list for many hospital medical procedures.
• Ranked last by the Commonwealth Fund regarding overall accessibility of appointments with primary-care physicians compared to the
USA, UK, Canada, Germany and the Netherlands.

Health Care System and Health Policy in Australia

 

The Health Care System 

The Australian health care system provides universal access to a comprehensive range of services, largely publicly funded through general
taxation. Medicare was introduced in 1984 and covers universal access to free treatment in public hospitals and subsidies for medical
services; Medicare is now sometimes used to describe the Australian health care system though precisely it refers to access to hospitals
(hospital Medicare) and medical care (medical Medicare).  Health indicators are strong, for example Australian life expectancy is the third
longest in the OECD. Nonetheless, there are concerns in common with many developed countries, such as the ageing of the population,
rising levels of obesity, the prevalence of mental illness, and the burden of chronic disease. There is a dramatic gap in the health indicators
for the indigenous population compared to non-indigenous Australians. Health care expenditure represents approximately 9% GDP, close to
the OECD median but much less than the US.

Australia has a federal system of government, with a national (Commonwealth) government and six States and two Territories. At
Federation, health remained the responsibility of the States. However, the Commonwealth Government holds the greatest power to raise
revenue, so States rely on financial transfers from the Commonwealth to support their health systems. This makes the Australian health care
system a complex division of responsibilities and roles across levels of government. It is also marked by a complex interplay of the public
and private sectors.  The system is financed largely through general taxation. Although there is a specific income tax levy (the Medicare
levy), it raises a small portion of total finance. There is also a high reliance on out of pocket payments, at 17% of total expenditure.
Government dominates funding, with 43% of total expenditure provided through the Commonwealth, and 25% through other levels of
government. This gives the Commonwealth the dominant role in policy making.

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The three major components of Medicare cover public hospitals, medical services, and pharmaceuticals. There is a strong and growing
private hospital sector. There is government support (subsidies) for private health insurance which covers both hospital inpatient treatment
and out of hospital services not covered by Medicare.

Public hospitals are owned and operated by the State and Territory Governments which also deliver a variety of mental health, dental, health
promotion, school health and community health programs.  Under funding agreements with the Commonwealth, all Australians are entitled
to free treatment as a public patient in a public hospital. Public hospitals can also admit private patients, who may face a range of out-of-
pocket charges. Private patients have choice of doctor, ie the patient selects the doctor who is responsible for their care while the public
patient has a treating doctor assigned by the hospital. In practice, these are the same doctors but the doctor charges the private patient
directly for their medical care. In general, emergency departments are in public hospitals while teaching, education, and research are found
in the larger public hospitals which also tend to a treat a more complex case-mix.

The private hospital sector is growing in size and complexity. There is an increasing presence of for-profit firms operating several hospitals.
There is a strong focus on elective surgery, and many day only facilities are private. Private patients benefit from subsidized insurance (if
insured), and the Medicare subsidies for medical services in hospital.

Most medical practitioners are in private medical practice with fee for service payments. The Medical Benefits Schedule (MBS) sets a fee
for each item or service covered by Medicare, for which the Government pays a fixed rebate.   New items added to the MBS are generally
assessed for safety, effectiveness and cost-effectiveness, and recommendations for public funding are made by an independent committee.
The MBS covers all out of hospital medical services, and in-hospital medical services for private patients. However, medical practitioners
are free to set their own fees above the MBS fee, thus exposing patient to out-of-pocket charges. Overall, around 70% of all medical services
are bulk billed (direct billed to Medicare) in which case there is no out of pocket fee; bulk billing rates are over 80% for primary care
attendances, and vary by specialty with . The out-of-pocket charges for out of hospital services cannot be covered by private insurance, and
recent changes have introduced the Extended Medicare Safety Net to provide some protection against high levels of private expenses
(though some services, such as cosmetic surgery, are excluded). There is a strong primary medical care sector, and general practitioners
(primary care doctors) play a gate keeping role, i.e. specialist treatment will be covered by Medicare only with a referral from a general
practitioner. There is free choice of provider, with no enrollment or restrictions. Until recently MBS payments were limited to services
delivered by medical practitioners but they are now also available in defined circumstances to patients who use practice-based nursing,
psychology, dental and other allied health services.  Generally such services must be delivered as part of a planned program of care, and
specifically requested by the patient’s physician, before a benefit can be paid.

The Pharmaceutical Benefits Scheme (PBS) provides subsidized drugs at a set co-payment (at a lower level for welfare recipients). It was
established more than 50 years ago and now covers about 600 drugs in over 1,500 formulations.  This comprises over 90% of all
prescriptions written in Australia. Patients therefore pay the set co-payment regardless of the cost of the drug they receive. There are safety
net provisions in place to limit total expenditure. There is direct negotiation on price between the Government and the pharmaceutical
company. All new items added to the PBS must be recommended for listing by an independent committee, the Pharmaceutical Benefits
Advisory Committee (PBAC), based on an assessment of safety, effectiveness and cost-effectiveness. Australia was the first country to
introduce a mandatory requirement for comparative effectiveness and economic evaluation.

Private health insurance funds (and there are many in Australia though the bulk of the market is covered by 4 funds) is highly regulated.
Insurance can cover private treatment in hospital (duplicating the public coverage) and out of hospital services not covered by Medicare, for
which the majority of services are dental care and physiotherapy. Since 1996, there have been incentives to encourage the purchase of
insurance, often described as ‘carrots and sticks’. The carrots comprise a 30% rebate on private insurance premiums, effectively reducing
the cost. The sticks are an income tax surcharge for higher income earners without private cover. Since 2000, there has been a financial
incentive to purchase insurance by the age of 30 and to stay with cover. This is Lifetime Health Cover, an age related premium based on the
number of years after 30 without private insurance. Other than that, premiums are community rated. From July 1, 2012, access to the rebate
has been means tested, with the full 30% applying only to individuals with an annual income less $84,000 and families less than $168,000.

The improvement of information technology as means of supporting better communication and co-ordination of care has been widely
accepted. There has been a Practice Incentives Program for primary care physicians to adopt IT strategies. Current efforts are focused on the
implementation of a Personally Controlled Electronic Health Record and are auspice under the National E-Health Transition Authority. 

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 Understanding the Australian health system.
So you’re planning to head ‘down under’. Good for you! Whether you’re going on holiday, visiting relatives or even intending to work there for a while, we
know you’ll have a great time. And hopefully, your stay will be accident and illness free too. But just in case the worst does happen, private health insurance
is worth considering...

Click the links below to skip to the section(s) relevant to you:

 Medicare eligibiltiy explained

 Why purchasing HIF Overseas Visitors Cover is a smart idea...

 Need a Visa Compliance Letter, pronto?

 Do permanent migrants need to take out Overseas Visitors Cover?

 What about overseas students?

 Can I get cover for other services too, like dental, optical and physiotherapy?

Medicare eligibility explained.

When relocating to Australia, you firstly need to ask yourself - are you covered by Medicare, our public health system? And the answer - well, it
depends. Residents of some countries enjoy limited Medicare cover, but only for emergency treatment, and only under certain conditions. If you aren’t
covered though, you’ll have to pay for hospital or medical treatment, which can be pricey. For instance, an emergency appendix removal can cost as much
as $30,000. Ouch! 

Overseas visitors who enter Australia on a temporary visa will not be eligible for Medicare benefits unless they’re a resident of a country that has a
'Reciprocal Health Care Agreement' with Australia. Currently, this includes New Zealand, the United Kingdom, Ireland, Italy, Malta, Finland, Sweden, the
Netherlands and Belgium. If you’re visiting Australia from one of these countries, you’re generally covered for medically necessary treatment in a public
hospital. You won’t be able to choose your own doctor though, and you also won’t be covered for:

 Treatment in a private hospital, only public hospitals; or

 Extras services like dental, optical, chiro or ambulance transport.

Even if you're covered by Medicare though, private health insurance still makes sense. Medicare is good, but it isn’t perfect. There are still waiting lists. And
who wants to wait for a doctor when you could be enjoying Australia?

Why purchasing HIF Overseas Visitors Cover is a smart idea...

Overseas Visitors Cover (OVC) is private health insurance designed for international visitors and workers, including:

 Visa 457 applicants (Temporary Business, Long Stay)

 Visa 676 applicants (Tourist Visa)

 Visa 410 applicants (Retirement Visa)

 Short-term visitors

 Temporary residents

 Norfolk Island residents

 and many more...

Need a Visa Compliance Letter, pronto?

If you’re applying for an Australian visa (for example, 457 temporary employment visa or a 676 tourist visa), you may need to provide the Department of
Immigration and Border Protection (DIBP) with a Visa Compliance Letter from your health insurer to verify that you have met this requirement. If you choose
to join HIF online, your letter of visa compliance will be emailed to you instantly (PDF format) upon confirming your application.

Important: If you choose to purchase HIF Overseas Visitor Cover, you must nominate a start date (the date your policy will commence). To activate your
membership, please note that we require a copy of the visa and passport details (confirming arrival dates) for everyone covered on the policy. The details
must be provided to HIF within one month of your arrival, as per legislative requirement.

Do permanent migrants need to take out Overseas Visitors Cover?

For the first two years in Australia (while waiting for permanent residency to be granted), migrants are not entitled to Medicare benefits so purchasing OVC is
recommended in the meantime. Once your residency or citizenship has been approved, you’ll then begin to receive Medicare benefits so you may then wish
to change your Overseas Visitors Cover policy to a standard domestic policy instead. As well as giving you continued peace of mind that your health is
protected, you’ll also limit potential tax implications and avoid public waiting lists.

What about overseas students?

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If you’re planning to study down under and will be visiting Australia on a temporary student visa, you may be required (as a condition of your visa) to take out
Overseas Student Health Cover (OSHC). For more information on OSHC, visit health.gov.au

NB: The requirements for Overseas Student Health Cover differs slightly for students from Belgium, Norway and Sweden.

Can I get cover for other services too, like dental, optical and physiotherapy?

Absolutely! Combining HIF Extras cover (also known as ‘ancillary’ or 'auxiliary') with one of our Visitors Cover options is the best way to ensure complete
peace of mind for you and your family while you’re in Australia.

Extras insurance is used to cover services out of hospital that are generally not provided under Medicare, such as ambulance, chiropractic, complementary
therapies, dental treatments, dietetics, glasses and contact lenses, healthy lifestyle services, occupational therapy, osteopathy, pharmaceuticals,
psychological consultations, physiotherapy, podiatry visits and speech therapy. To find out more , visit our Extras Cover Options page.

Request a Callback
If you'd like to speak to one of our consultants in person about cover options, simply email sales@hif.com.au  or phone us on 1300 13 40 60 and we'll be
happy to assist. Alternatively, complete the quick form below and we'll call you at a time that suits. After all, what's important to you is important to us, and we
want to ensure you're 100% happy with your decision.

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PBS Authorities
We administer the processing of pharmaceutical benefits and safety net claims, as well as authority

applications.

on this page
 About the online PBS Authorities system
 Logging on through upgraded clinical or prescribing software  

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 Logging on through HPOS
 Requesting a new PBS authority approval online
 Enquire about a previously recorded PBS authority approval online
 Cancel or amend a previously approved PBS authority approval online
 Items excluded from online service
 Writing authority PBS prescriptions
 Streamlined authorities

About the online PBS Authorities system

Online PBS Authorities provides an online solution for approved prescribers to get a PBS authority approval for

the majority of PBS items (excluding Complex authority items and Alzheimers items), including increased

quantity and repeats where allowed. This will remove the need for approved prescribers to call us for most

authority approvals.

You can request PBS authority approvals online through:

 upgraded clinical or prescribing software, or

 Health Professional Online Services (HPOS)

The online channels are available 24 hours a day, 7 days a week, where you can:

 request a new PBS authority approval to prescribe an authority item

 cancel or amend a request you submitted for PBS authority approval, not already dispensed, for a
period of 1 year from the date of prescribing, and
 enquire about any of your approved, cancelled or rejected PBS authority approvals for a period of 2
years from the date of prescribing

Logging on through upgraded clinical or prescribing

software  
Contact your software vendor for more details about software upgrades for accessing Online PBS Authorities

using clinical or prescribing software.

When using your upgraded clinical or prescribing software you need to register for a Provider Digital Access

(PRODA) account to access Online PBS Authorities.

Read more about PRODA.

Logging on through HPOS

If you are a new user you need to register for a Provider Digital Access (PRODA) account to access HPOS.

A PRODA account allows health professionals and administrators to securely access HPOS. It provides an

alternative to our Public Key Infrastructure (PKI) individual certificates (smart card or USB tokens), which are

used to log on to HPOS.

To create an account, you need to:

 set up a personal username and password

 verify your identity, and

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 link identifiers, such as your Australian Health Practitioner Regulation Agency (AHPRA) number and
provider number

When you create an account, your identity will be verified online in real time using the government’s Document

Verification Service (DVS), which connects to state and territory registration databases.

Once you have created your account, you can log on to HPOS. The process is digital, portable, and unlike

Medicare PKI individual certificates, doesn’t need additional hardware or software installed.

Each time you access HPOS you need to enter:

 your username
 your password, and
 a unique verification code

You receive the code by SMS, email or generated on a mobile iOS or Android application (set up when you

create your account).

Existing users can:

 continue to use an existing Medicare PKI individual certificate

 create a PRODA account and discontinue the use of a Medicare PKI individual certificate, or
 create a PRODA account to use in conjunction with an existing Medicare PKI individual certificate

Read more about PRODA.

Requesting a new PBS authority approval online

You can request a PBS authority approval for the majority of PBS items that can currently be obtained by

phone (excluding Complex authority items and Alzheimers items), including increased quantity and repeats

where allowed.

You can also cancel or amend an authority approval request previously recorded by you.

The online channels will display all restriction criteria in full. You will need to satisfy that the patient meets the

restriction criteria, and answer any questions to provide additional information about restricted items.

The online channels will dynamically respond to information you provide for the PBS authority approval

request. Approved Prescriber fix instructions are available if you are presented with a reason code  when

processing your PBS Authority.

You still need to complete and provide your patient with a prescription and comply with the rules of writing and

retaining an authority prescription.

Enquire about a previously recorded PBS authority

approval online

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You can enquire about previously recorded PBS authority approvals if:

 you applied for the PBS authority approval yourself, and

 it was approved, rejected or cancelled within the last 2 years

Note: the system can only display PBS authority approvals processed after 1 July 2015.

Cancel or amend a previously approved PBS authority

approval online
You can cancel or amend a PBS authority approval through the online channels if:

 you requested the PBS authority approval yourself

 the item has not been dispensed to the patient, and
 it is within 1 year from the date of prescribing

Items excluded from online service

All PBS authority approval requests to prescribe Complex authority items and Alzheimers items are excluded

from the online service at this time.

Contact us at PBS authority approvals to request PBS authority approval for PBS items excluded from the

online service.

Contact the Department of Veterans’ Affairs (DVA) to request Repatriation PBS (RPBS) authority approval.

Writing authority PBS prescriptions

You must write authority required PBS prescriptions on authority PBS/RPBS prescription forms.

This includes:

 the pharmacist or patient copy, that records the prescriber, patient and pharmaceutical benefit item.
This prescription is given to the patient to be dispensed at their pharmacy
 the prescriber’s copy, which is kept for 12 months. This copy must record the daily dose, details of the
disease, clinical justification for using the item, the patient's age (if the patient is a child) and whether the
patient already received an authority for this pharmaceutical benefit

As the approved prescriber you must:

 prescribe only 1 item per PBS authority prescription

 complete the PBS prescription in writing, unless we approve otherwise
 include your name, address and phone number
 include the patient's name, address and entitlement status, such as whether they are a concessional
or general patient
 identify when brand substitution is not permitted. PBS prescriptions must not be prepared using a
computer prescribing program that contains a default which would result in all PBS prescriptions being
indicated as ‘Brand Substitution Not Permitted’
 provide additional information to us with the authority application in certain circumstances, and
 sign and date the PBS prescription

We will return posted applications that cannot be approved without this information. If the matter can be

resolved by phone, an authority to prescribe form may be sent to you by us or DVA.

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Authority PBS prescriptions approved by phone or online must include the authority approval number on the

PBS prescription so the approved supplier can dispense the medication. If you are granted approval but decide

not to continue with the treatment, let us know quickly or cancel the authority approval online.

For authority required (STREAMLINED) prescriptions, the streamlined authority code must be written on the

PBS/RPBS prescription form. This allows the pharmacist to supply the medication as a PBS benefit.

Streamlined authorities
The Schedule of Pharmaceutical Benefits (the Schedule) identifies certain items as 'authority required

(STREAMLINED)'. Prescriptions for listed quantities or repeats for these items do not require prior approval

from us or the DVA to obtain an authority approval number.

Prescribers can find the streamlined authority code in the Schedule next to the text that describes the

indications for which the item may be prescribed.

Prior approval must be sought for increased quantities or repeats. Either contact us or the DVA.

Read more about the streamlined authority process.

Medicare provider number for health

professionals
We issue you with a Medicare provider number to identify you as a health professional at your practice

location.

on this page
 About Medicare provider numbers
 Applying for your initial Medicare provider number
 Processing times for applications
 Using your Medicare provider number
 Applying for additional Medicare provider numbers

About Medicare provider numbers

This number is used for Medicare and Department of Veterans’ Affairs (DVA) claims processing.

A provider number consists of:

 a 3 to 6 digit number that identifies you, such as 123456, and

 2 additional characters that identify your practice location, such as 1A or AA

In this example, the Medicare provider number would be 1234561A.

A Medicare provider number lets you:

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 claim Medicare benefits for services you provide at a particular practice location
 refer patients to another practice where they can claim a Medicare benefit, such as:
o to another health professional
o for diagnostic imaging, or
o for pathology services

If you’re registered in multiple health professions, we usually issue a separate number for each profession.

Applying for your initial Medicare provider number

If you’re a graduating health professional and have an intern position, you need to register for an initial

Medicare provider number.

This number identifies you as a health professional at your practice location.

It’s important to get your application in early. The processing timeframe for applications is up to 6 weeks

between November to March each year due to the increased demand.

When you register for a provider number, it’s important you give us your contact details and supporting

documents. If you are intending on claiming Medicare benefits, it’s important you give us your bank account

details to avoid delays in receiving your benefit.

Depending on your profession, there are different forms you need to complete:

 Allied health professional - Application for an initial Medicare provider / registration number for an
Allied Health Professional form
 Dentist - Application for an initial Medicare provider number for a dentist, dental specialist or dental
prosthetist form
 Medical practitioner - Application for an initial Medicare provider number for a medical practitioner
form
 Midwife/nurse practitioner - Application for a Medicare provider number or PBS prescriber number
for a midwife or nurse practitioner form
 Optometrist - Application for an initial Medicare provider number for an Optometrist form
 Orthoptist - Application for a Medicare provider/registration number for an orthoptist form

If you’re a new health professional you may also need to register with the Australian Health Practioner

Regulation Agency (AHPRA).

Processing times for applications

The processing time for applications can be up to 6 weeks. New health professionals can’t start billing until

they are advised of their provider number and Medicare eligibility.

Make sure you’re using the most current form from our website so your application isn’t delayed.

Applications are processed in the order we receive them. We have dedicated staff working hard to process

these as quickly as possible.

You’ll get a letter from us once your application has been processed.

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Applications from health professionals registered with us as a General Practitioner or Specialist can generally

claim from the date requested on their application. This means these providers can start working but should

wait to lodge Medicare claims until their application is processed.

Using your Medicare provider number

Your Medicare provider number is used to identify you and your practice location when processing claims.

It doesn’t automatically mean you’re eligible to access Medicare benefits.

We’ll confirm in writing the type of access granted and your eligibility to access Medicare benefits. You need an

additional Medicare provider number for each location where you provide, refer or request Medicare services.

Your Medicare provider number is also used for:

 claiming benefits through DVA, and

 determining eligibility for incentive payments

Let us know immediately when you stop practising at a certain location to make sure your Medicare provider

number is not used inappropriately.

You should claim for Medicare benefits when you're working in a private capacity and not getting other

government funding for these services.

Applying for additional Medicare provider numbers

If you’re registering for a provider number for a new location, it’s fast and easy to use HPOS.

You can also update your bank account details and contact details using HPOS.

Related services
 HPOS
 Medicare provider number for overseas trained doctors and foreign graduates
 Practice Incentives Program

Related subjects
 DVA program information for health professionals
 Medicare information for health professionals

Australia’s health system is too complex for patients

 
16/11/2015 - Australia should improve the integration of care across the patient pathway to prepare for a rise in chronic disease and make the health system less complex
for patients, according to a new OECD report.

The OECD Health Care Quality Review of Australia says the Australian health system is too complicated for patients to navigate, and this is amplified by a split in
funding and responsibilities between the federal and state and territory governments.

However, with an ageing population and the anticipated rise in chronic disease, Australia needs to strengthen primary health care to better co-ordinate the care of
patients. Poor co-ordination of care increases the risk of medical errors that are unacceptable to patients and costly for the health system.

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Evidence of Australia’s need to strengthen primary health care can be seen from the hospitalisation rates for respiratory disease such as asthma and chronic obstructive
pulmonary disease which are considerably higher than the OECD average.

One option to ease the fragmentation of the system is to devolve responsibility for delivering primary care to the states and territories, to better align it with hospital and
community services. In turn, the federal government’s role in steering the health system should be enhanced.

Australia should also emphasise the role of general practitioners (GPs) as care co-ordinators for patients with chronic conditions, and promote a system that enables
patients to receive care from a multidisciplinary team of health professionals. 

Head of the OECD Health Division, Francesca Colombo, said adopting a national approach to quality and performance could ease some of the system’s complexity.

“This could include an enhanced federal government role in steering policy, funding, co-ordination and performance monitoring. The states and territories in turn could
take on a strengthened role as health service providers, developing innovation responsive to local population need” she said.

Despite these challenges, Australia compares favourably to its OECD peers on many indicators of health. At 82.2 years, life expectancy is the sixth highest in the OECD.
Australia has the fourth lowest smoking rate in the OECD of 12.8%, and the heart disease mortality rate is well below the OECD average. The country’s breast cancer
five-year survival rate of 88% is behind that of only Sweden, the United States, Norway and Finland.

Australia achieves good health outcomes relatively efficiently, with health expenditure at 8.8% of GDP, about the same as the OECD average. However, Australia is the
fifth most obese country in the OECD, with 28.3% of Australians aged 15 and over obese, considerably higher than the OECD average of 19%. To improve the quality of
its health care system, Australia should also:

 Build on the Practice Incentives Programme with a more robust blended payment system comprising more indicators of quality and outcomes, to
provide GPs with financial incentives to improve the quality of care and patient outcomes;

 Require GPs to begin reporting data on a wide range of indicators linked to quality and patient outcomes and publish more indicators of quality online,
including hospital-level data for adverse events and the results of patient experience surveys for public and private hospitals; 

 Expand the scope and alignment of the National Safety and Quality Health Service Standards not only in hospitals, but also across primary health
care, long-term care and mental health services;

 Improve the quality of rural and remote health care by extending Australia’s basic information set on health service needs, service use and outcomes
to rural and remote settings.

Journalists can access the report’s main findings and recommendations as well as the full report here. 

For further information please contact Ian Forde (tel + 33 1 45 24 81 24) or Francesca Colombo (tel + 33 1 45 24 93 60).

OECD Reviews of Health Care Quality examine what works and what doesn’t in countries, benchmarking their efforts and providing advice on reforms to improve quality
of health care. The country reviews will be followed by a final summary report on the lessons and good practices relevant to all governments.

Working with over 100 countries, the OECD is a global policy forum that promotes policies to improve the economic and social well-being of people around the world.

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